Cardio

Question 1

Causes of aortic stenosis

Answer 1

Rheumatic fever
Degenerative calcification
Congenital bifid valve
IE
Paget's disease of the bone

Question 2

DDx for ejection systolic murmur loudest on expiration

Answer 2

Aortic stenosis
Hypertrophic obstructive cardiomyopathy
Supravalvular aortic stenosis

Question 3

How do you classify aortic stenosis severity?

Answer 3

valve area

normal 3-4 cm squared. mild >1.5, mod 1.5-1, severe 50mmHg

Question 4

What are the clinical signs of severe AS?

Answer 4

slow rising, low volume pulse
ejection systolic murmur radiating to carotids
aortic thrill at aortic area
heaving apex
reversed splitting of S2
soft or absent aortic component of S2

Question 5

complications of aortic stenosis?

Answer 5

LVF
AF and VT
pulmonary hypertension
heart block (calcification of conduction system)
IE
haemolytic anaemia

Question 6

Indications for aortic valve replacement?

Answer 6

symptomatic severe stenosis (mean gradient >50mmHg)
asymptomatic:
mod/severe AS pt having CABG/other valve surgery
severe AS and VT/LV sys dysfunction/valve area <0.6

Question 7

Features of pulmonary hypertension on cardiac exam

Answer 7

loud pulmonary component of S2,
pansystolic murmur loudest on inspiration of tricuspid regurg
large v waves of JVP
parasternal heave (RVH)

Question 8

features of mitral stenosis on examination

Answer 8

tapping apex beat (palpable S1)
loud S1 (could be soft if leaflets are calcified and immobile - not an indicator of severity)
opening snap in early diastole followed by a mid diastolic rumbling murmur
+/- malar flush

Question 9

Causes of mitral stenosis

Answer 9

rheumatic fever (most common)
congenital
rheumatoid arthritis
SLE

Question 10

DDx for mid-diastolic rumbling murmur

Answer 10

mitral stenosis

left atrial myxoma or thrombus

Question 11

Causes of mitral regurgitation

Answer 11

leaflets - rheumatic, CT, fibrosis
valve annulus - LV dilatation, calcification
chordae/papillae rupture - infiltration (amyloidosis), fibrosis

Question 12

signs of tricuspid regurg

Answer 12

PSM
raised JVP with cannon v waves
pulsatile hepatomegaly
peripheral oedema and ascites

Question 13

Causes of tricuspid regurgitation

Answer 13

pulmonary hypertension
IE
rheumatic fever
carcinoid syn (increased 5-HT from gut primary -> R side scarring and thickening -> TR +/- pulmonary stenosis

Question 14

complications of valve replacement

Answer 14

prosthesis dysfunction and LVH
haemolysis
warfarin - bleeding
thromboembolism (despite warfarin)
infective endocarditis (staph if post-op, strep viridans if late)

Question 15

Indications for implantable cardioverter defibrillator (ICD)

Answer 15

survived MI due to VF/VT
sustained VT causing syncope/haemodynamic compromise
familial condition (LQTS,Brugada, HCM, ARVD)
LFEF

Question 16

Indications for cardiac resynchronisation therapy (CRT) biventricular pacemakers (BiV)

Answer 16

LVEF 150

SR and QRS >120 and dyssynchrony on echo

Question 17

Signs of constrictive pericarditis

Answer 17

right heart failure
raised JVP
Kussmaul’s sign (JVP raises on inspiration)
pericardial knock (S3 - ventricular filling into a stiff pericardial sac)
peripheral oedema/ascites/hepatomegaly

Question 18

Causes of constrictive pericarditis

Answer 18

post MI (Dressler's syn)
TB
Trauma (surgery)
radioTherapy
connective Tissue disease (RA, SLE)

Question 19

Signs of a VSD

Answer 19

ESM or PSM localised to the left sternal edge, no radiation

Question 20

associations with a VSD

Answer 20

Tetralogy of Fallot (overriding aorta, RVH, VSD, pulmonary stenosis)
coarctation of the aorta
PDA

Question 21

Management of HOCM patient

Answer 21

rhythm disturbance - ICD
LVOT gradient >30 and Sx (SOB, syn/pre-syn/angina):
-B-Blockers
-pacemaker
-percutaneous alcohol septal ablation
-surgical septal myomectomy
-avoid strenuous sport
-family counselling and screening (AD inheritance)

Question 22

poor prognosis factors for HOCM

Answer 22

young age at diagnosis
syncope
family history of sudden death
septal thickness >3cm