Cardiology

Question 1

A 65 year old man is admitted after a collapse when running for the bus. On examination, he has a sustained heaving apex beat that is slightly displaced and an ejection systolic murmur.

Which of these clinical features are they most likely to demonstrate?

• Radiofemoral delay
• Pan-systolic murmur
• Systolic blood pressure of 220 mmHg
• Tapping apex beat
• Chest pain eased by glyceryl trinitrate in 5 minutes
• Third heart sound
• Splinter haemorrhages
• Breathlessness eased by lying flat
• Slow-rising carotid pulse
• Bradycardia with pulse rate 20 per minute
• Chest pain eased by glyceryl trinitrate after an hour

Answer 1

-Slow-rising carotid pulse

These are features of aortic stenosis which causes a slow rising pulse

Question 2

An 80 year old woman is admitted with an excruciating pain between the shoulder-blades. You can palpate the right radial pulse but not the left.
Which of these clinical features are they most likely to demonstrate?
-Radiofemoral delay
-Pan-systolic murmur
-Systolic blood pressure of 220 mmHg
-Tapping apex beat
-Chest pain eased by glyceryl trinitrate in 5 minutes
-Third heart sound
-Splinter haemorrhages
-Breathlessness eased by lying flat
-Slow-rising carotid pulse
-Bradycardia with pulse rate 20 per minute
-Chest pain eased by glyceryl trinitrate after an hour

Answer 2

-Systolic blood pressure of 220 mmHg

This pain is suggestive of aortic dissection and the asymmetric pulses increase the likelihood. Dissection may be caused by hypertension.

Question 3

A 70 year old man had a myocardial infarction two years ago. He is now admitted with gradually increasing breathlessness worse on lying flat with crepitations in the lung bases.
Which of these clinical features are they most likely to demonstrate?
-Radiofemoral delay
-Pan-systolic murmur
-Systolic blood pressure of 220 mmHg
-Tapping apex beat
-Chest pain eased by glyceryl trinitrate in 5 minutes
-Third heart sound
-Splinter haemorrhages
-Breathlessness eased by lying flat
-Slow-rising carotid pulse
-Bradycardia with pulse rate 20 per minute
-Chest pain eased by glyceryl trinitrate after an hour

Answer 3

-Third heart sound

These are features of heart failure, specifically left ventricular failure which can cause a third heart sound

Question 4

A 65 year old woman has been increasingly breathless over the last few years. On auscultation, she has a loud first heart sound and a mid-diastolic murmur.
Which of these clinical features are they most likely to demonstrate?
-Radiofemoral delay
-Pan-systolic murmur
-Systolic blood pressure of 220 mmHg
-Tapping apex beat
-Chest pain eased by glyceryl trinitrate in 5 minutes
-Third heart sound
-Splinter haemorrhages
-Breathlessness eased by lying flat
-Slow-rising carotid pulse
-Bradycardia with pulse rate 20 per minute
-Chest pain eased by glyceryl trinitrate after an hour

Answer 4

-Tapping apex beat

These are features of mitral stenosis. A loud first heart sound is usually accompanied by a tapping apex beat.

Question 5

The patient is a 60 year old man who smokes 20 per day. He comes to clinic complaining of a tight pain in the centre of his chest which comes on when he walks uphill

Which of these clinical features are they most likely to demonstrate?

• Radiofemoral delay
• Pan-systolic murmur
• Systolic blood pressure of 220 mmHg
• Tapping apex beat
• Chest pain eased by glyceryl trinitrate in 5 minutes
• Third heart sound
• Splinter haemorrhages
• Breathlessness eased by lying flat
• Slow-rising carotid pulse
• Bradycardia with pulse rate 20 per minute
• Chest pain eased by glyceryl trinitrate after an hour

Answer 5

-Chest pain eased by glyceryl trinitrate in 5 minutes

This man’s smoking puts him at risk of ischaemic heart disease. This pain sounds like stable angina.