Essential Revision Notes for MRCP Third Edition - PasTest

Essential Revision Notes for MRCPTable 1.8. Fitness to driveCondition Driving restriction NotesUnexplained syncope6 months from lastepisode or until effectivetreatment is givenClear vasovagal events that occur onlywhen the patient is erect do not precludedrivingCardiac catheter procedure (includingangiography, percutaneous coronaryintervention, electrophysiologicalstudies/ablation)Myocardial infarction1 week Should be able to perform emergency stopunhindered1 monthPermanent pacemaker 1 month Only 1 week if the patient has never beensyncopalProphylactic ICD 1 month No clinical arrhythmia or syncopeSecondary prevention ICD 6 months DVLA must be informedICD shock therapy 6 months Unless an inappropriate shock ispreventable by reprogramming orintervention, eg a change in the detectionor therapy programming to avoid shocksfor sinus tachycardia or atrial arrhythmiaswith regard to class 2 licences (for vehicles over3500 kg, minibuses and buses) but the essentialpoints are given in Table 1.8.1.7 OTHER MYOCARDIAL DISEASES1.7.1 Cardiac failureCardiac failure can be defined as the pumpingaction of the heart being insufficient to meet thecirculatory demands of the body (in the absence ofmechanical obstructions). A broad echocardiographicdefinition is of an ejection fraction (EF),40% (as in the SAVE trial, which enrolled patientsfor ACE inhibitors post-MI). Overall 5-year survivalis 65% with EF ,40%, compared to 95% in thosewith EF .50%.The most common single cause of cardiac failure inthe Western world is ischaemic heart disease (IHD).• Hypertension is also a very frequent cause –either acting alone or in combination with IHD• Diastolic heart failure is increasingly recognisedalthough difficult to diagnose as an isolatedcondition. It describes impaired ventricularfilling that elevates pulmonary and/or systemicvenous pressure with activation of theneurohormonal system as seen in systolic heartfailure• All patients with systolic heart failure have adegree of diastolic dysfunction – some believethat isolated diastolic dysfunction may be anearly step prior to development of systolic heartfailureEF is only a guide to cardiac function, which alsodepends on other factors including pre-load, after-38