Cardiology

Question 1

What is S4

Answer 1

From the contraction of the atria pushing blood into a stiff or hypertrophic ventricle, indicating failure of the left ventricle. Considered pathological, is a sign of left ventricular hypertrophy

Question 2

Signs of left ventricular hypertrophy

Answer 2

S4
Loud s2 (A loud P2 with narrow splitting of S2 indicates increased pulmonary vascular pressure and resistance)
Sustained apex beat

Question 3

What does S3 indicate

Answer 3

In individuals over 40 years of age, S3 typically indicates a volume overload (e.g., congestive cardiac failure, mitral/tricuspid regurgitation). Results from increased atrial pressure leading to increased flow rates.

Question 4

Outline the Renin-Aldosterone axis

Answer 4

Agniotensinogen to angiotensin I via renin
Angiotensin I to II via ACE
angiotensin II stimulates aldosterone, afferent and efferent vasoconstriction of the arterioles, and systemic vasoconstriction.

Question 5

Mechanism of aldosterone

Answer 5

increases blood pressure by stimulating sodium reabsorption, causes water to follow.

Question 6

What is Conns syndrome

Answer 6

too much aldosterone causes sodium reaborsptlon and increases BP.

Question 7

machine like murmur in a newborn

Answer 7

Patent ductus arteriosus

Question 8

holosytolic murmur in a newborn

Answer 8

ventriculoseptal defect

Question 9

crescendi-decrescendo systolic murmur in new born

Answer 9

tetrology of fallow– pulmonary stenosis and VSD

Question 10

svt therapies

Answer 10

carotid sinus massage (risk of tia)
electrical cardioversion (not first line)
radiofrequency ablation dependent on if its an AV nodal reentrant pathway
IV adenosine would block P wave and break tachycardia
application of cold water to face to block AV node.

Question 11

meds for afib

Answer 11

digoxin, diltiazem,
metoprolol, verapamil, amiodarone

rate control: metoprolol
rhythm control: amiodarone or ablation or flecainide

make sure to give DOAC dependent on CHADS65 score or if they need ASA.

Question 12

orthodromic AVRT

Answer 12

most common WPW== narrow QRS complex.

Question 13

antidromic AVRT

Answer 13

less common WPW== wider delta wave.

Question 14

JVP indicates what type of pressure

Answer 14

right atrial pressure if super high, could be backlogged from body

Question 15

soft early diastolic decreascendo murmur at the left sternal border

Answer 15

aortic regurgitation– can be seen in aortic dissection or ischemia

Question 16

most dominant coronary vessel is most people

Answer 16

Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA), which supplies the myocardium of the inferior third of the interventricular septum. Most hearts (80-85%) are right dominant where the PDA is supplied by the right coronary artery (RCA).

Question 17

a wide physiological split of S2 is associated with:

Answer 17

ASD

Question 18

a delayed carotid upstroke is associated with

Answer 18

severe aortic stenosis aka pulsus parvus et tardus

Question 19

a wide pulse pressure is associated with

Answer 19

aortic regurgitation: backflow on diastole.