Cardiology Station

Question 1

Features of severe aortic stenosis

Answer 1

Quiet/absent S2
Slow-rising pulse
S4
Echo: mean gradient >40 mmHg, valve area <1 cm2, reduced EF

Question 2

Differential for an AS murmur

Answer 2

Aortic sclerosis
VSD
HOCM
Increased flow in hyperdynamic states like pregnancy and anaemia

Question 3

Heyde’s syndrome

Answer 3

Aortic stenosis
Angiodysplasia
Acquired von Willebrand factor deficiency

Question 4

Causes of aortic stenosis

Answer 4

Congenital: bicuspid valve
Acquired: Degeneration & calculation, rheumatic heart disease

Question 5

Symptoms of aortic stenosis

Answer 5

Angina
Syncope
Dyspnoea

Question 6

Modified Duke’s criteria

Answer 6

Major
- typical organism in 2 blood cultures 12 hours apart
- typical echo findings (vegetation, abscess, dehiscence)

Minor
- temperature >38
- immunologic phenomena (Osler nodes, Roth spots, glomerulonephritis)
- vascular phenomena (septic emboli, Janeway)
- microbiological evidence: blood culture with atypical organism
- echo findings that are suggestive
- risk factors: prosthetic valve, RHD, IVDU

Diagnosis: 2 major, 1 major 3 minor, 5 minor

Question 7

Causes of TR

Answer 7

RV dilatation
IE with IVDU
Carcinoid syndrome
Rheumatic heart disease
Ebstein anomaly

Question 8

Differential for MS murmur

Answer 8

Austin-Flint murmur
Left atrial myxoma

Question 9

Criteria for aortic valve replacement

Answer 9

Aortic stenosis
- symptomatic
- asymptomatic but >40 mmHg mean gradient or <1 cm2 valve
- having CABG

Aortic regurgitation
- symptomatic
- asymptomatic but LVEF impaired or LV dilated
- having CABG

Infective endocarditis

Question 10

Reasons for a lateral thoracotomy scar in a cardiology station

Answer 10

MV replacement
Mitral valvotomy
Blalock-Taussig shunt
Coarctation repair

Question 11

Indications and contraindications for closure of ASD

Answer 11

Symptomatic: dyspnoea, paradoxical embolism
Significant shunt on echo: Qp\Qs >1.5, RV dilatation

Severe PHT with Eisenmenger’s syndrome

Question 12

Causes of an absent or reduced radial pulse

Answer 12

Acute: aortic dissection, embolism, trauma
Chronic: AV fistula, BT shunt, atherosclerosis, coarctation, Takayasu’s arteritis

Question 13

Genetics of Marfan’s syndrome

Answer 13

Autosomal dominant condition
Mutation in FBN1 gene encoding fibrillin 1 (an important protein in the extracellular matrix)

Question 14

Criteria for mitral valve replacement

Answer 14

MR: LVEF (<60%), LV dilatation >45 mm

MS: PHT, pulmonary oedema, haemoptysis, recurrent emboli