Essential Revision Notes for MRCP Third Edition - PasTest

CardiologyTable 1.5. Indications for referral to an electrophysiologistCondition When to refer Potential treatmentSVT More than one episode Radiofrequency ablationAtrial flutter More than one episode Radiofrequency ablationAtrial fibrillationVentricular fibrillationHighly symptomatic, refractory toor intolerant of drug therapyUnless there is an obviousreversible cause, eg ST-segmentelevation MI (STEMI)Radiofrequency ablationICDVentricular tachycardia Unless obvious reversible cause Radiofrequency ablation or ICDIschaemic cardiomyopathyNYHA class III–IV heart failure, QRS.130 ms, ejection fraction ,35%Ejection fraction ,30% onoptimal medical therapyOn optimal medical therapyPrimary prevention ICDHeart failure pacing1.6 ISCHAEMIC HEART DISEASEIn 1990 coronary artery disease became the leadingworldwide cause of death, currently claiming 7.2million lives per year.Risk factors for coronary artery disease• Primary• Hypercholesterolaemia (LDL*)• Hypertension• Smoking• Unclear• Low fibre intake• Hard water• High plasma fibrinogen levels• Raised Lp(a) levels• Raised factor VII levels• Protective factors• Exercise• Moderate amounts of alcohol• Low cholesterol diet• Increased HDL:LDL**• Secondary• Reduced HDL cholesterol• Obesity• Insulin-dependent diabetes mellitus• Non-insulin-dependent diabetes• Family history of coronary artery disease• Physical inactivity• Stress and personality type• Gout and hyperuricaemia• Race (Asians)• Low weight at 1 year of age• Male sex• Chronic renal failure• Increasing age• Low social class• Increased homocystine levels andhomocystinuria*Low-density lipoprotein**Ratio of high-density lipoprotein to LDL31