Cardio

Question 1

LBBB

Answer 1

QRS>120msec; no R wave in V1; tall R waves in I, V5 and V6

WILLIAM

Question 2

RBBB

Answer 2

QRS>120msec; RSR’ complex; qR or R morphology with a wide R wave in V1; QRS pattern with wide S wave in I, V5, and V6.

Question 3

Systolic murmurs; AS, MR, MVP, Flow murmur

Answer 3

AS: harsh sys ejection murmur that radiates to the carotids
MR: holosyst murmur that radiates to the axilla
MVP: midsys or late sys murmur with a preceding click
Flow murmur: common, not implying cardiac disease

Question 4

Diastolic Murmurs: AR, MS

Answer 4

AR: early decrescendo murmur
MS: mid to late, low pitched murmur.

Question 5

S3, S4

Answer 5

S3 - dilated/ floppy ventricle. may be normal in kids and pregnancy - rapid ventricular filling in setting of fluid overload
S4 - stiff ventricle. HTN, Aortic stenosis, may be normal in athletes and younger patients. hocm - Increased atrial kick

Question 6

Treat Acute CHF

Answer 6

LMNOP

lasix, morphin, nitrates, oxygen, position (upright)

Question 7

systolic dysfxn

Answer 7

reduced EF ( hypertrophy or dilation.
NO CCBs
digoxin second line agent

Question 8

nonsystolic dysfxn

Answer 8

decreased ventricular compliance with normal sys fxn - impaired active relaxation (2/2 ischemia, aging, hypertrophy) or impaired passive filling ( scarring from prior MI, restrictive cardiomyopathy).

• LVEDP increased, CO is normal and EF is normal or Increased.
• diuretics are first line therapy, Beta blockers, ACEI/ ARBs
• YES CCBs but digoxin not useful.

Question 9

hypertrophy murmur e.g in HOCM

Answer 9

S4 gallop with sys ejection crescendo-decrescendo murmur

• increases with decrease in preload (valsalva, standing)
• Decreases with Increase in preload (passive leg raise)