Cardiology

Question 1

Benign tumour of the heart commonly occurring in the left atrium.

• Classic triad of symptoms
• What would you find on echo?

Answer 1

Atrial myxoma

SS:

• Classic triad of mitral valve obstruction, systemic embolism and constitutional symptoms (fever, weight loss, breathlessness)
• Other symptoms:
• AF, emboli, mid-diastolic murmur (‘tumour plop’)

Echo: pedunculated heterogenous mass typically attached to the fossa ovalis region

Question 2

According to NICE guidelines, what score (QRISK2) would justify the prescription of a statin?

Answer 2

10%

Question 3

HOCM - genetic inheritance pattern?

Answer 3

Autosomal dominant (defect in genes coding contractile proteins, most commonly beta-myosin heavy chain protein or myosin binding protein C)

Question 4

What are the ECG features found in hyperkalaemia?

Answer 4

Tall tented P waves
Small P waves
Widened QRS

Leads to a sinusoidal pattern and asystole!

Question 5

What are the ways you can test for brain death?

Answer 5

1. Fixed pupils which do not respond to sharp changes in light intensity
2. No corneal reflex
3. No response to supraorbital pressure
4. Absent vestibulo-ocular reflexes - ice water into each ear
5. No cough reflex to bronchial stimulation/no gagging response to pharyngeal stimulation
6. No observed respirator effort for 5 mins.

Question 6

Name the two beta-blockers that have been shown to reduce mortality in stable HF

Answer 6

Carvedilol

Bisoprolol

Question 7

Nicorandil is most useful in the management of?

Answer 7

Angina

It is a potassium channel activator which has a vasodilatory effect on the coronary arteries.

SE: headache, flushing, anal ulceration

Question 8

Causes of third heart sound (S3)

Answer 8

• Caused by diastolic filling of the ventricle
• Considered normal if < 30 years old (may persist in women up to 50 years old)
• Heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

Question 9

Causes of a fourth heart sound (S4)

Answer 9

• May be heard in aortic stenosis, HOCM, hypertension
• Caused by atrial contraction against a stiff ventricle
• In HOCM a double apical impulse may be felt as a result of a palpable S4

Question 10

Stages of NYHA HF classification

Answer 10

Stage I - No limitation on ordinary physical activity (incorrect)

Stage II - Normal at rest. Ordinary physical activity causes breathlessness (correct)

Stage III - Normal at rest. Less-than-ordinary activity causes breathlessness (incorrect)

Stage IV - Symptoms at rest. (incorrect)

Question 11

Antibiotics causing long QT

Answer 11

Erythromycin

Question 12

ECG findings on STEMI

Answer 12

ST elevation of >1mm in contiguous limb leads and >2mm in chest leads or new LBBB

Q wave formation
T wave inversion

Question 13

Target PCI time for STEMI (guidelines and Grey book)

Answer 13

12h of onset of symptoms (must be done 120 min where fibrinolysis could have been done)

Grey book: 1h target door to balloon

Question 14

Cardiac arrest adrenaline vs anaphylaxis adrenaline

Answer 14

Cardiac arrest - 1mg 1 in 10 000 adrenaline IV

Anaphylaxis - 0.5mg (500mcg) 1 in 1000 IM or 0.5ml 1 in 10000

Question 15

4 H’s and 4 T’s - causes of cardiac arrest

Answer 15

4 H’s - hypoxia, hypovolaemia, hypothermia, hypo/hyperK+ (plus other metabolic)

4 T’s - tamponade, tension pneumothorax, thrombus, toxins

Question 16

Patient under 80 years treated for hypertension - what is the target clinic reading?

Answer 16

<140/90

Question 17

You hear an early diastolic murmur on a patient which is loudest on the left sternal edge 3rd intercostal space - what is the murmur and what type of pulse abnormality is associated with this?

Answer 17

Aortic regurgitation - linked to collapsing pulse

Question 18

Diseases that cause hypercholesterolaemia instead of hypertriglyceridaemia

Answer 18

Nephrotic syndrome, cholestasis, hypothyroidism