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Failed thrombolysis was defined as <50% ST-segment resolution 180 minutes after
the start of thrombolytic treatment.

Specific rules
angioplasty (elective) 1 week off driving
CABG 4 weeks off driving
acute coronary syndrome- 4 weeks off driving, 1 week if successfully treated by
angina driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion 1 week off driving
implantable cardioverter-defibrillator: if implanted for sustained ventricular arrhythmia:
cease driving for 6 months. If implanted prophylatically then cease driving for 1 month
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more notify DVLA. Licensing will be permitted subject to
annual review. An aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: DVLA do not need to be notified

Step 1 treatment
patients < 55-years-old: ACE inhibitor (A)
patients > 55-years-old or of Afro-Caribbean origin: calcium channel blocker

Step 2 treatment
ACE inhibitor + calcium channel blocker (A + C)

Step 3 treatment
add a thiazide diuretic (D, i.e. A + C + D)

Step 4 treatment
consider further diuretic treatment
if potassium < 4.5 mmol/l add spironolactone 25mg od
if potassium > 4.5 mmol/l add higher-dose thiazide-like diuretic treatment
if further diuretic therapy is not tolerated, or is contraindicated or ineffective, consider
an alpha- or betablocker
Remnant hyperlipidaemia (type III hyperlipidaemia). is associated with Palmar xanthomata
orange discoloration of skin creases

The late systolic murmur with mid systolic click is indicative of mitral valve prolapse where the
posterior leaflets bulge during systole.

A young, otherwise healthy person who suddenly develops a stroke is likely to have a
paradoxical embolism due to a patent foramen ovale (PFO or ostium secundum defect).

A transoesophageal echocardiogram with Doppler colourflow imaging would be the

investigation of choice in this case.
Patients with restrictive cardiomyopathy most likely secondary to amyloidosis should avoid
digoxin as it is thought that digoxin may bind to amyloid fibrils and lead to increased toxicity.

WPW Digoxin and verapamil should be avoided as they may allow a higher rate of
conduction over the aberrant pathway.
OMACOR (omega-3-acid ethyl esters) increases peroxisomal beta-oxidation of fatty acids in
the liver.

Clopidogrel prevents platelet aggregation through antagonism of the adenosine diphosphate

(ADP) receptor.
PR prolongation is the commonest feature seen in association with congenital myotonic

HOCM:Poor prognostic factors

family history of sudden death
young age at presentation
non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring
abnormal blood pressure changes on exercise

Which one of the following types of bariatric surgery is most likely to cause
significant malabsorption?

Sleeve gastrectomy

Biliopancreatic diversion with duodenal switch

Intragastric balloon

Roux-en-Y gastric bypass surgery

Laparoscopic-adjustable gastric banding


Biliopancreatic diversion with duodenal switch is a primarily malabsorptive

procedure and reserved for patients who are very obese.