Master Specialist Cardiology (CRD5751)
for DHA Speciality

A 68-year-old man with permanent atrial fibrillation, hypertension, and type 2 diabetes presents with an acute ischaemic stroke. He is thrombolysed and improves. On day 3 he remains bed-bound with an NIHSS of 12. Creatinine clearance is 28 mL/min (Cockcroft-Gault), platelets 210 x 10^9/L, and a repeat CT head shows a small haemorrhagic transformation within the infarct but no mass effect. The stroke team asks you to advise on anticoagulation. What is the most appropriate anticoagulant strategy?

A 34-year-old woman at 30 weeks' gestation presents with a 2-day history of progressive dyspnoea, orthopnoea, and a new systolic murmur. She has no prior cardiac history. BP 138/86 mmHg, HR 118/min, SpO2 94% on air. ECG shows sinus tachycardia with left bundle branch block. Transthoracic echo shows a left ventricular ejection fraction of 28% with global hypokinesia and moderate mitral regurgitation. NT-proBNP is 3200 pg/mL. She is haemodynamically stable. What is the most appropriate initial pharmacological therapy?

A 72-year-old man with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m2) and non-valvular atrial fibrillation has a CHA2DS2-VASc score of 5. He has had two previous falls in the last year but no major bleeding. He is currently on aspirin 75 mg daily. What is the most appropriate management?

A 58-year-old woman with a history of peptic ulcer disease treated 2 years ago presents with an acute coronary syndrome. She undergoes percutaneous coronary intervention with drug-eluting stent placement and is started on aspirin and clopidogrel. She has no active bleeding. What is the most appropriate gastroprotection strategy?

A 45-year-old man with hypertrophic cardiomyopathy and a resting left ventricular outflow tract gradient of 70 mmHg presents with exertional dyspnoea. He is in sinus rhythm with a blood pressure of 120/70 mmHg. He is not on any cardiac medications. What is the most appropriate initial pharmacological therapy?