Amir Sam 1 - Cardio

Question 1

List the investigations (in order!!) you would do for chest pain suggesting MI?

Answer 1

ECG Troponin Echocardiogram

Question 2

What are the 4 categories for DDx in chest pain?

Answer 2

Cardio Resp GI Musculoskeletal

Question 3

List DDx for chest pain

Answer 3

Cardio - IHD, aortic dissection, pericarditis Resp - PE, pneumothorax, pneumonia GI - oesophageal spasm, oesophagitis, gastritis Musculoskeletal - costochondritis

Question 4

How would you differentiate between cardiac causes of chest pain?

Answer 4

IHD - risk factors Aortic dissection - sudden pain radiating to back with difference of BP between 2 arms Pericarditis - flu like Sx, better leaning forward

Question 5

ST elevation is seen in leads II, III and aVF. Which artery is affected and therefore which type of MI is this?

Answer 5

RCA Inferior

Question 6

ST elevation is seen in leads V1-4. Which artery is affected and therefore which type of MI is this?

Answer 6

LAD Anterior

Question 7

ST elevation is seen in leads V5, V6, I and aVL. Which artery is affected and therefore which type of MI is this?

Answer 7

Circumflex Lateral

Question 8

What 3 questions do you ask in a LOC history?

Answer 8

What happened before / during / after ?

Question 9

List DDx of collapse

Answer 9

Hypoglycaemia Vasovagal Arrhythmia Outflow obstruction (PE or aortic stenosis) Postural hypotension Seizure

Question 10

List causes of R and L outflow obstruction

Answer 10

R = PE L = AS or HOCM

Question 11

What is the relevance of long QT syndrome?

Answer 11

Predisposes to tachyarrhythmias

Question 12

List 4 causes / associations of long QT syndrome

Answer 12

FH sudden death Low K or MG Drugs K channel malformation

Question 13

If a murmur is louder on INspiration, it is …

Answer 13

Right sided

Question 14

Pansystolic murmurs and raised JVP indicate what?

Answer 14

Tricuspid regurgitation

Question 15

IV drug use leading to infective endocarditis leads to what?

Answer 15

R sided murmurs

Question 16

What is DDx of raised JVP?

Answer 16

R heart failure

Tricuspid regurg

Constrictive pericarditis - due to TB / inflam / cancer

Question 17

What is DDx of systolic murmur?

Answer 17

Aortic stenosis Mitral regurg Tricuspid regurg VSD

Question 18

How do you differentiate between the 3 main causes of a systolic murmur?

Answer 18

Aortic stenosis - loudest in aortic area, radiating to neck

Mitral regurg - loudest in apex, radiating to axilla

Tricuspid regurg - loudest in tricuspid area, with raised JVP VSD

Question 19

List 3 causes of sinus tachycardia

Answer 19

Sepsis Hypovolaemia Endocrine eg thyrotoxicosis or phaeochromocytoma

Question 20

What is supra ventricular tachycardia?

Answer 20

No p waves before QRS

Question 21

What causes SVT?

Answer 21

Re entry circuit - accessory pathway of blood around heart

Question 22

How can you tell an SVT on ECG?

Answer 22

Regular but fast rhythm No p waves Delta waves (short PR intervals and slurred upstroke)

Question 23

Describe AF on ECG

Answer 23

Irregular rhythm with no p waves

Question 24

List causes of AF

Answer 24

Thyrotoxicosis, alcohol, heart (valve, muscle, pericardium) and lungs (pneumothorax, PE, cancer)

Question 25

What does ventricular tachycardia look like on ECG?

Answer 25

Broad QRS complex

Question 26

Describe Mx of SVT with normal BP

Answer 26

Vagal manoeuvres eg valsalva Adenosine and cardiac monitor DC cardioversion

Question 27

Describe Mx of fast AF

Answer 27

Rhythm control Rate control - beta blockers, digoxin Anticoagulate to reduce complications

Question 28

Describe Mx of VT

Answer 28

IV amiodarone (if no haemodynamic compromise) Look for and treat cause No pulse = defibrillation and CPR

Question 29

Describe LVH on ECG

Answer 29

Deep S in V1 and V2 Tall R in V5 and V6

Question 30

Explain the difference between the 3 types of heart block

Answer 30

1st degree = long PR interval 2nd degree = p waves not followed by QRS 3rd degree = bradycardia, brand QRS, no relationship between P and QRS

Question 31

What is the Tx for 3rd degree heart block?

Answer 31

Pacemaker

Question 32

What does S1 represent?

Answer 32

Closure of mitral valve

Question 33

What does S2 represent?

Answer 33

Closure of aortic valve

Question 34

What does S3 represent?

Answer 34

Ventricular filling

Question 35

What does S4 represent?

Answer 35

Ventricular hypertrophy

Question 36

What does fixed splitting of S2 represent?

Answer 36

Atrial septal defect

Question 37

What is the immediate management of heart failure?

Answer 37

Sit pt up Give high flow O2

Question 38

List signs of heart failure

Answer 38

High JVP Peripheral oedema Fine crepitations in lungs

Question 39

What does fluffy airspace shadowing show on CXR?

Answer 39

Pulmonary oedema

Question 40

What is RBBB?

Answer 40

Activation of the right ventricle is delayed as depolarisation has to spread across the septum from the left ventricle

Question 41

What does RBBB look like on ECG?

Answer 41

MARROW M shaped QRS in V1 -3 W shaped QRS in I, aVL, V5-6 (wide slurred S wave) Broad QRS

Question 42

How do you determine axis deviation?

Answer 42

Look at I & II - is either overall negative? Yes = deviation Is aVL more + or - ? + = L axis deviation, - = R axis deviation