Block 2 - Cardiology

Question 1

Symptoms of left sided heart failure?

Answer 1

Orthopnea - increased venous return from lying down

Paroxysmal nocturnal dyspnea - increased venous return from edema reabsorption

Pulmonary edema

Question 2

Symptoms of right sided heart failure?

Answer 2

Hepatomegaly - increased central venous pressure

Jugular venous distension - increased CVP

Peripheral edema

Question 3

What are the side effects of ACEi?

Answer 3

Diarrhea

Muscle pain

Rabdomyolysis - break down of muscle

Question 4

What virus causes spenomegaly?

Answer 4

EBV

Question 5

What are the triad of symptoms of pyelonephritis

Answer 5

Fever

Pain at costo-vertebral junction

nausea or vomiting

Question 6

Whats is POTS

Answer 6

Postural Orthostatic Tachycardic Syndrome

ALso known as syautonomia. Main symptom is widely variable blodd pressure and can lead to syncopy, dizziness etc. Is part of a wider ANS dysfunction syndrome.

Treatment: High salt intake of salt, stockings, Low dose ß blockers, avoid standing up for long times

Question 7

What is cardio-renal syndrome?

Answer 7

Where both the heart and kidneys are dependent on each other. This is through:

Heamodynamic stability

Renal-cardiac connectors e.g: BNP and inflammatory markers

Question 8

Treatment of acute heart failure?

Answer 8

Patient at 45° and O2

Morphine

ECG

FLurosemide

CXR and ABG

Nitrates if systolic > 100 mmHg

Question 9

What is the advantage of morphine apart from pain relief.

Answer 9

Anxiolytic

Vasodilator with quick onset

Question 10

How long does it take IV flurosemide to take effect?

Answer 10

20 mins

This is why morphine is given as a vasodilator first.

Question 11

Triad of cogestive heart failure?

Ft - Ryan Bartar CT1

Answer 11

Raised JVP

Crepitations at lung bases

Ankle oedema

Question 12

Symptoms and signs of Arotic stenosis?

Answer 12

Triad of heart failure, angina and sncopy

Patient experiences - Chest pain, exertional dyspnoea and syncopy

Signs - slow rising pulse, displaced apex and systolic ejection mumur ( and ejection click?)

Question 13

Symptoms and signs of Mitral regurgitation?

Answer 13

Symptoms include dyspnoea fratigue and palpitations

Signs: AF, displaced apex, pansystolic murmur.

Question 14

What is the anion gap?

Answer 14

[Na⁺] - ([Cl^-] + [HCO₃^-])

> 17 confirms there is a metabolic acidosis

Question 15

What are the causes for a raised anion gap?

KARMEL

Answer 15

Ketosis

Asprin (also paracetamol and other toxins)

Renal failure

Methanol

Ethylene Glycol

Lactate

Question 16

When do you use Flecanide for cardioeversion?

Answer 16

No structural change or ischaemia (usually younger people) who are in AF

Question 17

What is the treatments for SVT?

Answer 17

Adenosine - slows the heart rate

Has a half life of 8s

Question 18

What can cause LBBB?

Answer 18

Digitalis intoxication

Hyperkalaemia

Hypertrophy

ischaemia

Aortic stenosis

Question 19

What causes RBBB?

Answer 19

Hypertrophy/ Cor pulmonale

PE

Ischaemia

Myocarditis

Rheumatic heart disease

Artial septal defect

Question 20

What is P pulmomale and what are its causes?

Answer 20

Right atrial hypertrophy due to portal hypertension.

Causes:

Chronic lung disease

Tricuspid stenosis

Congenital heart disease

Question 21

What is P mitrale and what causes it?

Answer 21

Left artial hypertrophy.

Causes:

LV hypertrophy, Mitral stenosis

Question 22

What features of a ECG indicate p pulmonale?

Answer 22

Peaked T waves in V1/2, II, III, AvF

Question 23

What features of a ECG indicate p mitrale?

Answer 23

Bifid P waves

T wave > 40 ms

Question 24

What feature on ECG indicates Hypokaleamia?

Answer 24

Porminant U wave

Question 25

What feature on ECG can indicate Hyperkalaemia?

Answer 25

Peaked T waves

Question 26

What types of AF are there?

Answer 26

First degree

Paroxysmal

Persistant

Perminant

Question 27

What is the difference between paroxysmal and persistant AF?

Answer 27

Both have 2 or more episode however paroxysmal self terminate spontaneously where as persistant has to be cardioverted.

Question 28

What is Dresslers syndrome?

Answer 28

Usually 2-6 weeks post MI.

Autoimmune attack on myocardium

Question 29

What does the ECG image indicate

Answer 29

Digitalis toxicity. Usually acompinied by hypekalaemia, GI dystress arrythmias.

Digibindin is used as treatment.

Question 30

What are SVTs and how are they treated?

Answer 30

Artrial tachycardia, Atrial flutter and Atrialventricular nodal ventrant tachycardias (AVNRT).

Haemodynamically stable use Carotid sinus masage and adenosine.

If haemodynamically unstable then try DC cardioeversion.

Question 31

What qualifies someone as haemodynamically unstable?

Answer 31

HR

BP

Hypoxic

Heart failure

Question 32

What criteria is used for heart failure?

Answer 32

Framingham Criteria

Question 33

How is heart failure diagnosed using the Framingham Criteria?

Answer 33

2 Major symptoms

1 Major and 2 Minor symptoms

Question 34

What are major symptoms of the Framingham Criteria?

Answer 34

SAW PANIC

S₃

Acute pulmonary oedema

Weight loss

PND

Abdominal hepatic reflux

Neck dystension

Increased cardiac shadowing on CXR

Crackles on lung bases

Question 35

What are minor symptoms of the Framingham Criteria?

Answer 35

HEARTVN

Hepatomegaly

Effusion

Ankle oedema bilaterally

exeRtional dyspnoea

Vital capactiy (1/3)

Nocturnal cough

Question 36

What is the management of Torsades de pointes (haemodynamically stable)?

Answer 36

IV magnesium sulphate