Cardiology

Question 1

Signs of Mitral Stenosis

Answer 1

Malar flush
Atrial fibrillation
Raised JVP (late sign)
Apex beat is not displaced (narrowed mitral valve protects the left ventricle)
Apex beat tapping in quality - loud palpable first heart sound

Question 2

Apex beat tapping (palpable first heart sound)

Answer 2

Normally mitral valve glides shut towards the end of diastole due to ventricle pressure > atrial pressure. Properly closes at start of ventricular systole - mitrao component of first HS.
Mitral stenosis causes high left atrial pressure therefore mitral valve does not glide shut at end of diastole but is kept open until right at the end of diastole - loss of normal way the valve glides shut & instead valve is slammed shut from a more open position than normal.

Question 3

Signs of left ventricular failure

Answer 3

On inspection: pt looks acutely unwell (pale & grey), cold clammy peripheries, frothy blood stained sputum (due to pulmonary venous hypertension), orthopnoeic using accessory muscles, wheeze (cardiac asthma)

Sinus tachycardia or atrial fibrillation, systolic hypotension, signs of cardiomegaly (displaced apex beat), 3rd and 4th heart sounds, right sided or bilateral pleural effusions

Question 4

Wolff-Parkinson-White Syndrome

Answer 4

Caused by congenital accessory conducting pathway between the atria and the ventricles resulting in atrioventricular re-entry tachycardia (AVRT)
Accessory pathway does not slow conduction atrial fibrillation so it can rapidly degenerate into ventricular fibrillation

Question 5

Possible ECG features of WPW

Answer 5

Short PR interval
Wide QRS complex with slurred upstroke (delta wave)
left axis deviation if right-sided accessory pathway
right axis deviation if left-sided accessory pathway

Question 6

Right sided heart failure

Answer 6

Peripheral oedema
Raised JVP
Parasternal heave
Loud or palpable P2 heart sound
Tricuspid regurgitation

Question 7

Cor pulmonale

Answer 7

Pulmonary heart disease

Enlargement of right ventricle in response to increased resistance in the lungs or pulmonary hypertension

Question 8

Complications of MI

DARTH VADER

Answer 8

Death
Arrhythmia
Rupture (of speptum or outer walls)
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler's syndrome
Embolism
Reinfarction

Question 9

Dressler’s Syndrome

Answer 9

Autoimmune pericarditis 2 to 10 weeks post MI
Pleuritic chest pain, pericarditis, low grade fever +/- peridcardial effusion

Pain is main symptom - often in left shoulder, often pleuritic in nature, worse on deep inspiration and often worse on lying down

Pericardial friction rub - pericarditis sounds like boots walking over fresh snow

Question 10

ECG Over

Answer 10

Rate: divide number of large squares into 300
Rhythm: p wave before every QRS complex - sinus
A-fib - irregularly irregular
A-flutter - saw tooth pattern
Heart block?
Axis: leads I, II and III
Left axis deviation - +ve R wave in I, -ive R II and III
Right axis deviation - +ve R wave in II & III, -ve in I
P wave: 120-200ms, flat hyperkalaemia, long PR in 1st HB
QRS: broad complexes suggest BBB
ST: elevation - MI, depression - repolarisation abnormality
Q: deep Q waves - full thickness infarct
T: inverted - normal in V1, abnormal elsewhere, non-specific if no other abnormality