Cardiology

Question 1

Indications for AICD

Answer 1

• 2o Prevention: Hx VT/VF arrest, sustained/symptomatic VT
• Hereditary cardiac conditions w High risk SCD: HOCM, LQT, ARVD, Brugada
• LVEF <30%, >1month post MI
• CCF/CM- LVEF <35%

Question 2

Indications for PPM

Answer 2

• Irreversible symptomatic Bradycardiac
• CHB, 2nd degree HB
• Bi, Tri fascicular block + recurrent syncope

Question 3

Indications for CRT

Answer 3

• EF<35%
• SR
• QRS>150
• NYHA II despite OMT
  can use in AF but has to have another indication for pacing and high expected need for pacing

Question 4

Heart Transplant referral Indications

Answer 4

Intractable HF NYHA III-IV

When you have to start downtitrating HF management

Question 5

Heart Transplant contraindications

Answer 5

Malignancy
Other organ failure
Active infection
Poor compliance

Question 6

Torsades-de-points ECG findings

Answer 6

VT with multiple ventricular foci

QRS complexes varying in amplitude, axis and duration

Question 7

Long QT ECG findings

Answer 7

Men: >0.45
Women: >0.47
correct for HR + age. QRS must be normal

Question 8

KVLQT1/KCNQ1

Answer 8

Long QT 1 - regulates K channels

Question 9

HERG

Answer 9

Long QT2 - regulates K channels

Question 10

SCN5A Increase

Answer 10

Long QT3- regulates Na channels

Question 11

SCN5A Decrease

Answer 11

Brugada Syndrome

Question 12

LQT1 ECG

Answer 12

Hill like/peaked T wave

Question 13

LQT2 ECG

Answer 13

U wave within T wave

Question 14

LQT3 ECG

Answer 14

long ST segment

Question 15

Brugada ECG + Inheritance

Answer 15

Right precordial ST Elevation on ECG

Autosomal Dominance

Question 16

ARVD ECG findings

Answer 16

• Epsilon wave
• T wave inversion in V1-3
• Prolonged S-wave upstroke of 55ms in V1-3
• Localised QRS widening of 110ms in V1-3

Question 17

Severe Mitral Stenosis

Answer 17

Mean gradient >10mmHg

Valve Area <1.0 cm2

Question 18

Severe Aortic Stenosis

Answer 18

Mean Gradient > 40mmHg
Valve Area <1cm2
Velocity >4m/s
DI <0.25

Question 19

Impaired Diastolic filling
Abnormal septal motion
Exaggerated x descent

Answer 19

Pericardial Tamponade

Question 20

Rapid early diastolic filling, delayed late diastolic filling
Kussmaul sign
Septal bounce
Ventricular interdependence
Exaggerated x descent
Sharp y descent

Answer 20

Constrictive Pericarditis

Question 21

Impaired Diastolic filling
Kussmaul sign
LVEDP > RVEDP by 5mmHg

Answer 21

Restrictive cardiomyopathy

Question 22

MoA of Ezetimibe

Answer 22

down-regulates ABCA-1 transporter (gut absorption)

Question 23

Target of Evolocumab

Answer 23

PCSK9

Question 24

Target of Alirocumab

Answer 24

PCSK9

Question 25

JVP- Dominant a wave

Answer 25

pulmonary hypertension, TS, PS

Question 26

JVP- Cannon a wave

Answer 26

complete heart block, VT with AV dissociation

Question 27

JVP- Dominant v wave

Answer 27

TR

Question 28

JVP- Sharp y descent

Answer 28

severe TR, constrictive pericarditis

Question 29

JVP- Prominent x and y descent

Answer 29

RV infarction

Question 30

Valve Replacement- AR

Answer 30

Severe AR with symptoms Severe AR with resting LVEF <50% even if asymptomatic Severe AR undergoing CABG or surgery of ascending aorta or another valve

Question 31

Valve Replacement- AS

Answer 31

- Severe AS with high gradient and symptoms - Severe AS undergoing CABG or surgery of ascending aorta or of another valve - Asymptomatic patients with severe AS and LVEF <50% not due to another cause - AS symptoms with exercise TTE showing symptoms are AS related

Question 32

Percutaneous Valvuloplasty- MS

Answer 32

- Symptoms + Mod/Sev MS - Asymptomatic. Mod/Sev MS with: - -High risk HD compromise (PulmHT, desire for pregnancy) - -High thromboembolic risk

Question 33

Aortic Stenosis Examination Findings

Answer 33

``` Slow rising pulse S4 Paradoxical splitting of the second heart sound Aortic thrill Length and harshness of murmur LVH – displaced apex beat LVF – a late sign ```

Question 34

Mitral Stenosis Examination Findings

Answer 34

``` Small pulse pressure Soft first heart sound Early opening snap Long diastolic murmur Diastolic thrill @ apex PHT signs ```

Question 35

Mitral Regurgitation Examination Findings

Answer 35

``` Small volume pulse Displaced forceful apex Pansystolic murmur -> axilla S3 Soft S1 A2 early Early diastolic rumble AF LVF signs ```

Question 36

Aortic Regurgitation Examination Findings

Answer 36

``` Collapsing pulse Wide pulse pressure Long decrescendo diastolic murmur S3 Soft A2 Austin Flint murmur (low pitched rumbling mid-diastolic and presystolic murmur @ apex) LVF ```

Question 37

Mitral Valve Prolapse Examination Findings

Answer 37

Click -> high pitched late-systolic murmur extending throughout systole

Question 38

Tricuspid Regurgitation Examination Findings

Answer 38

``` JVP: Large v-waves, elevated Right ventricular heave Pansystolic murmur @ the lower sternal edge (increases with inspiration) Large, pulsatile liver Ascites Peripheral oedema ```

Question 39

Pulmonary Stenosis Examination Findings

Answer 39

Ejection systolic murmur peaking late in systole Absent ejection click S4 RVF signs

Question 40

ASD Examination Findings

Answer 40

wide fixed splitting of S2 | mid diastolic flow murmur over tricuspid area (when significant shunt present)

Question 41

VSD Examination Findings

Answer 41

harsh pansystolic murmur @ left sternal edge systolic thrill mid diastolic flow murmur over mitral area (when significant shunt present)

Question 42

Patent Ductus Arteriosus Examination Findings

Answer 42

continuous murmur over pulmonary area | mid diastolic flow murmur over mitral area (when significant shunt present)

Question 43

Features of a cholesterol emboli

Answer 43

Levido reticularis Purpura Renail failure Eosinophilia

Question 44

Poor prognostic features of HOCM

Answer 44

syncope family history of sudden death young age at presentation non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring abnormal blood pressure changes on exercise

Question 45

Features suggesting VT rather than SVT with aberrant conduction

Answer 45

``` AV dissociation fusion or capture beats positive QRS concordance in chest leads marked left axis deviation history of IHD lack of response to adenosine or carotid sinus massage QRS > 160 ms ```