Cardiology

Question 1

new LBBB is always _________.

Answer 1

pathological

Question 2

what causes LBBB?

Answer 2

1) MI
2) HTN
3) aortic stenosis
4) cardiomyopathy
5) digoxin toxicity, idiopathic fibrosis, hyperkalaemia

Question 3

ejection systolic murmur louder on expiration (2)

Answer 3

1) aortic stenosis 2) hypertrophic obstructive cardiomyopathy

Question 4

ejection systolic murmur louder on inspiration (3)

Answer 4

1) pulmonary stenosis
2) ASD
3) tetralogy of fallot

Question 5

pansystolic murmur (3)

Answer 5

1) mitral regurgitation
2) tricuspid regurgitation (louder on inspiration)
3) VSD

Question 6

late systolic murmur (2)

Answer 6

1) coarctation of the aorta
2) mitral valve prolapse

Question 7

early diastolic murmur (high pitched and blowing) (2)

Answer 7

1) aortic regurgitation
2) pulmonary regurgitation (graham-steel murmur)

Question 8

mid-late diastolic murmur (2)

Answer 8

1) mitral stenosis (rumbling)
2) austin flint murmur (severe aortic regurg)

Question 9

continuous machine-like murmur

Answer 9

patent ductus arteriosus

Question 10

how is a STEMI managed?

Answer 10

1) 300mg aspirin

2) medical or reperfusion therapy (PCI or fibrinolysis)?

• Medical: ticagrelor or clopidogrel
• fibrinolysis e.g. alteplase (presents within 12 hours of onset of sx and PCI not possible within 120 mins) + antithrombin, followed by ticagrelor
• PCI (presents within 12 hours of onset of sx and can be done witin 120 mins): prasugrel (clopidogrel if already on oral anticoagulant) and unfractionated heparin

Question 11

what causes RBBB?

Answer 11

1) normal variant, common with increasing age
2) right ventricular hypertrophy
3) chronically increased right ventricular pressure (cor pulmonale)
4) PE
5) MI
6) ASD
7) cardiomyopathy/myocarditis

Question 12

what are some side effects of beta blockers?

Answer 12

1) bronchospasm
2) cold peripheries
3) fatigue
4) sleep disturbances including insomnia and nightmares
5) erectile dysfunction

Question 13

what are some possible complications following an MI?

Answer 13

1) cardiac arrest (most commonly VF)

2) cardiogenic shock

3) heart failure

4) pericarditis
- within first 48 hours common
- Dressler’s syndrome is a delayed form of pericarditis typically 4-6 weeks post-MI

5) left ventricular aneurysm (need to anticoagulate due to
increased thrombus risk)

6) VSD (rupture of interventricular septum)

7) acute mitral regurgitation

Question 14

what are the blood pressure targets for patients <80 and >80?

Answer 14

clinic:
<80 140/90
>80 150/90

home/ambulatory:
<80 138/85
>80 145/85