Cardio Vivas

Question 1

rheumatic fever

Answer 1

– post Strep pyogenes, molecular mimicry. Jones criteria. ESR + ASOT special tests. Abx, analgesia, normalise CRP, treat chorea. 3 month attacks + possible recurrence + likely valve disease. Prophylactic Abx for 5-10 years.

Question 2

infective endocarditis

Answer 2

normal valves = IVDU/ISupp/wounds = Staph + acute. Cardiac disease = replaced valve/valve disease = Viridans/HACEK + subacute.
o/e – clubbed, splinter, Osler, Janeway, Roth, SM, new murmur. Duke’s + IV Abx.

Question 3

valve replacement

Answer 3

Valve replacement – o/e – s1 click= mitral / s2 click=aortic metallic, AC bruises, scars (midline, LLI thoracotomy for MVR, angio access, harvest). Normal HS if bio. Regurg if poor fit. Echo to assess. Systolic flow murmurs normal for AVR.

Question 4

valve types

Answer 4

Valve types– mech = if young, last 20-30yrs, need warfarin. Not for young women as no warfarin in preg. Bio = porcine – for old / bleed risk, last 10 yrs, only 6/12 AC + aspirin. Considerations – HF+ state of valve, co-morbs, age, risk of anticoag, pt

Question 5

valve replacement complictions

Answer 5

VR complications – periop (arrhythmia, stroke, inf, bleed, VTE, PO, AKI), valve (leak, dehiscence, VTE, haemolysis, I.E.), warfarin (bleeding)

Question 6

assessing valvular lesions 3 x things o/e

Answer 6

assess severity
assess cardiac decompensation
assess for signs of infective endocarditis

Question 7

signs of severe valve problems AS AR MR MS

Answer 7

AS - slow rising pulse, narrow pulse pressure, quiet s2

AR - collapsing pulse, wide PP, signs of backflow, displaced apex

MR - AF, displaced apex, RV heave and loud S2 (pHTN)

MS - AF, pulmHTN signs

Question 8

valve replacement assessment o/e

Answer 8

midline sternotomy scar

abnormal s1 = mitral rep
abnormal s2 = aortic rep

assess function - any signs of stenosis or regurg?
assess for decompensation
assess for infective endocarditis
assess for over-anticoag e.g. bruising, pallor
assess for hamolysis - jaundice, pallor

Question 9

o/e heart failure

Answer 9

tachypnea / cardia
cool peripheries
raised JVP
displaced apex
s3
bibasal fine creps
peripheral oedema

Question 10

atrial septal defect murmur

Answer 10

soft ejection systolic flow murmur
wide split s2

assoc Down’s

Question 11

ventricular septal defect

Answer 11

pansystolic
assoc thrill
RV heave/loud p2

Question 12

cor pulmonale signs

Answer 12

plethoric face
central cyanosis 
raised JVP large a waves
assoc TR possible 
rv HEAVE
loud s2
ankle oedema

signs of cause (chronic lung disease ) i.e. fine creps - PF, clubbing - PF, signs of COPD

Question 13

hypertrophic obstructive cardiomyopathy signs

Answer 13

evidence of pacemaker or ICD
jerky pulse
double apex beat
ejection systolic
s4 heard

young + signs of HF

Question 14

tetralogy of fallot repair

Answer 14

sternotomy scar
clubbing
loud pulmonary stenosis
youngish pt

Question 15

coarctation of aorta

Answer 15

pre repair:
radio femoral delay
weak left radial pulse
systolic murmur over region of stenosis (may be interscapular or infraclavicular)

post repair:
left lateral thoractomy scar

assoc signs - Turner’s - webbed neck + short female

Question 16

differentiating JVP from cartoid

Answer 16

double waveform
not palpable
changes with position and inspiration
abdo pressure increases

Question 17

assessing a replaced valve

Answer 17

ausc, evidence of I.E. / decomp HF / bleeding / anaemia

Question 18

pacemakers

Answer 18

– for bradyarrhythmias. Permanent – Mobitz 2, complete block, symptom brady, 3 sec pauses symptom, trifasc block. Temp – unstable + unresponsive to atropine. Commonest – dual chamber in RA + RV. Single lead if AF – only pace RV. Pacing spikes 2x if dual, 1x before QRS if single lead. Coded by 3 letters (1-chamber paced, 2 – chamber sensed, 3- response)

Question 19

ICDs

Answer 19

high risk VT/VF patients – prev arrhythmias / haemo comp, poor EF, congen

Question 20

heart failure summary

Answer 20

with reduced EF = systolic HF, preserved = diastolic (stiff ventric, usually old age+HTN trigger). Causes- go by anatomy – outflow (pulm/system HTN), valves (murmur or congenital), coronary (IHD), myocardium (toxins, AI, infiltration, genetic), conductive (arrhythmias), pericardium (pericarditis, tamp).
Features = LVF – exert SOB, orthopneoa, PND, frothy pink sputum, PO, effusions, s3 RVF = peripheral oedema, wt gain, bloating, raised JVP, HM, ascites. Fatigue.
Inv – BNP bloods. CXR – Alveolar shadowing, B lines, Cardiomeg, Diversion upper lobes, Effusion. Echo Dx. Find cause – more bloods, ECG, angio, cardiac MRI (if ?)
Manage – treat cause. ACEx + BB + diuretic + spriro. Add ivabradine if BB not lowering HR below 70. Consider ICD.