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100 Questions in Cardiology / Edition 1

100 Questions in Cardiology / Edition 1

by Diana Holdright, Hugh Montgomery


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Product Details

ISBN-13: 9780727914897
Publisher: Wiley
Publication date: 05/28/2001
Pages: 240
Product dimensions: 5.48(w) x 8.56(h) x 0.56(d)

About the Author

Diana Holdright and Hugh Montgomery are the authors of 100 Questions in Cardiology, published by Wiley.

Table of Contents



1. What are the cardiovascular risks of hypertension?.

2. Is 24 hour blood pressure monitoring necessary, and what do Ido with the information?.

3. Who should be screened for a cause of secondary hypertension? How do I screen?.

4. What blood pressure should I treat, and what should I aim forwhen treating a 45 year old, a 60 year old, a 75 year old or an 85year old?.

5. Is one treatment for hypertension proven to be better thananother in terms of survival?.

6. It was once suggested that calcium channel blockers might bedangerous for treating hypertension. Is this still true?.

7. How can I outline a management plan for the patient withessential hypertension?.

8. How do I manage the patient with malignant hypertension?.

9. Which asymptomatic hypercholeterolaemic patients benefit fromlipid-lowering therapy? What cholesterol level should I aimfor?.

10.Which patients with coronary disease have been proven tobenefit from pharmacological intervention? What lipid levels shouldI aim for?.

11.What drugs should I choose to treat dyslipidaemia, and howshould I monitor treatment?.

12. What are the side effects of lipid-lowering therapy, and howshould they be monitored?.

13. Is there a role for prescribing antioxidant vitamins topatients with coronary artery disease? If so, who should get them,and at what dose?.

14. What is the sensitivity, specificity and positive predictivevalue of an abnormal exercise test?.

15. What are the risks of exercise testing? What are thecontraindications?.

16. What are the stratification data for risk from exercisetests in patients with angina? Which patterns of response warrantreferral for angiography?.

17. Who should have a thallium scan? How does it compare withstandard exercise tests in determining risk?.

18. What are hibernating and stunned myocardium? Whatechocardiographic techniques are useful for detecting them? How dothese methods compare with others available?.

19. Which class of antianginal agent should I prescribe instable angina? Does it matter?.

20. What is the role of troponin T in the diagnosis and riskstratification of acute coronary syndromes?.

21. What is the risks of myocardial infarction and death insomeone with unstable angina during hospital admission, at sixmonths and one year?.

22. What medical treatments of unstable angina are of provenbenefit?.

23. Under what circumstances should the patient with unstableangina undergo PTCA or CABG?.

24. What new approaches are there to prevent restenosisfollowing PTCA?.

25. Which thrombolytics are currently available for treatingacute myocardial infrarction? Who should receive which one? Whatnewer agents are there?.

26. Is angioplasty better than thrombolysis in myocardialinfarction? Which patients should receive primary or "hot"angioplasty for these conditions?.

27. Whar are the contraindication to thrombolytic therapy foracute myocardial infarction? Is diabetic retinopathy acontraindication?.

28. Exercise testing after myocardial infarction: how soon, whatprotocol, how should results be acted upon?.

29. What are the risks of recurrent ischaemic events aftermyocardial infarction: prehospital, at 30 days and at 1 year?.

30. What is appropriate secondary prevention after acutemyocardial infarction?.

31. What advice should I give patients about driving and flyingafter myocardial infarction?.

32. What is the mortality rate for cardiogenic shockcomplicating myocardial infarction? How should such patients bemanaged to improve outcome and what are the results?.

33. What is the risk of a patient dying or having a myocardialinfarction around the time of surgery for coronary artery diseaseand for valve replacements?.

34. Which patients with post-infarct septal rupture should betreated surgically, and what are the success rates?.

35. What patterns of coronary disease are associated withimproved short and long term survival after CABG compared withmedical therapy?.

36. Coronary artery bypass grafting: what is the case for totalarterial revascularization?.

37. How common are neuropsychological complications aftercardiopulmonary bypass (CPB)? How predictable are severe are they? Can they be prevented?.

38. Are there benefits to switching from sulphonylureas toinsulin after coronary artery bypass grafting?.

39. How does recent myocardial infarction affect theperioperative risks of coronary artery bypass grafting?.

40. How soon before cardiac surgery should aspirin bestopped?.

41. When should we operate to relieve mitral regurgitation?.

42. When to repair the miral valve?.

43. What is the Ross procedure? When is it indicated and whatare the advantages?.

44. What is the risk of stroke each year after a) tissue or b)mechanical MVR or AVR? What is the annual risk of bacterialendocarditis on these prosthetic valves?.

45. When and how should a ventricular septal defect be closed inadults?.

46. How should I treat atrial septal defects in adults?.

47. How do I follow up a patient who has had correction ofaortic coarctation? What should I look for and how should they bemanaged?.

48. How should I investigate a patient with hypertrophiccardiomyopathy (HCM)?.

49. What is the medical therapy for patients with hypertrophiccardiomyopathy, and what surgical options are of use?.

50. What is the role of permanent pacing in hypertrophiccardiomyopathy?.

51. How do I investigate protocol should a patient withhypertrophic cardiomyopathy? How should they be followed?.

52. What investigation protocol should a patient with dilatedcardiomyopathy undergo?.

53. Which patients with impaired ventricles should receive anACE inhibitor? We are the survival advantages? Do ATI-receptorantagonist confer the small advantages?.

54. What is the role of vasodilators in the chronic heartfailure? Who should receive them?.

55. Should I give digoxin to patients with heart failure if theyhave sinus rhythm? If so, to whom? Are there dangers to stopping itonce started?.

56. Which patient with heart failure should have a beta blocker? How do I start it and how should I monitor therapy?.

57. What is mean and model life expectancy in NYHA I-IV heartfailure?.

58. What are LVADs and BIVADS, who should have them?.

59. Who is eligible heart or heart-lunging transplant? How do Iassess suitability for transplantation?.

60. What are the survival figures for the heart andheart-lunging transplantation?.

61. What drugs do post-transplant patients require, and what arethere side effects? How should I follow up such patients?.

62. Can a cardiac transplant patient get angina? How is thisinvestigated?.

63. What drugs should be used to maintain someone in sinusrhythm who has paroxysmal atrial fibrillation? Is there a role fordigoxin?.

64. Which patients with paroxysmal or chronic atrialfibrillation should I treat with aspirin, warfarin or neither?.

65. Which patients with SVT should be referred for anintracardiac electrophysiological study (EP study)? What are thesuccess rates and risks of radiofrequency (RF) ablation?.

66. What drugs should I use for chemically cardioverting atrialfibrillation and when is DC cardioversion preferable?.

67. How long should someone with atrial fibrillation beanticoagulated before DC cadioversion, and how long should this becontinued afterwards?.

68. What factors determine the chances of successful electivecardioversion from atrial fibrillation?.

69. What are the risks of elective DC cardioversion from atrialfibrillation?.

70. Are patients with atrial flutter at risk of embolisationwhen cardioverted? Do they need anticoagulation to cover theprocedure?.

71. How do I assess the risk of CVA or TIA in a patient withchronic atrial fibrillation?.

72. How sensitive are transthoracic and transoesophagealechocardiography for the detection of thrombus in the leftatrium?.

73. What are the roles of transthoracic and transoesophagealechocardiography in patients with a TIA or stroke?.

74. Which patient with a patent foramen ovale should be referredfor closure?.

75. How should I investigate the patient with collapse? Whoshould have a tilt test, and what do I do if it is positive?.

76. What are the chances of a 24 hour tape detecting the causesfor collapse in a patient? What other alternative monitoringdevices are now available?.

77. Should the patient with trifascicular disease be routinelypaced? If not, why not?.

78. Who should have VVI pacemakers and who should have dualchamber pacemakers? What are the risks of pacemaker insertion?.

79. Can a patient with a pacemaker touch an electric fence?…have an MRI scan? …go through airport metal detectors?…use a mobile phone?.

80. What do I do if a patient has a pacemaker and needscardioversion?.

81. What do I do about non-sustained ventricular tachycardia ona 24 hour tape?.

82. How do I treat torsades de pointers at a cardiacarrest?.

83. How do I assess the patient with long QT? Should I screenrelatives, and how? How do I treat them?.

84. How do I investigate the relatives of a patient with suddencardiac death?.

85. What percentage of patients will suffer the complications ofamiodarone therapy, and how reversible are the eye, lung, and liverchanges? How do I assess thyroid function in someone on amiodaronetherapy?.

86. Who should have a VT stimulation study? What are the risksand benefits?.

87. What are the indications for implantable cardioverterdefibrillator (ICD) implantation and what are the survivalbenefits?.

88. How do I manage the patient with an ICD?.

89. How do I follow up the patient with the implantablecardioverter defibrillator?.

90. What do I do if an ICD keeps discharging?.

91. How do I manage the pregnant woman with dilatedcardiomyopathy?.

92. How do I manage the pregnant woman with valve disease?.

93. Which cardiac patients should never get pregnant? Whichcardiac patients should undergo elective Caesarean section?.

94. A patient is on life-long warfarin and wishes to becomepregnant. How should she be managed?.

95. How should the anticoagulation of a patient with amechanical heart valve be managed for elective surgery?.

96. What are the indications for surgical management ofendocarditis?.

97. What is the morbidity and mortality of endocarditis withmodern day management (and how many relapse)?.

98. What percentage of blood cultures will be positive inendocarditis?.

99. Which patients should receive antibiotic prophylaxis forendocarditis, and which procedures should be covered in thisway?.

100. Which patients should undergo preoperative non-invasiveinvestigations or coronary angiography?.

101. Which factors predict cardiac risk from general surgery andwhat is the magnitude of the risks associated with eachfactor?.




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