Cardiology

Question 1

What are the respiratory symptoms of heart disease?

Answer 1

Dyspnoea- abnormal awareness of breathlessness, caused by left ventricular failure due to a rise in pressure in the left atrium and pulmonary capillaries leading to interstitial and alveolar oedema
Orthopnoea
Paroxysmal nocturnal dyspnoea
Wheezing (cardiac asthma)
Cheyne-strokes- alternate hyperventilation and apnoea occur (depression of respiratory centre, consequence of poor cardiac output)

Question 2

What pain is felt in pericarditis?

Answer 2

Centre of the chest

Aggravated by movement, posture, respiration and coughing, relieved by sitting forwards

Question 3

What causes central chest pain that radiates to the back?

Answer 3

Dissecting or enlarging aortic aneurysm

Mimic MI

Question 4

What are paroxysms of rapid tachycardia associated with?

Answer 4

Syncope
Presyncope
Dyspnoea
Chest pain

Question 5

What can supra ventricular tachycardias cause?

Answer 5

e.g AF

Polyuria

Question 6

What are the characteristics of cardiovascular syncope?

Answer 6

Stokes-Adams attack
Patient falls to ground, pale, deeply unconscious
Pulse is very slow or absent
After a few seconds patient flushes brightly and recovers conciesness

Question 7

What are the cardiac causes of syncope?

Answer 7

Arrhythmias:
VT, rapid supra ventricular tachycardia, sinus arrest, atrioventricular block, artificial pacemaker failure
Obstruction:
aortic/pulmonary stenosis, hypertrophic obstructive cardiomyopathy, Fallots tetralogy, pulmonary hypertension/embolism, atrial myxoma, atrial thrombus, defective prosthetic valve
Situational:
Neurocardiogenic (vasovagal)
Postural hypotension

Question 8

What is pulmonary capillary wedge pressure?

Answer 8

Measured using a balloon tipped Swan-Ganz catheter which is inserted into the pulmonary artery. The pressure measured is similar to that of the left atrium (normally 6-12 mmHg).
Determines whether pulmonary oedema is caused by either heart failure or acute respiratory distress syndrome.

Question 9

What is acute heart failure?

Answer 9

Life threatening- sudden onset or worsening symptoms of heart failure 
Usually presents after 65
Caused by a reduced cardiac output 
Precipitating causes:
Acute coronary syndrome
Hypertensive crisis
Acute arrhythmia
Valvular disease

Question 10

What are the causes of long QT syndrome?

Answer 10

Jervell-Lange-Nielsen syndrome (includes deafness)
Romano-Ward syndrome (no deafness)
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram), methadone, chloroquine, terfenadine**, erythromycin, haloperidol, ondanestron
Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
Acute myocardial infarction
Myocarditis
Hypothermia
Subarachnoid haemorrhage

Question 11

What is the scoring system used to decide if patients need anticoagulation when they have AF?

Answer 11

1 point: Congestive heart failure, hypertension, 65-74, diabetes, vascular disease, sex female
2 points: over 75, prior TIA/stroke

Question 12

What complications occur following a MI?

Answer 12

VF- 24 hours
Ventricular septal defect- 3-5 days 
Cardiac tamponade- 5-14 days 
Mural thrombus- 2 weeks 
Dressler syndrome- several weeks

Question 13

What is hypertrophic obstructive cardiomyopathy?

Answer 13

Often asymptomatic
Exertional dyspnoea, angina, syncope typically following exercise
Sudden death (most commonly due to ventricular arrhythmias), arrhythmias, heart failure
Hypertrophic cardiomyopathy may impair mitral valve closure, thus causing regurgitation
Associated with Friedreich’s ataxia and Wolff-Parkinson White

Question 14

What is the management for acute heart failure?

Answer 14

Oxygen
Loop diuretics
Opiates
Vasodilators
Inotropic agents
CPAP
Ultrafiltration
Mechanical circulatory assistance: e.g. intra-aortic balloon counterpulsation or ventricular assist devices

Question 15

What are the causes of acute pericarditis?

Answer 15

Viral infections (Coxsackie)
Tuberculosis
Uraemia (causes 'fibrinous' pericarditis)
Trauma
Post-myocardial infarction, Dressler's syndrome
Connective tissue disease
Hypothyroidism
Malignancy

Question 16

What are the ECG changes seen in acute pericarditis?

Answer 16

Often global/widespread, as opposed to the ‘territories’ seen in ischaemic events
‘saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis
all patients with suspected acute pericarditis should have transthoracic echocardiography

Question 17

What are the causes of raised JVP?

Answer 17

Right sided heart failure
Cardiac tamponade
Superior vena cava obstruction
Fluid overload
NORMAL JVP- less than 3cm from the vertical height above the sternal angle, or therefore less than 8cm from the right atrium.

Question 18

What causes reflex syncope?

Answer 18

vasovagal: triggered by emotion, pain or stress. Often referred to as ‘fainting’
situational: cough, micturition, gastrointestinal
carotid sinus syncope

Question 19

What causes orthostatic syncope?

Answer 19

primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea

Question 20

What causes cardiac syncope?

Answer 20

arrhythmias: bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)
structural: valvular, myocardial infarction, hypertrophic obstructive cardiomyopathy
others: pulmonary embolism

Question 21

What are the ECG signs seen in pulmonary embolism?

Answer 21

Sinus tachycardia (the most common)
Signs of right heart strain (not left)
T wave inversion in the anterior leads
S1Q3T3