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Med school finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Recall 2 observations about a person’s pulse that may be seen if they have aortic stenosis vs aortic regurgitation

A

Aortic stenosis: NARROW pulse pressure, slow rising pulse

Aortic regurgitation: WIDE pulse pressure, ‘waterhammer’ pulse (Corrigan’s pulse)

Pulse pressure = SBP-DBP (eg if BP = 120/80, PP = 40)

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2
Q

How would you describe the heart sounds that are auscultated in aortic stenosis vs regurgitation?

A

Aortic stenosis = soft S2 +/- S4

Aortic regurgitation = soft S2 +/- S3

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3
Q

What is the difference in cause between an S3 and S4 heart sound?

A

S3 heart sound is caused by blood filling against a non-compliant ventricle, whereas S4 is blood filling against a compliant ventricle

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4
Q

How can you hear the difference between an S3 and S4 heart sound?

A

S3 is early diastolic

S4 is late diastolic

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5
Q

What clinical examination findings can help differentiate aortic stenosis caused by valve sclerosis from aortic stenosis caused by HOCM?

A

In HOCM, the valsalva manoevre increases the volume of the murmur, whereas squatting decreases it

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6
Q

What might a CXR reveal in aortic stenosis?

A

Left ventricular hypertrophy
Pulmonary oedema
Valve calcification

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7
Q

What is the most useful investigation for assessing the severity of aortic stenosis?

A

Echo +/- doppler

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8
Q

Recall some general principles of management of heart valve disease

A

QRISK3 score to stratify risk
Manage risk with a statin (eg atorvastatin) and an antiplatelet (aspirin/ clopidogrel)
Manage coexistent HTN/ angina etc

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9
Q

Recall some indications for open replacement of the aortic valve (rather than cath lab procedure)

A

Symptomatic
Non-symptomatic with a low EF
Severe undergoing CABG

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10
Q

What does CABG stand for?

A

Coronary artery bypass graft

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11
Q

What are the 2 main types of artificial aortic valve?

A

Ball-in-cage

Bileaflet/ tilting disc

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12
Q

Recall some pros and cons of TAVI

A

Pros: no bypass required, no large scars
Cons: higher risk of stroke compared to open replacement

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13
Q

What is a balloon aortic valvuloplasty

A

Procedure which stretches the aortic valve to improve symptoms of aortic stenosis

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14
Q

When is the aortic stenosis murmur heard vs aortic regurgitation?

A

AS: Ejection systolic
AR: Early diastolic

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15
Q

What is an Austin Flint murmur?

A

‘Rumbling diastolic murmur’

  • Associated with severe aortic regurgitation
  • Best auscultated in 5th ICS in MCL
  • Caused by blood flowing back through the aortic valve and over the mitral valve
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16
Q

When in the heart cycle is an Austin flint murmur heard, and what causes it?

A

Mid-diastole

Caused by regurgitant jet that runs over the mitral valve leaflets

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17
Q

Which heart murmurs are best heard on expiration?

A

Left heart murmurs

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18
Q

Where is the aortic regurgitation murmur best auscultated?

A

Erb’s point - Left 3rd ICS parasternal

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19
Q

Where is the main site of production of BNP?

A

Left ventricle (not actually brain, as name may suggest)

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20
Q

What is the advantage of measuring NT-proBNP over BNP?

A

NT-proBNP has a much longer half life as it is inactive - BNP, being an active hormone, has a much shorter half life

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21
Q

What can an echo and doppler be used to determine in cases of aortic regurgitation?

A

Severity
LV function
Cause

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22
Q

What is the mainstay of medical management for aortic regurgitation (other than managing cardiac risk with statins etc)?

A

Reduce afterload - can use:
ACE inhibitors (eg enalopril/ captopril)
Beta blockers (bisoprolol etc)
Diuretics (furosemide etc)

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23
Q

Which 2 antihypertensives are contra-indicated in aortic stenosis?

A 
Beta blockers (don't want to depress LV function)
Nitrates (may precipitate life-thretening hypotension)
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24
Q

Which heart murmur is most associated with atrial fibrillation?

A

Mitral stenosis

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25
Q

Which of the left heart murmurs will NOT produce a displaced apex beat?

A

Mitral stenosis (causes atrial hypertrophy not ventricular)

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26
Q

By what mechanism can heart valve disease cause a parasternal heave, and which murmurs can cause this?

A

Right ventricular hypertrophy (RVH) is cause of PSH (right ventricle is most anterior chamber of the heart so can cause heave)
MS and MR can cause RVH - as increased left atrial pressure –> pulmonary HTN –> RVH

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27
Q

Why might the apex beat be displaced in mitral regurgitation?

A

Left ventricle is pumping the stroke volume AND the regurgitant volume

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28
Q

Differentiate the timing of mitral stenosis and mitral regurgitation

A

Mitral stenosis is a MID DIAstolic murmur

Mitral regurgitation is a pan SYStolic murmur

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29
Q

Which of the heart murmurs might radiate to the axilla?

A

Mitral regurgitation

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30
Q

Recall some clinical signs of pulmonary hypertension

A

Malar flush
Raised JVP
Right ventricular (parasternal) heave
Loud S2

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31
Q

What might be seen on an ECG in mitral valve disease

A 
Atrial fibrillation
P mitrale (bifid 'm-shaped' p waves in lead II as well as V1-V6)
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32
Q

What is the mainstay of medical management for mitral stenosis, other than heart disease risk modification eg statins?

A

RhF prophylaxis with benzylpenicillin
AF (rate control + DOAC)
Diuretics for symptomatic relief

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33
Q

What is the first line surgical treatment for mitral stenosis?

A

Balloon valvuloplasty

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34
Q

What is the mainstay of medical management for mitral regurgitation (other than managing cardiac risk with statins etc)?

A

Like AR, reduce afterload - can use:
ACE inhibitors (eg enalopril/ captopril)
Beta blockers (bisoprolol etc)
Diuretics (furosemide etc)

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35
Q

Describe briefly the NYHA classifications

A

1 - no limitation on activity
2 - comfortable at rest but dyspnoea on ordinary activity
3 - marked limitation on ordinary activity
4 - dyspnoea at rest

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36
Q

Recall the broad approach to medically managing heart failure

A 
BASHeD up by the heart:
(Beta blocker or 
ACE inhibitor)
Spironolactone
Hydralazine (+ nitrate) 
Digoxin
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37
Q

Which extra immunisations should be offered in patients with heart failure?

A

Annual influenza

Pneumococcal

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38
Q

What must be monitored whilst patients are on spironolactone?

A

Potassium (as is a potassium-sparing diuretic)

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39
Q

Recall some drugs that are contra-indicated in heart failure

A

Thiozolidinediones (type 2 diabetes)
Verapamil (as is negative inotrope)
NSAIDs (can cause fluid retention)
Glucocorticoids (can cause fluid retention)
Flecainide (negative inotrope, arrhythmogenic)

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40
Q

How quickly should GTN spray relieve angina pain?

A

Within 5 minutes

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41
Q

What is the first line investigation for angina in stable patients, and what score is this investigation used to calculate?

A

CT coronary angiography

Calcium score

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42
Q

What are some pharmacological options for preventing angina (NOT symptomatic relief)?

A

Aspirin (75mg, OD)
Atorvastatin (80mg, ON)
ACE inhibitor (especially if co-existent DM)
Antihypertensives

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43
Q

What calcium score would be classified as low risk, and what score would be high risk?

A

Low risk < 100

High risk > 400

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44
Q

What care needs to be taken when prescribing CCBs abd BBs together?

A

If you prescribe a non-dihydropyrimidine CCB (eg verapamil) with a BB it can cause complete heart block

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45
Q

What are some medical options for managing angina symptoms?

A

1st line: GTN (spray or sublingual) + beta blocker or CCB (if CCB used as monotherapy, use a rate limiting one like verapamil or dilitiazem)
2nd line: GTN + BB AND CCB
3rd line options:
- Long-acting nitrates eg Isosorbide mononitrate
- Ivabradine

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46
Q

What are the 3 types of AF?

A

Acute (<48 hours)
Paroxysmal (self-limiting, <7 days, recurs)
Persistent (>7 days, may recur even after cardioversion)

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47
Q

How does anti-clotting drug choice differ following a stroke, depending on whether or not they have AF?

A

If they have AF –> anti-coagulant (DOAC or warfarin if DOAC is CI)

If they do NOT have AF –> anti-platelet

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48
Q

Why are anti-platelets not used in AF?

A

Anti-platelets are specifically for artherogenic causes of clots eg atheroma

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49
Q

Within what window of AF beginning can it be treated differently to longer-standing AF? What is this different treatment? Why is it so difficult to treat within the initial window of time?

A

AF <48 hours duration and HAEMODYNAMICALLY UNSTABLE can be cardioverted electrically

Difficult to establish onset of AF as patient may not have palpitations, or may be unsure as to when they started

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50
Q

For how long before and after cardioversion for arrhythmia should a patient be anti-coagulated?

A

3w before and 4w after OR lifelong (if CHA2DS2VASc high or if paroxysmal AF)

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51
Q

How can chadsvasc score be used to determine the need for longterm anticoagulation?

A

Score:
0 = no need for longterm anticoagulation
1 = anticoagulate if male, do not anticoagulate if female
2 or more: anticoagulate

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52
Q

What is the main contraindication to be aware of for all CCBs?

A

Peripheral oedema (increased capillary hydrostatic pressure that results from greater dilation of pre-capillary than post-capillary vessels)

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53
Q

What are the 1st, 2nd and 3rd line options for rate control in AF?

A

1st line: beta blocker or CCB (verapamil is better than dilitiazem)
2nd line: digoxin
3rd line: amiodarone

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54
Q

With what waveform on the ECG should DC cardioversion be synchronised?

A

R wave

If synchronised with T wave it can cause VT

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55
Q

Recall 2 options for chemical cardioversion, and any important indications/ contra-indications for each

A

Flecainide - if young and no structural heart disease

Amiodarone - in structural heart disease (eg HF)

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56
Q

Recall 2 surgical options for managing AF

A
  1. Radiofrequency ablation of AV node

2. Maze procedure

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57
Q

Recall the components of the CHA2DS2VASc score

A 
CHF
HTN
Age >75
DM
Stroke
Vascular disease
Age 65-74
Sex Category (female)
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58
Q

In HTN, what BP is defined as ‘severe’?

A

> 180/110

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59
Q

What is the first line treatment for HTN for diabetics?

A

ACE inhibitor

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60
Q

What is the first line treatment for HTN for black Africans?

A

CCB

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61
Q

What is the first line treatment for HTN for under vs over 55s who are not diabetic or Black African?

A

Under 55: ACE inhibitor or ARB

Over 55: CCB

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62
Q

Recall some side effects of ACE inhibitors

A

Angioedema (for around 4 weeks), cough, hyperkalaemia

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63
Q

Recall the name of one thiazide-like diuretic

A

Indapamide

nb bendoflumethiazide is thiazide, not thiazide-like

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64
Q

Why do CCBs cause oedema?

A

Cause dilation of arterioles but not venules

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65
Q

What is the atorvastatin dose for primary vs secondary prevention?

A

Primary prevention: 20mg OD

Secondary prevention: 80mg OD

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66
Q

What is the most commonly affected heart valve in infective endocarditis when the patient is an IVDU?

A

Tricuspid

67
Q

What is the most common pathogen to cause an acute presentation of infective endocarditis?

A

Strep epidermidis

68
Q

How does strep viridans infective endocarditis most commonly present?

A

Subacute presentation, most commonly in the developing world

69
Q

What is Libman-Sacks endocarditis?

A

Non-infective endocarditis caused by SLE

70
Q

Differentiate the empirical antibiotics used in native vs prosthetic valves affected by infective endocarditis

A

Native valve: amoxicillin +/- gentamicin

Prosthetic valve: vancomycin + rifampicin + gentamicin

71
Q

How far apart should blood cultures be taken to investigate infective endocarditis?

A

12 hours

72
Q

What is the most likely pathogen to cause rheumatic fever?

A

GAS (strep pyogenes)

73
Q

What is the broad pathophysiology of rheumatic fever?

A

AB cross reactivity with myosin, muscle glycogen and VSMC

74
Q

What is the latent period between pharyngeal infection and onset of rheumatic fever?

A

2-6 weeks

75
Q

Recall some of the key symptoms of rheumatic fever

A

Pericarditis
Polyarthritis
Erythema marginatum

76
Q

What are sydenham’s chorea?

A

Unwanted jerky movements that appear 2-6 months following rheumatic fever

77
Q

Recall the Duckett-Jones diagnostic criteria

A 
For diagnosing rheumatic fever: 
CASES (major) FRAPP (minor) 
Carditis 
Arthritis
Sydenham's chorea
Erythema marginatum
Subcutaneous nodules
78
Q

What is the antibiotic treatment recommended in rheumatic fever?

A

Phenoxymethylpenicillin QDS 10/7

79
Q

What drugs can be used to treat sydenham’s chorea?

A

Haloperidol

Diazepam

80
Q

How long does penicillin treatment need to continue following an episode of rheumatic fever to prevent rheumatic heart disease?

A

If carditis and residual heart disease: 10 years or until age 40 (whichever is longer), possibly lifetime

If carditis but NO residual heart disease: 10 years or until age 21 (whichever is longer)

If NO carditis: 5 years or until age 21 (whichever is longer)

81
Q

What is ‘fibrinous’ pericarditis?

A

Pericarditis caused by uraemia

82
Q

Recall some signs and symptoms of pericarditis

A 
Pleuritic chest pain 
Non-productive cough 
Dyspnoea
Flu-like symptoms 
Pericardial rub 
Tachypnoea + tachycardia
83
Q

What are the typical ECG findings in pericarditis?

A

Widespread PR depression or saddle-shaped ST elevation

84
Q

How should pericarditis be broadly managed?

A

Treat cause

NSAIDs and colchicine

85
Q

Recall some cardiac causes of clubbing

A

Atrial myxoma
Cyanotic heart disease
Infective endocarditis

86
Q

What can cause a collapsing pulse other than aortic regurgitation?

A

Pregnancy
Thyrotoxicosis
Anaemia

87
Q

What do the S1 and S2 heart sounds represent?

A 
S1 = mitral valve closure
S2 = aortic valve closure
88
Q

What would cause a split S1?

A

Mitral and tricuspid valve closing at different times - normal in some

89
Q

What are the 2 types of purely genetic primary cardiomyopathy?

A

HOCM

Arrhythmogenic right ventricular dysplasia

90
Q

What are the 2 types of purely acquired primary cardiomyopathy?

A

Peripartum cardiomyopathy

Takotsubo cardiomyopathy

91
Q

Recall 2 types of primary cardiomyopathy that have mixed genetic/ acquired causes?

A

Dilated cardiomyopathy

Restrictive cardiomyopathy

92
Q

Recall 4 possible causes of dilated cardiomyopathy

A

Alcohol
Cocksackie B
Wet beri beri
Doxorubicin

93
Q

Recall 3 possible causes of restrictive cardiomyopathy

A

Amyloidosis
Post-radiotherapy
Loeffler’s endocarditis (due to eosinophillic infiltration)

94
Q

What is the most common gene mutation causing HOCM?

A

Beta-myosin heavy chain protein mutation

95
Q

What would the following echo findings be suggestive of:
Mitral regurgitation
Systolic anterior motion of the anterior mitral valve
Asymmetrical septal hypertrophy

A

HOCM

96
Q

What is arrhythmogenic right ventricular dysplasia?

A

Replacement of right ventricular myocardium with fatty and fibrofatty tissue

97
Q

What is the following description of an abnormal ECG most suggestive of:
Abnormalities in V1-3, typically T wave inversion. Possible epsilon wave.

A

Arrhythmogenic right ventricular dysplasia

98
Q

What would the following echo findings be suggestive of:
All 4 heart chambers dilated
Tricuspid and mitral regurgitation

A

Dilated cardiomyopathy

99
Q

What condition does the following describe: “transient, apical ballooning of the myocardium”?

A

Takotsubo cardiomyopathy

100
Q

Recall some causes of secondary cardiomyopathy

A

Infiltration (eg amyloidosis )
Inflammation (eg sarcoidosis)
Storage (eg haemochromatosis)
Deficiencies (eg beri beri)
Neuromuscular (eg Friedereich’s ataxia, duchenne-becker musculdystrophy)
Infective (cocksackie B, chagas)
Endocrine (thyrotoxicus, diabetes mellitis, acromegaly)

101
Q

Why is long QT syndrome dangerous?

A

Can cause VT –> death

102
Q

Recall 2 causes of congenital long QT syndrome, and how they can be differetiated?

A

Jervell-Lange-Nielsen syndrome (deafness)

Romano-Ward syndrome (no deafness)

103
Q

Recall some drugs that can cause long QT syndrome

A 
METH CATS
Methadone 
Erythromycin 
Terfenadine 
Haloperidol

Clarithromycin
Amiodarone/ arythromycin
TCAs
SSRIs (especially citalopram)

104
Q

What is the 1st line management of torsades de pointes?

A

IV magnesium sulphate

105
Q

What is torsades de pointes?

A

A type of polymorphic VT that is associated with QT prolongation

106
Q

How much does BP have to drop on standing to classify as ‘orthostatic hypertension’?

A

Over 3 mins, BP needs to fall by 20/10

107
Q

What is pulsus paradoxus, and in which conditions would it be seen?

A

> 10mmHg fall in SBP during inspiration
Seen in severe asthma and cardiac tamponade - why?:
Inspiration –> reduced intrathoracic pressure –> blood pulled into right side of heart
Interventricular septum bulges into the left side of the heart –> reduced CO –> transient BP drop
You will feel varying strength of the pulse with inspiration and expiration

108
Q

What is pulsus alternans and in which condition is it seen?

A

Regular alternation of the force of the arterial pulse

Seen in severe LVF

109
Q

In which disease might a ‘jerky’ pulse be felt?

A

HOCM

110
Q

What is the inheritance pattern of HOCM?

A

Autosomal dominant

111
Q

How can HOCM cause sudden death?

A

Can cause spontaneous VF/VT

112
Q

How might the JVP be abnormal in a patient with HOCM?

A

Large a waves

113
Q

What are the 3 key features of HOCM on echo?

A

Mitral regurgitation
Systolic anterior motion (SAM)
Asymmetric hypertrophy

114
Q

Recall some general principles of HOCM management

A 
A to E
Amiodarone 
Beta blockers
Cardioverter defibrillator
Dual chamber pace maker
Endocarditis prophylaxis
115
Q

What are the classical clinical signs of pulmonary oedema?

A

Reduced exercise tolerance
Raised jugular venous pressure
Audible third heart sound

116
Q

Which electrolyte abnormalities may cause torsades de pointes?

A

Hypocalcaemia
Hypokalaemia
Hypomagnesaemia

117
Q

Name 2 drugs that can increase the effect of warfarin

A

Metronidazole

Sertralline

118
Q

Name one drug that can decrease the effect of warfarin

A

Phenobarbital

119
Q

When should DC cardioversion be attempted before chemical cardioversion for a tachyarrhythmia?

A

If SBP <90

120
Q

What should an inferior MI + aortic regurgitation raise suspicion of?

A

Ascending aortic dissection

121
Q

When would thrombolysis be the first line for treating PE, rather than anticoagulative medicines?

A

If circulatory collapse - eg hypotension

122
Q

What is the antibiotic of choice in native valve infective endocarditis?

A

IV amoxicillin

123
Q

What should the initial management be for patients with bradycardia and signs of shock?

A

500micrograms of atropine (repeated up to max 3mg)

124
Q

What ECG abnormality is most likely in hypercalcaemia?

A

Lengthened QT interval

125
Q

What are prominent V waves in the JVP indicative of?

A

Tricuspid regurgitation

126
Q

What are cannon A waves in the JVP indicative of?

A

Complete heart block

127
Q

What is a prominent x descent in the JVP indicative of?

A

Can be caused by:
Acute cardiac tamponade
Constrictive pericarditis

128
Q

Which 2 beta blockers have been proven to be effective in stable heart failure?

A

Carvedilol and bisoprolol

129
Q

What are the 3 most-commonly used drugs for treating NSTEMI medically?

A

Aspirin, ticagrelor, and fondaparinux

Take special care to avoid GTN in hypotensive patients

130
Q

When would you NOT use flecainide for rate control?

A

In structurally abnormal hearts (which includes those with a PMH of ischaemic heart disease)

131
Q

What is Beurger’s disease also known as?

A

Thromboangiitis obliterans

132
Q

What are the symptoms of Beurger’s disease?

A

Raynaud’s syndrome, intermittent claudication and finger ulcerations

133
Q

What is the biggest risk factor for Beurger’s disease?

A

Smoking

134
Q

What is the medical management of choice for conservative management of an NSTEMI?

A

Dual antiplatelet therapy:
Aspirin + clopidogrel/ ticagrelor
Clopidogrel if high bleeding risk, ticagrelor if low bleeding risk

135
Q

What is the biggest risk factor for renal impairment following prescription of an ACE inhibitor?

A

If the patient already has bilateral renal artery stenosis it can cause significant renal impairment

136
Q

What is radiofemoral delay a sign of?

A

Aortic coarctation

137
Q

Which congenital condition is strongly associated with aortic coarctation?

A

Turner’s

138
Q

In which arrhythmia is verapamil contraindicated and why?

A

Ventricular tachycardia

Verapamil is a CCB - may reduce cardiac contractility

139
Q

Recall the location on the praecordium where each valve is best auscultated

A

Aortic: Right 2nd ICS
Pulmonary: Left 2nd ICS
Tricuspid: left 4th ICS at sternal border
Mitral: left 5th ICS, MCL

140
Q

Where is aortic regurgitation best auscultated

A

Tricuspid area: left 3rd ICS parasternally (Erb’s point)

141
Q

At what point in the breathing cycle is aortic regurgitation best auscultated, and in which position?

A

End expiration
Sat up and forward
Put stethoscope at Erb’s point

142
Q

Why are right-sided murmurs louder on inspiration?

A

Increased venous return to the RHS

143
Q

Recall 2 types of murmur that are louder when there is LESS blood flow across the affected area

A

HOCM murmurs

Mitral valve prolapse

144
Q

Which murmur is best auscultated when the patient is in the left lateral decubitus position?

A

Mitral stenosis

145
Q

Which murmurs can radiate? Where do they radiate to?

A

Aortic stenosis –> carotids

Mitral regurgitation –> axilla

146
Q

Describe the meaning of each of the 6 grades of heart murmur

A

Grade 1 - Difficut to hear
Grade 2 - Quiet
Grade 3 - Easy to hear
Grade 4 - Easy to hear with a palpable thrill
Grade 5 - Easy to hear with stethoscope barely touching chest
Grade 6 - Easy to hear with stethoscope away from patient

147
Q

How does mitral stenosis vs regurgitation affect the heart structurally and why?

A

Stenosis –> atria have to work really hard to push blood through valve –> hypertrophic left artium

Regurgitation –> backflow of blood into atria stretches chamber –> left atrial dilatation

148
Q

What are the 2 main possible causes of mitral stenosis?

A

Rheumatic heart disease is the most common (learn!)

Infective endocarditis

149
Q

Why do you get a loud S1 in mitral stenosis?

A

Thickened valve needs a large systolic force to shut - once this systolic threshold is met the valve will shut very suddenly

150
Q

What is the cause of malar flush in patients with mitral stenosis?

A

Backflow of blood into the pulmonary system –> rise in CO2 and vasodilation

151
Q

What is the link between mitral regurgitation and congestive heart failure?

A

Backflow of blood –> reduced ejection fraction

–> backlog of blood waiting to pass through left side of heart

152
Q

What are the possible causes of mitral regurgitation and which of them is most common?

A 
Age-related weakening is most common 
Also associated with: 
- IHD 
- Infective endocarditis 
- Rheumatic heart disease 
- Connective tissue disease (EDS/Marfan's)
153
Q

Which type of valve disease is associated with exertional syncope and why?

A

Aortic stenosis

Difficulty perfusing brain

154
Q

What is the most common cause of aortic stenosis?

A

Idiopathic age-related calcification

155
Q

What is Corrigan’s pulse?

A

Also known as collapsing pulse

Pulse rapidly appears and then disappears

156
Q

Recall 2 causes of aortic regurgitation

A

Age-related calcification

Connective tissue disease

157
Q

What is paroxysmal nocturnal dyspnoea?

A

Waking up suddenly in the night feeling acutely SOB with a really bad cough/ wheeze
They have to get up and gasp for air
Symptoms typically improve after a few minutes

158
Q

What is the mechanism of PND (3 aspects)?

A
  1. Lying flat –> fluid settling across large surface area of lungs
  2. Respiratory centre in the brain is less responsive during sleep - so lungs can become much more congested that they would normaly do before they wake up
  3. Adrenaline levels are much lower at night so myocardium is more relaxed –> reduced CO
159
Q

Recall the immediate management of rheumatic fever

A

Aspirin prn
Benzylpenicillin IM stat
10 day course of benzylpenicillin PO

160
Q

When in the course of rheumatic fever/heart disease is valve imcompetence most likely?

A

Acutely

161
Q

Which murmur is best heard at the apex with the bell of the stethoscope?

A

Mitral stenosis

162
Q

Is pericarditis more commonly viral or bacterial?

A

Viral

163
Q

ST elevation in which leads would represent an anteroseptal STEMI?

A

V1-V4

Med school finals (27 decks)

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