Cardiology

Question 1

What are the classic ECG findings in hypothermia?

Answer 1

J waves
(also bradycardia, long QT)

Question 2

R coronary artery
- Supply
- What happens if occluded

Answer 2

• RA, RV, nodes (in 90% of people)
• Proximal occlusion = complete heart block, Distal occlusion = first degree heart block/Wenckebech. Complete heart block in this instance develops progressively (initially first degree then second then complete)/resolves in 5-7d and causes asymptomatic brady. If it does not resolve it causes symptomatic brady.

Question 3

Branches of L coronary artery and what they supply

Answer 3

• L anterior descending supplies anterior L side of heart
• Circumflex artery supplies outer side and back of the heart, occlusion causes lateral MI

Question 4

Angina: what classifies as typical/atypical/non-anginal?

Answer 4

• Constricting sensation arm/chest/neck
• Precipitation by exertion
• Symptoms relieved in 5m by GTN

3 = typical
2 = atypical
0/1 = non-anginal

Question 5

Treatment for IE with streptococcus viridans

Answer 5

Gent 3mg/kg + benzylpenicillin

Question 6

ECG findings 1st degree heart block

Answer 6

PR >200ms

Question 7

ECG findings 2nd degree heart block (mobitz 1)

Answer 7

Gradually increasing PR interval then dropped QRS

Question 8

ECG findings 2nd degree heart block (mobitz 2)

Answer 8

PR interval stays the same and prolonged but also dropped QRS

Question 9

ECG findings complete heart block

Answer 9

No association between P wave and QRS

Question 10

How does complete heart block present clinically?

Answer 10

Syncope
Heart failure

Question 11

How does clinical examination present in complete heart block?

Answer 11

Cannon a waves, wide pulse pressure, variable S1 intensity

Question 12

Indications for a temporary pace maker

Answer 12

• Trifasicular block prior to surgery
• Symptomatic/unstable brady not responding to atropine
• ANTERIOR MI resulting in Mobitz 2 or complete heart block

Question 13

Permanent pacemaker indications (6)

Answer 13

• Complete heart block
• Mobitz 2
• Heart block following MI
• Trifasicular block if syncope/other cardiac Sx/complete heart block
• Sick sinus syndrome
• Drug resistant tachy

Question 14

What are 4 types of cardiomyopathy

Answer 14

• Hypertrophic cardiomyopathy (HOCM)
• Dilated cardiomyopathy
• Restrictive cardiomyopathy
• Takutsubo cardiomyopathy

Question 15

What are the gene mutations in HOCM

Answer 15

B myosin heavy chain and myosin binding protein C
Autosomal dominant

Question 16

HOCM features on examination

Answer 16

Ejection systolic murmur
Jerky pulse
Large A waves
S4

Question 17

Management HOCM

Answer 17

A: amiodarone (NOT ACE/ARB)
B: beta blocker
C: Cardiac pacemaker
D: dual chamber pacemaker
E: (infective) endocarditis prophylaxis

Question 18

ECG changes in HOCM

Answer 18

Progressive TWI
Deep Q waves
LAD
LVH

Question 19

ECHO in HOCM

Answer 19

LV hypertrophy with no dilation
Mitral Regurg
Systolic anterior motion of anterior valve leaflet
Asymmetrical hypertrophy

Question 20

What type of dysfunction is caused by dilated cardiomyopathy and why?

Answer 20

Dilation of all 4 chambers of the heart causing systolic dysfunction

Question 21

Causes of dilated cardiomyopathy

Answer 21

Alcohol
Pregnancy
myocarditis
Duchenne
Doxorubicin

Question 22

What type of dysfunction is caused by restrictive cardiomyopathy and why?

Answer 22

Diastolic dysfunction due to reduced ventricular compliance

Question 23

ECG findings in restrictive cardiomyopathy

Answer 23

Low voltage
BBB

Question 24

Causes of restrictive cardiomyopathy

Answer 24

Amyloidosis
Sarcoid
Scleroderma
Haemochromatosis