Cardiology

Question 1

Investigations for 60 year old patient presenting with tight chest pain with nausea and sweating?

Answer 1

1. ECG (most important next investigation)
   • STEMI - cath lab
   • NSTEMI - aspirin
2. Troponin
   • +ve - coronary angiography
   • -ve - exercise tolerance test, aspirin, clopidogrel, LMWH
3. Echo

Question 2

Cardiac causes of collapse?

Answer 2

• Vasovagal
• Arrhythmia
• Outflow obstruction: left (HOCM, aortic stenosis) or right (PE)
• Postural hypotension

Question 3

30 year old man collapses
• not confused after
• brother died at young age
• BP 120/80 lying
• 115/75 standing

Cause of collapse?
A. Aortic stenosis B. Pulmonary embolism C. Postural hypotension D. Seizure E. Tachyarrhythmia

Answer 3

• Not confused after - cardiac
• No significant change in BP - not postural hypotension
• FHx - ARRHYTHMIA

E

Question 4

How does long QT syndrome cause collapse and how can you visualise it on ECG?

Answer 4

Predisposes patient to VT (arrhythmia)

T wave doesn’t finish before halfway between 2 QRS waves

Question 5

When are right sided heart murmurs louder?

Answer 5

On inspiration

Question 6

Cardiac ddx of raised JVP?

Answer 6

• Right heart failure - secondary to LHF, pulmonary HTN
• Tricuspid regurgitation - valve leaflets (endocarditis - IV drugs), right ventricular dilatation
• Constrictive pericarditis

Question 7

65 year old man
• breathless
• palpitations
• high temperature
• Irregular and high pulse
• dull percussion, coarse crackles L base

What would you see on ECG - AF, sinus tachy, SVT, VF or VT?

Answer 7

Atrial fibrillation

Question 8

Causes of sinus tachycardia? (3)

Answer 8

• Sepsis
• Hypovolaemia
• Endocrine

Question 9

Causes of atrial fibrillation?

Answer 9

• Thyrotoxicosis
• Alcohol
• Heart pathology
• Lung pathology e.g. pneumonia, PE

Question 10

Causes of VT?

Answer 10

• Ischaemia
• Electrolyte abnormality
• Long QT

Question 11

Management of SVT?

Answer 11

1. Vagal manoeuvres
2. Adenosine
3. DC cardioversion if haemodynamic compromise

Question 12

Management of AF?

Answer 12

1. Rhythm control - cardioversion (anticoagulate for 3-4 weeks before if > 48 hours)
2. Rate control - beta blocker, digoxin

Question 13

Management of VT if no haemodynamic compromise? What if it’s pulseless?

Answer 13

1. IV amiodarone
2. Treat underlying cause
3. ICD

Pulseless - defibrillate

Question 14

What does a deep S in V1/2 and tall R in V5/V6 suggest?

Answer 14

Left ventricular hypertrophy caused by HYPERTENSION

Question 15

Cause of third heart sound (immediately after S2)?

Answer 15

Rapid ventricular filling

Question 16

Cause of fourth heart sound (just before S1)

Answer 16

Ventricular hypertrophy - atrial heart contraction

Question 17

Treatment for heart failure?

Answer 17

1. Sit up
2. High flow O2
3. Furosemide (IV)
4. GTN infusion
5. Treat underlying cause e.g. MI

Question 18

Sound of pulmonary oedema on auscultation of chest?

Answer 18

Fine end inspiratory crepitations

Question 19

Management of VF or pulseless VT?

Answer 19

• Shock
• CPR for 2 mins
• Assess rhythm
• Adrenaline 3-5 mins
• Amiodarone after 3 shocks
• Correct reversible causes (4Hs 4Ts)

Question 20

Management of Pulseless Electrical Activity or asystole?

Answer 20

Unshockable
• CPR for 2 mins
• Adrenaline every 3-5 mins

• Correct reversible causes (4Hs 4Ts)

Question 21

30 year old woman
• URTI
• Pleuritic chest pain
• Better when leaning forward

Diagnosis?

Answer 21

Pericarditis

Question 22

Causes of pleuritic chest pain?

Answer 22

• Pericarditis
• PE
• Pneumonia
• Pneumothorax
• Pleural pathology