Cardio

Question 1

8 potential features of severe aortic stenosis

Answer 1

narrow pulse pressure

slow rising pulse

delayed ESM

soft/absent S2

S4

thrill

duration of murmur

left ventricular hypertrophy or failure

Question 2

3 main symptoms of aortic valve disease

Answer 2

Chest pain, dysponea, Syncope

Question 3

7 Features of mitral stenosis

Answer 3

mid-late diastolic murmur (best heard in expiration)

loud S1,opening snap

low volume pulse

malar flush

atrial fibrillation

Question 4

What would you suspect if a patient has persistent ST elevation following recent MI and no chest pain?

Answer 4

Left ventricular aneurysm (ischaemic damage sustained may weaken myocardium -> persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm thus anticoagulate these patients)

Question 5

Where is BNP produced?

Answer 5

Left ventricular myocardium (in response to strain)

Question 6

What can cause raised BNP?

Answer 6

Heart failure
and any cause of left ventricular dysfunction
such as MI or valvular disease
CKD (due to reduced excretion)

Question 7

What are the effects of BNP?

Answer 7

vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and the renin-angiotensin-aldosterone system

Question 8

What type of murmur do you get in mitral stenosis?

Answer 8

Mid-late diastolic, ‘rumbling’ in character (like Austin-Flint murmur of severe aortic regurgitation)

Question 9

3 causes of an ejection systolic murmur

Answer 9

aortic stenosis
pulmonary stenosis, hypertrophic obstructive cardiomyopathy
atrial septal defect, tetralogy of Fallot

Question 10

What type of murmur do you get in aortic regurgitation?

Answer 10

Early diastolic murmur, high-pitched and ‘blowing’ in character
(same as Graham-Steel murmur of pulmonary regurgitation)

Question 11

What type of murmur is typical for mitral regurgitation?

Answer 11

Holosystolic/Pansystolic (starts at S1 ends at S2) murmur, high-pitched and ‘blowing’ in character (tricuspid is same)