Cardiology (Week 5)

Question 1

Name two main features that characterise heart failure?

Answer 1

Systemic vasoconstriction and neurohumoral activation

Question 2

List three causes of heart failure

Answer 2

1. MI
2. Hypertension
3. Idiopathic
4. Alcohol
5. Chemotherapy

Question 3

Name a common sign of heart failure

Answer 3

Displaced apex beat
3rd heart sound
Elevated JVP

Question 4

What class of drugs are used for symptomatic relief in heart failure but do not improve outcomes

Answer 4

Diuretics

Question 5

What does a neprilysin inhibitor do in terms of heart failure treatment?

Answer 5

Inhibits neprilysin, an enzyme which breaks down natriuretic peptides whose function is to cause vasodilation and diuresis (maintain this as is beneficial to HF)

Question 6

Why should ACE inhibitors and angiotensin receptor blockers never be given together?

Answer 6

Because they both prevent the breakdown of bradykinin which causes cough and angioedema

Question 7

What do low natriuretic peptides mean in terms of heart failure diagnosis?

Answer 7

That the patient does not have heart failure

Question 8

What are Kerley B lines?

Answer 8

Fluid moving into the interstitial space and causing pressure build up in vessel s, appearing as small, white straight lines on the edge of chest X-ray

Question 9

How does alveolar oedema present on chest X-ray and what is it indicative of?

Answer 9

Appears as fluffy white surrounding black tubes in the lungs and is a late sign of heart failure

Question 10

In which condition would the loss of costophrenic angles be seen on chest X-ray?

Answer 10

Pleural effusion

Question 11

What is the definition of myocardial infarction?

Answer 11

Elevated troponin in a clinical setting consistent with myocardial ischaemia

Question 12

What is the difference between type 1 and type 2 MI?

Answer 12

Type 1 is due to plaque rupture and thrombus formation
whereas
Type 2 is due to increased oxygen demand or decreased oxygen supply

Question 13

Describe unstable angina

Answer 13

An acute coronary event without a rise in troponin

Question 14

What does ST elevation in MI indicate?

Answer 14

Coronary artery occlusion

Question 15

Name the three types of atrial fibrillation in order of increasing duration?

Answer 15

Paroxysmal
Peristsent
Permanent

Question 16

Name the two main features of AF on an ECG

Answer 16

Narrow, irregular QRS complex

No P waves

Question 17

Subclinical thyrotoxicosis can cause which heart arrhythmia?

Answer 17

Atrial fibrillation

Question 18

Describe the mechanism of action of Verapamil

Answer 18

Acts on Ca channels in the heart muscle to slow heart rate

Question 19

Name three components of vegetation which can go onto damage cusps of heart valves

Answer 19

Any three of:
Fibrin mesh 
Platelets 
WBCs
RBC debris 
Trapped organisms

Question 20

Strep. viridans is commonly associated with what type of endocarditis?

Answer 20

Native valve endocarditis

Question 21

Which strain of bacteria is commonly found in endocarditis of IVDU?

Answer 21

Staphylococcus aureus

Question 22

What are the two main categories of late stage infection in endocarditis?

Answer 22

Immunological and tissue damage

Question 23

In foetal circulation, via which structure does blood pass from the IVC to the left atrium?

Answer 23

Foramen Ovale

Question 24

Which term describes a heart with normal anatomy in a normal anatomical position?

Answer 24

Situs solitus

Question 25

In Fontan circulation, what adaptations are made in order to allow perfusion of blood?

Answer 25

IVC and SVC are plumbed directly into the pulmonary arteries, allowing bypassing of the heart

Question 26

What measurement defines systemic hypertension?

Answer 26

BP over 140/90mmHg

Question 27

Name three potential causes of secondary hypertension

Answer 27

Hyperaldosteronism Coarctation of aorta NSAIDs

Question 28

What is the first line treatment for under 55s with hypertension?

Answer 28

ACE inhibitor or low-cost angiotensin II receptor blocker