CCs - in brief

Question 1

What are the main symptoms of valvular heart disease?

Answer 1

Exertional SOB
Exertional syncope (AS)
Exertional chest pain (AS)
Peripheral oedema (MS, TR)

Question 2

How do stenotic lesions affect the heart?

Answer 2

Narrowed valves
Pressure overload in chamber before the lesion
Ventricles will hypertrophy, atria will dilate

Question 3

How do regurgitant lesions affect the heart?

Answer 3

Volume overload in chamber before the lesion

Ventricles and atria will dilate

Question 4

What causes right ventricular failure?

Answer 4

Left ventricular failure
Pulmonary stenosis
Lung disease

Question 5

How does right ventricular failure present?

Answer 5

Peripheral oedema
Ascites
Nausea
Anorexia
Facial engorgement
Epistaxis

Question 6

What is the difference between systolic and diastolic heart failure?

Answer 6

Sys: inability of the heart to properly contract, so EF is <40%, resulting in decreased CO
Dias: inability of the ventricle to properly relax and fill, EF is preserved, but filling pressures increase

Question 7

What are the risk factors for infective endocarditis?

Answer 7

Acute: skin breaches, renal failure, immunosuppression, DM
Chronic: Aortic / mitral valve disease (tricuspid in IVDU), coarctation, PDA, VSD, prosthetic valves

Question 8

What are the most common causative organisms of infective endocarditis?

Answer 8

Strep viridans
Staph aureus
Strep bovis (may be linked to colonic malignancy)

Question 9

How does infective endocarditis present?

Answer 9

Fever
Rigors
Night sweats
Malaise
Weight loss
Clubbing
New murmur / change in pre-existing murmur

Question 10

How is Duke’s criteria used to diagnose infective endocarditis?

Answer 10

Major criteria: positive blood culture, endocardium involved (on echo/CT)
Minor criteria: risk factors, fever >38, vascular signs, immunological phenomena
2 major OR 1 major and 3 minor OR all 5 minor

Question 11

How is postural hypotension defined?

Answer 11

A drop in systolic >20mmHg or diastolic >10 mmHg on standing for 3-5 mins

Question 12

What causes postural hypotension?

Answer 12

Hypovolaemia
Drugs
Addison's
Hypopituitarism
Autonomic neuropathy eg DM
After intense exercise eg a marathon

Question 13

What are two key investigation findings in cases of aortic dissection?

Answer 13

1. Mediastinal widening on CXR

2. False lumen in a vessel on CT angiography