Cardiology

Question 1

Aortic regurgitation

Answer 1

chronic:
valvular AR:
- rheumatic (rarely the only valve involved)
- congenital - bicuspid AoV, VSD
- seronegative arthropathy esp Ank Spond
aortic root dilatation:
- Marfan's
- aortitis - seronegative arthropathies, RA, tertiary syphilis
- dissecting aneurysms

acute:
valvular:
- IE
- dissecting aneurysm aortic root
- Marfan's

Question 2

Diastolic murmurs

Answer 2

Aortic regurgitation

• 3/4th ICS
• high-pitched, early diastolic decrescendo murmur

Pulmonary regurgitation (rare)

• LSE
• high-pitched, early diastolic decrescendo murmur

Mitral stenosis

• apex
• mid-diastolic, low-pitched

Tricuspid stenosis - rare

PDA
- continuous murmur

Question 3

Unconscious collapse

Answer 3

1. Neurally mediated
   - vasovagal syncope
   - carotid sinus hypersensitivity
   - cough syncope
   - micturition/defacation syncope
2. Cardiac
   - primary arrhythmia - bradycardia, tachycardia
   - obstructive - AS, HOCM
3. Orthostatic
   - volume depletion - haemorrhage, diarrhoea
   - autonomic - diabetic, PD, MSA, drugs, amyloid
4. Seizure disorder
5. Hypoglycaemia
6. Hyperventilation
7. Drug toxicity - overdose, alcohol
8. Narcolepsy
9. Intracranial event - massive stroke, haemorrhage
10. Vertibrobasillar TIA
11. Fall with secondary head injury

Question 4

Cardiomyopathy

Answer 4

DILATED
- ischemic heart disease
- hypertension
- idiopathic
- autoimmune: SLE, sarcoidosis, RA
- endocrine: hyper/hypothyroidism, phaeo, GH excess/deficiency, cushings, diabetes
- genetic: duchennes MD, myotonic dystrophy, freidrichs ataxia, ARVC
- drugs: chemo (anthracycline, trastuzumab), clozapine, ART, alcohol, amphetamines
- infections: myocarditis, viral, HIV, rheumatic fever
- other: uraemia, thiamine deficiency, haemochromatosis, amyloid, peripartum, rate related, radiation induced
RESTRICTIVE
- amyloidosis, sarcoidosis
- storage diseases: fabrys, haemochromatosis
- scleroderma
- radiation/anthracyclines
HYPERTROPHIC
- congenital hypertrophic cardiomyopathy
OTHER
- stress induced cardiomyopathy (Takotsubo)
- cirrhotic cardiomyopathy