Cardiology

Question 1

Symptoms: chest pain, dyspnea, syncope or exertional dizziness, ejection systolic murmur radiating to the carotids.

Other features: narrow pulse pressure, slow rising pulse, soft/absent S2, S4, thrill and delayed ESM.

Answer 1

Aortic stenosis.

Question 2

Name some medications that may exacerbate heart failure

Answer 2

Thiazolidinediones
Verapamil
NSAIDs/ glucocorticoids
Class I antiaarhythmics

Question 3

What is the most important investigation to monitor in a Marfan syndrome patient

Answer 3

Echocardiogram.

Question 4

How should we prescribe isosorbide mononitrate ( ISMN )?

Answer 4

Asymmetric dosing regime ( twice a day, one at 8am and another at 4pm ). This is to prevent nitrate tolerance.

Question 5

What is the rationale behind giving anticoagulation to patients with atrial fibrillation?

Answer 5

To prevent cardioembolic stroke.

( due to irregular contraction of the atria, AF is associated with atrial thrombus formation. These thrombi are at risk of embolising to the brain and causing cardioembolic stroke. )

Question 6

What may cause a shortened PR interval?

Answer 6

Wolff-Parkinson-White syndrome and Lown-Ganong-Levine syndrome.

( an accessory pathway results in pre-excitation )

Question 7

What score may be used to assess the stroke risk of a patient with AF?

Answer 7

CHADSVASc score.

(HAS-BLED score is used to assess risk of bleeding in the patients, to guide in weighing up the risk of anticoagulation )

Question 8

What is the most common ECG finding in pulmonary embolus?

Answer 8

Sinus tachycardia ( S1Q3T3 is neither sensitive or specific )

Question 9

What is the normal QRS duration?

Answer 9

80-120ms ( 2-3mm )