Cardiology

Question 1

Which chamber of the heart is measured using JVP?

Answer 1

Right atrium

Question 2

What does the a wave represent in JVP?

Answer 2

Atrial contraction

Question 3

What does the c wave represent in JVP?

Answer 3

Closure of the tricuspid valve

Question 4

What does the x descent represent in JVP?

Answer 4

Downward movement of the heart causing atrial stretch and drop in pressure

Question 5

What does the v wave represent in JVP?

Answer 5

Passive filling of the blood into the atrium against a closed tricuspid valve

Question 6

What does the y descent represent in JVP?

Answer 6

Opening of the tricuspid valve with passive movement of blood from the right atrium to the right ventricle

Question 7

What can cause a raised JVP?

Answer 7

Heart failure
Fluid overload
Severe bradycardia
Inspiration
SVC syndrome

Question 8

What is Kussmaul’s sign in JVP?

Answer 8

Raised JVP on expiration and drop on inspirations (i.e. backwards from normal). It is caused by the inability fo the right heart chambers to increase in size.

Question 9

How does atrial fibrillation affect the JVP wave?

Answer 9

Loss of a wave

Question 10

How does tricuspid regurgitation affect the JVP wave?

Answer 10

Large c-V waves

Question 11

How does raised right atrial pressure affect the JVP wave?

Answer 11

Prominent a waves

Question 12

How does constriction affect the JVP wave?

Answer 12

Prominent and deep x and y descents

Question 13

How does tamponade affect the JVP wave?

Answer 13

Prominent x descent only. Y descent is slow or absent.

Question 14

What can cause an absent radial pulse?

Answer 14

Latrogenic: post-catheterisation or arterial line
Blalock-Taussig shunt for congenital heart disease
Aortic dissection with subclavian involvement
Trauma
Takayasu’s arteritis
Peripheral arterial embolus

Question 15

What can cause a collapsing pulse?

Answer 15

Aortic regurgitation
Arteriovenous fistula
Patent ductus arteriosus

Question 16

What can cause a slow rising pulse?

Answer 16

Aortic stenosis (delayed percussion wave)

Question 17

What can cause bisferiens pulse?

Answer 17

A double shudder due to mixed aortic valve disease with significant regurgitation

Question 18

What can cause a jerky pulse?

Answer 18

Hypertrophic obstructive cardiomyopathy

Question 19

What can cause an alternans pulse?

Answer 19

Severe left ventricular dysfunction. Ejection fraction is reduced meaning the end-diastolic volume is elevated. This may stretch the myocytes to improve the ejection fraction of the next heartbeat leading to alternating strong and weak pulses.

Question 20

What can cause a paradoxical pulse?

Answer 20

Excessive reduction on inspiration caused by ventricular compression, tamponade, constrictive pericarditis, or severe asthma

Question 21

What is the cardiac apex?

Answer 21

The ventricle striking the chest wall during isovolumetric contractions

Question 22

What can cause an absence of the apical impulse?

Answer 22

Obesity/emphysema
Right pneumonectomy with displacement
Pericardial effusion or constriction
Dextrocardia

Question 23

What can cause a heaving apical impulse?

Answer 23

Left ventricular hypertrophy

Question 24

What can cause a thrusting/hyperdynamic apical pulse?

Answer 24

High left ventricular volume (e.g. in mitral regurgitation, aortic regurgitation, PDA, ventricular septal defect)

Question 25

What can cause a tapping apical pulse?

Answer 25

Palpable first heart sound in mitral stenosis

Question 26

What can cause a displaced apical pulse?

Answer 26

Left ventricular impairment and dilatation

Question 27

What can cause a double apical pulse?

Answer 27

(with dyskinesia) left ventricular aneurysm | (without dyskinesia) hypertrophic cardiomyopathy

Question 28

What can cause a pericardial knock?

Answer 28

Constrictive pericarditis

Question 29

What can cause a parasternal heave?

Answer 29

Right ventricular hypertrophy Pulmonary hypertension Chronic obstructive pulmonary disease Pulmonary stenosis

Question 30

What can cause a palpable third heart sound?

Answer 30

Heart failure and severe mitral regurgitation

Question 31

What can cause loud first heart sounds?

Answer 31

``` Mobile mitral stenosis Hyperdynamic states Tachycardic states Left-to-right shunts Short PR interval ```

Question 32

What can cause soft first heart sounds?

Answer 32

``` Immobile mitral stenosis Hypodynamic states Mitral regurgitation Poor ventricular function Long PR interval ```

Question 33

What can cause split first heart sounds?

Answer 33

``` RBBB LBBB VT Inspiration Ebstein's anomaly ```

Question 34

What can cause variable first heart sounds?

Answer 34

Atrial fibrillation | Complete heart block

Question 35

What can cause loud second heart sounds?

Answer 35

Systemic hypertension Pulmonary hypertension Tachycardic states ASD

Question 36

What can cause soft or absent second heart sounds?

Answer 36

Severe aortic stenosis

Question 37

What can cause fixed second heart sounds?

Answer 37

ASD

Question 38

What can cause widely split second heart sounds?

Answer 38

RBBB Pulmonary stenosis Deep inspiration Mitral regurgitation

Question 39

What can cause a single second heart sound?

Answer 39

``` Severe pulmonary/aortic stenosis Hypertension Large VSD Tetralogy of Fallot Eisenmenger's syndrome Pulmonary atresia Elderly ```

Question 40

What can cause a reversed split second heart sound?

Answer 40

LBBB Right ventricular pacing PDA Aortic stenosis

Question 41

What can cause left axis deviation?

Answer 41

``` LBBB Left anterior hemi-block LVH Primum ASD Cardiomyopathies Tricuspid atresia ```

Question 42

What can cause low-voltage ECG?

Answer 42

``` Pulmonary emphysema Pericardial effusion Myxoedema Severe obesity Incorrect calibration Cardiomyopathies Global ischaemia Amyloid ```

Question 43

What can cause right axis deviation?

Answer 43

Infancy RBBB Right ventricular hypertrophy

Question 44

What are some abnormalities seen in ECGs of athletes?

Answer 44

``` Sinus arrhythmia Sinus bradycardia First-degree heart block Wenckebach's phenomenon Junctional rhythm ```