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Egyptian Board Internal Medicine study materials
Egyptian Board Internal Medicine study resources

Egyptian Board Internal Medicine: Cardiology

Egyptian Board Internal Medicine · Work through your exam, one topic at a time.

All guide sections

Cardiology

Cardiology carries heavy weight in the Egyptian internal medicine board. Questions test whether you can convert an ECG or bedside finding into a time-critical decision: reperfusion in STEMI, diuresis versus inotropy in heart failure, rate versus rhythm control in atrial fibrillation, and drainage in tamponade.

Acute coronary syndromes

  • STEMI means ST elevation of 1 mm or more in two contiguous limb leads, 2 mm or more in V2-V3 (men over 40), or new LBBB with typical pain. Reperfusion is decided on the ECG, never on the troponin result.
  • Primary PCI within 120 minutes of first medical contact is the default. Fibrinolysis is acceptable only when PCI cannot be delivered inside that window, symptoms are under 12 hours, and there is no bleeding contraindication.
  • Inferior STEMI suggests right coronary occlusion: obtain right-sided leads, withhold nitrates if there is right ventricular infarction or hypotension, and anticipate bradyarrhythmia or AV block.
  • In NSTEMI the GRACE score drives timing: very high risk (refractory ischaemia, shock, malignant arrhythmia) within 2 hours, high risk within 24 hours.

Heart failure and rhythm

  • HFrEF treatment is quadruple therapy started early: ARNI or ACE inhibitor, beta-blocker, mineralocorticoid receptor antagonist, and an SGLT2 inhibitor, irrespective of diabetes.
  • Acute pulmonary oedema: intravenous loop diuretic, oxygen, non-invasive ventilation, and nitrates when systolic pressure allows. Avoid negative inotropes in hypotension.
  • Narrow-complex tachycardia: vagal manoeuvres, then adenosine. Wide-complex tachycardia is ventricular tachycardia until proven otherwise; use amiodarone or procainamide, and cardiovert if unstable.
  • Anticoagulate atrial fibrillation by CHA2DS2-VASc, not by rhythm.

Worked example

A 58-year-old smoker has two hours of crushing chest pain, sweating, and ST elevation in II, III and aVF with reciprocal depression in I and aVL. The diagnosis is inferior STEMI from right coronary occlusion. The next steps are right-sided lead V4R to detect right ventricular infarction, cautious fluid loading rather than nitrates if the right ventricle is involved, continuous rhythm monitoring for complete heart block, aspirin plus a P2Y12 inhibitor plus anticoagulation, and transfer for primary PCI without waiting for troponin.

Traps that cost marks

Calling anterior ST depression in an inferior infarct 'anterior ischaemia' instead of reciprocal change; missing posterior infarction (tall R and ST depression in V1-V3); giving nitrates in right ventricular infarction; delaying reperfusion for a troponin result; and forgetting that new-onset atrial fibrillation with instability needs cardioversion, not rate control.