Cardiology

Question 1

Syndrome X

Answer 1

FHx IHD, Hx angina-like pain, abnormal ECG

NO rises in cardiac enzyme, and pseudonormalisation on exercise ECG

Question 2

MC heart murmur with infective endocarditis?

Answer 2

Aortic regurgitation - loud early diastolic murmur best heard at LSE

Question 3

What type of pericarditis presents acutely post-MI?

Answer 3

FIBRINOUS

Question 4

CVP — a wave

Answer 4

Atrial contraction (during p wave)

DOMINANT = pulmonary HTN, TS, PS

CANNON = complete heart block, VT w/ AV dissociation

Question 5

CVP — c wave

Answer 5

Early systole

Merges w/ a wave during tachycardia

Question 6

CVP — x descent

Answer 6

Mid systole (TV descends towards apex of RV)

ABSENT = atrial fibrillation

PROMINENT = tamponade, constrictive pericarditis

Question 7

CVP — v wave

Answer 7

Late systole (RA filling)

DOMINANT = tricuspid regurg (increased RA volume)

Question 8

CVP — y descent

Answer 8

Early diastole (RA emptying)

SLOW = TR, atrial myxoma

SHARP = severe TR, constrictive pericarditis

Question 9

What causes prominent X AND Y descent?

Answer 9

Right Ventricle infarction

ECG = ST elevation in V1 + ST depression in V2

Question 10

ECG — pulmonary embolism

Answer 10

Sinus tachycardia

S1T3Q3 = deep S wave in I, inverted T wave in III, Q waves in III

Question 11

ECG — hypokalaemia

Answer 11

Increased PR interval
Depressed ST
Flattened T
Prominent U waves

Question 12

ECG — hyperkalaemia

Answer 12

Peaked T waves (earliest sign)
Absent p waves
Bizarre QRS
Conduction block
Sinus brady/slow AF

Question 13

ECG — digoxin

Answer 13

Decreased QT
‘Reverse tick’ ST
Dysrhythmias

Question 14

ECG — LVH

Answer 14

Voltage critera = SV1 + RV5/V6 >/= 35mm (7 large squares)

Question 15

ECG — RVH

Answer 15

P wave in II > 2.5mm (usually pointed)

Question 16

ECG — LBBB

Answer 16

QRS > 120ms
Dominant S in V1
Notched R in V6
"WiLLiaM"
Left axis deviation
Poor R wave progression

Question 17

ECG — RBBB

Answer 17

QRS >120ms
RSR in V1-V3
Wide S in lateral leads
“MaRRoW”

Question 18

ECG — P pulmonale

Answer 18

P wave >2.5mm in inferior leads

Question 19

ECG — P mitrale

Answer 19

Bifid P wave in II

Biphasic P wave in V1

Question 20

ECG — INFERIOR MI

Answer 20

ST elevation in II, III, aVF

ST depression in anterior leads

Question 21

ECG — ANTERIOR MI

Answer 21

ST elevation in V1-V6 and aVL

ST depression in inferior leads

Question 22

ECG — POSTERIOR MI

Answer 22

Enlarged R and T waves in V1-V3

+/- inferior/lateral MI

Question 23

ECG — LATERAL MI

Answer 23

ST elevation in I, aVL and V5-V6

ST depression in III and aVF

Question 24

What are the MAJOR criteria in Duke criteria?

Answer 24

Positive blood culture (typical organisms in 2+ cultures OR peristent positive cultures)

ECHO evidence (+ve echo or new valve regurgitation)

Question 25

What are the MINOR criteria in Duke criteria?

Answer 25

Risk factors (e.g. rheumatic fever)
Fever >38
Vasculitic disease
Blood culture/ECHO not meet major criteria

Question 26

How is Duke criteria used?

Answer 26

DEFINITE = 2 major OR 1 major + 3 minor OR 5 minor

Question 27

Patient with heart failure is given some medication and subsequently develops hyperglycaemia - what is the causative drug?

Answer 27

Thiazide diuretic

Question 28

Side effects of RAMIPRIL

Answer 28

Dry cough (increased bradykinin)

Give an ARB instead

Question 29

Side effects of VERAPAMIL

Answer 29

CCB for HTN, angina, arrhythmias

Bilateral ankle oedema

Dizziness, headaches, facial flushing

Question 30

Side effects of FUROSEMIDE

Answer 30

Loop diuretic

Hypokalaemia and hyponatraemia

Question 31

Side effects of SIMVASTATIN

Answer 31

Acute myositis

Hepatotoxicity

Question 32

Side effects of STREPTOKINASE

Answer 32

Thombolytic agent (STEMI)

Haemorrhagic stroke, GI bleed, reperfusion arrythmia, anaphylaxis

MC side effect = HYPOTENSION

Question 33

Arterial ulcer

Answer 33

Aetiology –> diabetes / PVD / smoking / HTN

Sx –> Intermittent claudication, numb, painful

o/e –> red, warm, tender, punched out, pressure points

Leg oedema, hair loss, wasting, shining, absent peripheral pulses

Question 34

Venous ulcer

Answer 34

MCC varicose veins

Painless, large, shallow ulcer +/- features venous insufficiency

*****ABPI with doppler scan

Question 35

How do you manage a venous ulcer?

Answer 35

Graduated compression / debride + clean / dress / antibiotics

CHRONIC = pentoxifylline

Question 36

DVT in pregnancy - management?

Answer 36

LMWH

Question 37

Baker’s cyst - management?

Answer 37

Reassure and discharge

Question 38

Musculoskeletal injury - management?

Answer 38

Reassure and discharge

Question 39

Patient presents with DVT but has a Hx of heparin-induced thrombocytopenia - management?

Answer 39

Fondaparinux (FXa inhibitor)

Question 40

Recurrent DVT - management?

Answer 40

LMWH

Question 41

Digoxin

Answer 41

Used to treat CCF and some atrial fibrillation/flurrer

Inhibit Na/K-ATPase –> positive inotrope effect

Side effects = ARRHYTHMIA, visual disturbances, GI problems (N+V)

Increased risk of toxicity = hypokalaemia (e.g. thazides), hypercalcaemia, CCBs

Question 42

What is Beck’s triad?

Answer 42

Seen with acute CARDIAC TAMPONADE

Muffled heart sounds, engorged neck veins + hypotension

Question 43

What is the medical treatment for severe HYPERKALAEMIA?

Answer 43

10ml 10% calcium gluconate

Question 44

How do you manage an SVT?

Answer 44

Patient compromised –> DC cardioversion

Vagal manoueuvres are 1st line

Adenose is 1st drug

Verapamil given after

Question 45

`How do you manage VF / pulseless VT?

Answer 45

Check for reversible causes

Give oxygen, gain vascular access

Asynchronised DC shock

Resistant? –> amiodarone 300mg IV

Question 46

How do you treat asystole/PEA?

Answer 46

Commence CPR

Adrenaline 1mg stat

Continue CPR

Question 47

How do you manage stable VT?

Answer 47

High flow oxygen, IV access, send bloods, 12 lead ECG

**Amiodarone cardioversion

***Torsades de pointes –> magnesium sulphate 2g

*Failure –> DC shock