Cardiology

Question 1

JVP pathology
Prominent v wave

Answer 1

Mitral regurgitation

Question 2

JVP pathology - cannon A waves

Answer 2

Regular cannon a waves
- AVNRT
- VT

Irregular cannon a waves
- Complete heart block

Question 3

INR target for mechanical valve?

Answer 3

Aorta: 3.0
Mitral 3.5

Mechanical valve = warfarin + aspirin

Question 4

Bioprosthetic valve anticoagulation?

Answer 4

Lifelong antiplatelet.
Anticoagulation usually not needed, except for the first 3 months with warfarin

Question 5

What causes 3rd and 4th heart sounds?

Answer 5

Third heart sound:
During passive ventricular filling (@ early diastole)
Causes: LV failure e.g dilated CM, constrictive pericarditis, mitral regurgitation

Fourth heart sound:
During active ventricular filling (atrial contraction) into a non-compliant ventricle
Causes- aortic stenosis, HOCM, hypertension, likely due to LVH

Question 6

Management of heart failure

Answer 6

1st line; ACEI + B blocker
2nd line; Aldosterone antagonist
3rd line;
Digoxin - especially if AF
Ivabradine - LVEF <35% + HR >75bpm
Sacubtril/valsartan - LVEF <35% and still symptomatic with ACEI. (Need to wean and washout ACEI first before starting this)
Hydralazine + nitrate
CRT - LVEF <35% + LBBB or QRS >150ms

Question 7

Features indicating SEVERE aortic stenosis?

Answer 7

• Length of murmur
• Delayed ESM
• S4
• Soft/absent S2
• Thrill
• Slow rising pulse
• Narrow pulse pressure
• LVH/LVF

Question 8

What medications reduces and potentiates effect of adenosine?

Answer 8

Reduces - aminophylline (adenosine receptor antagonist)
Enhances - dipyridamole (reducing intracellular uptake of adenosine thus higher extracellular levels)