Cardiovascular

Question 1

Why heart rhythms are shockable?

Answer 1

VF and pulseless VT are shockable rhythms

Question 2

Discuss the main histological features of age-related vascular changes

Answer 2

Progressive fibrosis and thickening of the intima

Loss of elasticity through fibrosis and scarring of elastic media

Question 3

Which heart murmur is a collapsing or water hammer pulse often associated with?

Answer 3

Aortic regurgitation

Question 4

Describe the murmur associated with Mitral stenosis

Answer 4

Diastolic murmur with loud P2/splitting heard of pulmonary valve

Question 5

Describe the murmur heard with aortic stenosis

Answer 5

crescendo - decrescendo or ejection systolic murmur

Question 6

Where does an aortic stenosis murmur radiate to

Answer 6

Carotids

Question 7

AF is often associated with which heart murmur?

Answer 7

Mitral Stenosis

Question 8

Mechanism of diltiazem and verapamil

Answer 8

Non-DHP calcium channel blocker - cardio selective

Question 9

Management of STEMI

Answer 9

1st line - Primary PCI within 120 minutes
+ Anticoagulation
+ Dual anti-platelet therapy

Suspected MI

• Aspirin
• Oxygen
• Morphine + GTN (symptom relief)

Question 10

Management of NSTEMI

Answer 10

1) Dual antiplatelet therapy
- Aspirin
- Clopidogrel or ticagrelor or prasugrel
adjunct - Oxygen (if hypoxic)

2) Analgesia + Symptom relief
- Glyceryl trinitrate
- Morphine

3) Beta - blocker

Adjunct - calcium channel blocker

4) PCI within 72 hours
+ anticoagulation with LMWH, dalteparin, enoxaparin

Question 11

Causes of diastolic heart failure (preserved ejection fraction)

Answer 11

Ventricular hypertrophy, constrictive pericarditis, tamponade, obesity

Question 12

Discuss clinical features of heart failure

Answer 12

• Presence of risk factors
• Dyspnoea
• Orthopnoea and paroxysmal nocturnal dyspnoea
• Neck vein distension
• S3 gallop
• Hepatojugular reflux
• Rales
• Narrow pulse pressure
• Ankle oedema
• Night cough
• Signs of pleural effusion
  Tachycardia
• Cyanosis

Question 13

Discuss key diagnostic features of atrial fibrillation

Answer 13

• Presence of risk factors –> increasing age, DM, hypertension, congestive HF , valvular heart disease, coronary artery disease and hyperthyroidism
• irregular pulse rate
• Palpitations
• Hypotension
• Elevated JVP
• Added heart sounds
• Stroke

Question 14

Differentiate Kussmaul’s sign from Kussmaul breathing

Answer 14

Kussmal’s sign is a paradoxical rise in JVP on inspiration
Kussmal breathing is deep laboured breathing observed when the body or organs have become too acidic, most commonly seen in diabetic ketoacidosis

Question 15

Describe CXR findings of congestive heart failure

Answer 15

• Dilated prominent upper lobe vessels
• Alveolar oedema (Bat’s wings)
• Kerley B lines (interstitial oedema)
• Blunting of the costophrenic angles
• Cradiomegaly
• Pleural effusion

Question 16

Discuss heart failure management

Answer 16

1) Diuretics e.g. furosemide or bumetanide
2) ACE-i (reduce afterload)
3) Beta blockers
4) Mineralcorticoid receptor antagonists e.g. spironolactone
5) Digoxin

Question 17

Features of mitral stenosis

Answer 17

Hx of rheumatic heart disease
AF
Malar Flush
Mid-diastolic murmur (low pitched)
Features of pulmonary hypertension