Cardiology

Question 1

Heart Murmurs

1. Mitral stenosis
   i.
   ii.
2. Aortic Regurgitation
   i.
   ii.
3. Mitral regurgitation
   i.
   ii.
4. Tricuspid regurgitation
   i.
   ii.

Answer 1

1i. mid-diastolic, loud at apex and when in left lateral position
1ii. commonly causes AF (secondary to left atrial enlargement) which may result in embolic sequelae (e.g. stroke, TIA, mesentric ischaemia)
*Left atrial myxoma cann imitate this
2i. early diastolic murmur, louest over aortic area
3i. pansystolic murmur over apex to axilla
3ii. MR can result in dyspnea, fatigue and palpitations. MR can cause AF.
4i. systolic murmur over tricuspid.
4ii. caused by rhumatic fever or carcinoid syndrome. NOT associated with AF or embolic sequelae

Question 2

Features of Aortic dissection on CXR?

Answer 2

-Widened mediastinum: > 8.0-8.8 cm at the level of the aortic knob on portable AP chest films
-Double aortic contour
-irregular aortic contour
-inward displacement of atherosclerotic calcification (>1cm from the aortic margin)

-Cardiomegaly/Kerly-B = CCF
-False lumen = only on CT angio
-Hilar lymphadenopathy = TB, malignancy, sarcoidosis

Question 3

What is the conservative management of an NSTEMI?

Answer 3

First calculate grace score> Aspirin + Ticagrelor + Fundaparinux. If high risk of bleeding, clopidogrel instead of ticagrelor.

Immediate coronary angio in NSTEMI patient if clinically unstable. Offer one in 72hrs if GRACE >3%

Thrombolysis should be offered to STEMI within 12hrs if onset of symptoms if PCI cannot be given within 120 minutes