Cardiology

Question 1

Aortic stenosis:
Systolic or diastolic?
Shape/description of murmur
Heard best? (Where and when)
Special way to elicit further/hear more
Pulse

Clinical presentation?

Answer 1

Systolic murmur
Ejection click (after s1), crescendo-decrescendo murmur
Aortic area, expiration
Radiates to the carotids
Slow rising pulse

NB similar to pulmonary stenosis, this is in pulmonic area

SAD: Syncopy, angina, dyspnoea

Question 2

Mitral Regurgitation
Systolic or diastolic?
Shape/description of murmur
Heard best? (Where and when)
Special way to elicit further/hear more
Pulse

Answer 2

• Systolic
• Pansystolic (right at S1)
• Apex/Mitral area, expiration
• Radiates to AXILLA
• Nil

tricuspid similar, but tricuspid area+inspiration

Question 3

Mitral Valve prolapse

Answer 3

Mid-late systolic click, with a murmur after

Best heard at apex

Question 4

Aortic Regurgitation
Systolic or diastolic?
Shape/description of murmur
Heard best? (Where and when)
Special way to elicit further/hear more
Pulse

Answer 4

• Diastolic
• EARLY diastolic, decrescendo shape, high pitched
• Aortic area/ left sternal border, expiration
• Patient to lean forward
• Wide pulse pressure, COLLAPSING/water hammer pulse

Pulmonic heard on upper left sternum*

Question 5

Mitral stenosis
Systolic or diastolic?
Shape/description of murmur
Heard best? (Where and when)
Special way to elicit further/hear more
Pulse

Answer 5

• Diastolic
• Opening snap (leaflets snap open), decrescendo, on atrial contraction pre systolic accentuation= OS + Mid diastolic murmur/rumble
• Apex/Mitral area, expiration
• Lay on left hand side

tricuspid similar in tricuspid area +inspiration

Question 6

S3
Best heard?
Why/cause?

Answer 6

Best heard mitral area, in left and side
Volume overload related
Heard in early diastole, during rapid filling, chordae stretch (ventricular gallop)

Can be present in young people, normal

CHF a cause

Question 7

S4

Why/cause

Answer 7

Mitral area, left hand side
Pressure overload
End of diastole before systole, when the atria contract into stiff ventricle (atrial gallop)

Question 8

ECG hack: MI position
Anteroseptal
Inferior
Anterolateral
Lateral
Posterior

Answer 8

Anteroseptal: V1-V4, LAD
Inferior: 2,3, aVF, RCA
Anterolateral: V1-V6, aVL, 1, LAD or circumflex
Lateral: 1, aVL, V5,V6, circumflex
Posterior: V1,V2

Question 9

ECG hack: axis determination
LAD
RAD

Answer 9

LAD: 1+avF upwards; normal, if not, avF negative and lead 2 positve good, if lead 2 negative, Lead 1 + aVL positive, LAD
RAD?

Loosely LAD: +–
RAD: -++