Cardio

Question 1

Mx of unstable angina

Answer 1

Aspirin + Clopidogrel
LMWH
GTN Spray

Question 2

Standard treatment of STEMI/STEMI

Answer 2

MONAC

Morphine
Oxygen
Nitrates
Aspirin
Clopidogrel

Question 3

Occlusion of which vessel can lead to heart block

Answer 3

RCA

(located by SA and AV nodes)

Question 4

What is negative in RAD

Answer 4

Lead I

Question 5

What is negative in LAD

Answer 5

Lead II (& Lead III)

Question 6

Causes of syncope?

Answer 6

Vasovagal (fainting)
Orthostatic

Cardiovascular: arrhythmia, aortic dissection, ACS

Question 7

Slow rising pulse

Answer 7

Aortic stenosis

Question 8

Most common causes of aortic stenosis

Answer 8

Calcific degeneration
Congenital bicuspid valve

Question 9

Signs of mitral stenosis

Answer 9

Palmar erythema
Malar Flush
Left parasternal heave
Stigmata of endocarditis

Loud S1 – closing snap of stenosed mitral valve.
Loud P2- secondary to pulmonary HTN

Question 10

Most common cause of Mitral stenosis

Answer 10

Rheumatic fever (90%)

Question 11

Mx of mitral stenosis

Answer 11

Observation
Percutaneous balloon mitral valvuloplasty
Surgical repair/replacement

Question 12

Scar present if valvular replacement

Answer 12

Median sternotomy scar

Question 13

How to differentiate the sound of an aortic or mitral valve replacement

Answer 13

Remember that the 1st heart sound is closure of the mitral valve and 2nd heart sound closure of the aortic valve.

So a metallic click just before the carotid pulse is a mitral valve replacement and just after the carotid pulse is an aortic valve replacement.

(Listen over both areas for intensity of the click)

Question 14

Sx of HOCM

Answer 14

Jerky pulse
Large A waves in JVP
Ejection systolic murmur radiating to the apex

Question 15

Differentials for Ejection systolic murmur

Answer 15

Aortic stenosis
Pulmonary Stenosis
Aortic sclerosis
HOCM
ASD

Question 16

Differentials for pansystolic murmur

Answer 16

Mitral regurgitation & Tricuspid regurgitation.
VSD ASD

Question 17

Differentials for diastolic murmur

Answer 17

Aortic regurg
Pulmonary regurg
Mitral stenosis
Tricuspid stenosis

Question 18

Causes of aortic stenosis

Answer 18

Calcific degeneration (commonest)

Congenital bicuspid valve, post rheumatic fever & IE

Question 19

Causes of aortic regurg

Answer 19

IE, aortic dissection, rheumatic fever, bicuspid aortic valve, Marfan’s

Question 20

Causes of mitral regurg

Answer 20

IE, rupture of chordae tendinae (post-MI), Marfan’s

Question 21

Valve problem associated with carcinoid syndrome

Answer 21

Tricuspid stenosis

Question 22

Indications for a median sternotomy

Answer 22

Aortic aneurysm/dissection
Mechanical valves
Heart transplant
Coronary artery bypass graft
Thymectomy

Question 23

Signs of LVF

Answer 23

Fatigue
Exertional dyspnoea
Orthopnoea + PND
Nocturnal cough (± pink, frothy sputum)

Question 24

Signs of RVF

Answer 24

↑JVP + jugular venous distension
Tender smooth hepatomegaly
Pitting oedema
Ascites

Question 25

Chronic heart failure classification

Answer 25

*New York Classification** 1. No breathlessness 2. Breathless on moderate exertion 3. Breathless on mild exertion 4. Breathless at rest

Question 26

Heart failure Ix

Answer 26

Bloods: FBC, U+E, NT-proBNP, lipids, glucose CXR ECG ECHO: the key Ix

Question 27

Heart failure Ix

Answer 27

Bloods: FBC, U+E, NT-proBNP, lipids, glucose CXR ECG ECHO: the key Ix

Question 28

Chronic Heart Failure Mx

Answer 28

Beta Blocker + ACEi + Loop diuretic 2nd add spironolactone 3rd consider ivabradine

Question 29

Narrow pulse pressure

Answer 29

Aortic stenosis

Question 30

Causes of aortic stenosis

Answer 30

Age-related senile calcification Bicuspid aortic valve Rheumatic heart disease

Question 31

Clinical Symptoms of Severe AS

Answer 31

Angina: 50% dead in 5yrs Syncope: 50% dead in 3yrs Dyspnoea: 50% dead in 2yrs

Question 32

AS Ix

Answer 32

ECG Echo

Question 33

AS Mx

Answer 33

MDT approach Optimise CV risk: statins, anti-HTN, DM, anti-plat Sx: valve replacement ± CABG

Question 34

Causes of AF

Answer 34

IHD Rheumatic heart disease Thyrotoxicosis Hypertension RA

Question 35

Ix of AF

Answer 35

ECG Bloods: FBC: pneumonia, sepsis U+E: ↓K TFTs: ↓TSH, ↑fT4 Troponin D-dimer: PE CXR Echo

Question 36

dDx for irregulary irregular pulse

Answer 36

AF Multiple ventricular ectopics Clinical Distinction: Exercise pt. AF: pulse stays irregularly irregular VE: ↑ HR → regular pulse ↓ diastole time closes window for ectopics

Question 37

IE diagnostic criteria

Answer 37

Duke criteria: 2 major 1 major + 3 minor All 5 minor MAJOR: +ve blood cultures (2 separate cultures) Endocardial involvement: +ve echo: vegetation, abscess, dehiscence or new valvular regurgitation MINOR: Predisposition: cardiac lesion, IVDU Fever >38 Emboli: septic infarcts, splinters, janeway lesions Immune: GN, Osler nodes, roth spots, RF blood cultures not meeting major criteria

Question 38

Causes of impalpable apex breat (4)

Answer 38

COPD Obesity Pericardial effusion D​extrocardia

Question 39

Fx of Pulmonary HTN

Answer 39

^JVP Left parasternal heave Loud P2 Pulsatile hepatomegaly Peripheral oedema

Question 40

Heart sounds (S1-4)

Answer 40

S1: mitral valve closure S2: aortic valve closure S3: rapid ventricular filling of dilated left ventricle S4 atrial contraction against a stiff ventricle

Question 41

Causes of aortic regurgitation

Answer 41

Bicuspid aortic valve Rheumatic heart disease Autoimmune: Ank spondylitis, RA Connective tissue: Marfan’s, Ehler’s Danlos Acute: Infective endocarditis Type A aortic dissection

Question 42

Murmur standard Ix and Mx

Answer 42

Ix: ECG, CXR, Echo + Doppler Bloods: FBC, U&E, Lipids, glucose, BNP Mx: MDT approach: GP, cardiologist, dietician Optimise CV risk: statins, anti-HTN, DM, anti-plat Regular monitoring

Question 43

Diagnosis of Rheumatic fever

Answer 43

Jones Criteria 2 major, 1 major + 2 minor Major Criteria (CASES) Pancarditis Arthritis Subcut nodules Erythema marginatum Sydenham’s chorea Minor criteria Prolonged PR interval (not if carditis is a major) Arthralgia (not if arthritis is a major) Fever ↑ESR or ↑CRP Prev rheumatic fever

Question 44

Ix of Rheumatic fever

Answer 44

Bloods: FBC, ESR, ASOT ECG Echo

Question 45

Rheumatic fever Tx

Answer 45

Bed rest until CRP normal for 2 wks Benzylpenicillin 0.6-1.2 IM for 10 days Analgesia; carditis/arthritis: aspirin/NSAIDs Add oral pred if CCF, cardiomegaly, 3rd degree block

Question 46

What pulse sign would you see in pt with HOCM?

Answer 46

Pulsus bisferiens - biphasic pulse, is a cardiac cycle with two peaks, a small one followed by a strong and broad one

Question 47

Complications of valve replacement

Answer 47

Acute failure of valve e.g. breakage Chronic failure of valve e.g. stenosis, incompetence Infective endocarditis Anaemia AF Thromboembolism