Cardio interns 2021-22 - Answers
Answer 001
We can start - Diuretic (though many dont start with this) or ACEI / ARB or Calcium Blocker
so we can start
Enalapril - 5mg half bid or Ramipril - 2.5mg OD or Losartan - 50mg half bid or Telmisartan 20mg OD, etc.
or
Amlodipine - 5mg OD
after 1 week or 10 days, if BP doesnt come down below 160 /100 - we can increase dose
enlapril to 5mg bid. Ramipril to 5mg OD. losartan - to 50mg bid. telmi to 40mg OD.
or
amlodipine to 10mg od
if still after one week no response - we can give 2 drugs
to ACEI/ARB - we can add diuretic
ramipril-H or losartan-H or telmisartan - H
(H is usually hydrochlorthiazide 12.5mg)
or add calcium blocker to the ACEI/ARB
Answer 002
HTN + angina - Prefer - betablocker (metoprolol 12.5 to 25mg bid) or amlodipine 5mg OD if already on beta blocker
HTN+ asthma - avoid beta blocker
HTN + diabetes - prefer ACEI/ ARB.
HTN + failure- diuretic + ACEI / ARB;
HTN + renal failure - avoid - ACEI/ARB. Prefer beta blocker / calcium blocker
(amlodipine as above or usually it wont be very effective - especially
Nifedipine Retard may help - 10mg BID - can increase to 20mg bid
Answer 003
Anterior STEMI -
in ICU ttmt would be
Aspirin - 300mg loading /stat & later 150mg OD
Clopidogrel - 300mg loading / stat dose & later 75mg OD
Atorvastatin - 80mg stat & later OD
Inj Morphine (we are giving here Fentanyl 25 mcg)
As window period is 8 hrs and pain present we can give STK or Tenecteplase
we can start enlapril 2.5mg bid & metoprolol 12.5 mg bid if BP is ok and pt not in acute LVF
Even if ECG is normal, because complaints are suggestive of angina, we will admit - with a provisional diagnosis of unstable angina and give initial treatment with antiplatelets, atorva and enoxaparin and repeat ECG every hour or SOS. and also send Trop T. and treat accordingly
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Answer 004
3-5mm (0.12 - 0.2 secs or 120-200 msecs)
Answer 005
IV adenosine 6mg rapid iv bolus (if no h/o asthma)
Answer 006
50-70%
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