Gen Med 1 Cardio

Question 1

60 M, chest pain and tightness. Nausea, sweating, breathlessness
Has HTN and takes amlodipine.

What is the most likely diagnosis?

Answer 1

Myocardial Infarction

Question 2

What investigations do you do for an MI?

Answer 2

ECG
Troponin
i. If positive do a coronary angiogram
ii. if negative fo an ETT
Echocardiograph

Question 3

What are the differentials of chest pain?

Answer 3

Cardiac
Respiratory
GI
Musculoskeletal

Question 4

What are the cardiac causes of chest pain?

Answer 4

• Angina (IHD)
• MI (IHD)
• Pericarditis
• Aortic dissection

Question 5

What are the respiratory causes of chest pain?

Answer 5

• Pneumonia
• PE
• Pleural effusion
• Pulmonary oedema
• Pneumothorax
• Collapsed lung

Question 6

What are the GI causes of chest pain?

Answer 6

• Oesophageal spasm
• Oesophagitis
• GORD
• Hernia (hiatus)
• Oesophageal varices

Question 7

What are the musculoskeletal causes of chest pain?

Answer 7

Costochondritis

Question 8

Which ECG changes denotes an anterior MI?

Answer 8

– Left Anterior Descending Art.

– V1‐V4

Question 9

Which ECG changes denotes a lateral MI?

Answer 9

• Circumflex

- V5, V6, Li, aVL

Question 10

Which ECG changes denotes an inferior MI?

Answer 10

• Right coronary Artery

- LII, LIII, aVF

Question 11

How do cardiac enzymes change after an MI?

Answer 11

Tropnin peaks 1-2 days after a large MI rising quickly or within the first day after a small MI

CK/ myoglobin peaks a few hours after an MI

Question 12

30 M collapse with no warning, no tongue biting and no confusion. Brother died at a young age.
Normal examination findings
What is the likley diagnosis?

Answer 12

Tachyarrhythmia

Question 13

What are the differentials for collapse?

Answer 13

Hypoglycaemia
Cardiac
i. vasovagal
ii. arrhythmia
iii. outflow obstruction (aortic stenosis/ HOCM/ PE)
iv. postural hypotension
CNS
i. seizure

Question 14

What do we look for for arrhythmias?

Answer 14

long QT (ECG)
Cardiac monitor
24 hr tape

Question 15

What do we look for in Outflow obstruction?

Answer 15

Low volume/ slow rising pulse
ESM
Echo

Question 16

What do we look for in postural hypotension?

Answer 16

Lying/ standing BP

Question 17

What is long QT syndrome?

Answer 17

Abnormal ventricular repolarisation
Congenitally acquired (e.g. via mutations in the K+ channel)
FH of sudden death
Acquired( e.g. Low K+/ Mg2+. drugs)

Question 18

45 yr old man, fever, malaise, drug use- 38 degrees, increased JVP, S1S2PSM (louder on inspiration) and hepatomegaly.

What is the most likely cause of his raised JVP?

Answer 18

Tricuspid regurgitation

Question 19

What are the differentials for a raised JVP?

Answer 19

• R heart failure (secondary to left heart failure, pulmonary HTN)
• Tricuspid regurgitation (valve leaflets, R ventricle dilatation)
• Constrictive pericarditis (infection, infl. , malignancy)

Question 20

What are the differentials of a systolic murmur?

Answer 20

• Aortic stenosis
• Mitral regurgitation
• Tricuspid regurgitation
• VSD

Question 21

How do you differentiate murmurs?

Answer 21

• Where is it
loudest/radiation?
• Associated features

Question 22

65 M
Breathless, palpitations
HTN
on Bendroflumethiazide
38C
160 bpm, irregular
110/80
Dull percussion with coarse crackles in L base

What will you see on an ECG?

Answer 22

Atrial Fibrillation

Question 23

What causes sinus tachy on an ECG?

Answer 23

Sepsis,

hypovolaemia,

endocrine (thyrotoxicosis,
phaeochromocytoma)

Question 24

What causes SVT?

Answer 24

Re-entry circuits (AVRT and AVNRT)

Question 25

What causes AF?

Answer 25

Thyrotoxicosis, alcohol • Heart: muscle, valve, pericardium • Lungs: Pneumonia, PE, cancer

Question 26

What causes a VT?

Answer 26

ischaemia, electrolyte abnormality, long QT

Question 27

What is an ECG sign of AVRT?

Answer 27

Short PR with delta wave (slow upslope of R)

Question 28

What is the management of SVT?

Answer 28

* Vagal maneuvers * Adenosine (cardiac monitor) * DC cardioversion if evidence of haemodynamic compromise

Question 29

What is the management of AF?

Answer 29

``` Rhythm control • If onset > 48hours, anticoagulate for 3‐4 weeks before cardioversion • Rate control – beta blocker – Digoxin • Think of the underlying Cause • Think of the Complications (Anticoagluation) ```

Question 30

What is the management of VT?

Answer 30

If no haemodynamic compromise: IV Amiodarone • Look for & treat underlying cause • ICD • Pulseless VT: defibrillate

Question 31

What ECG changes are shown by LVH?

Answer 31

``` • (Remember SR) • Deep S in V1/2 • Tall R in V5/6 • S in V1 + R in V5 or V6 (whichever is larger) ≥ 7 large squares ```

Question 32

What is shown in 1st degree heart block?

Answer 32

Long PR

Question 33

What is 2nd degree heart block?

Answer 33

Dropped QRS periodically

Question 34

What is 3rd degree heart block?

Answer 34

P and QRS not associated

Question 35

What would you see on an ECG for ischaemia, arrhythmias and ventricular hypertrophy/ strain?

Answer 35

* Ischaemia * ST, T, Q * Arrhythmia or conduction defects * Rate, Rhythm * PR, QRS, QT * Ventricular strain or hypertrophy * Axis, R, S

Question 36

What is each heart sound linked to?

Answer 36

``` S1. Closure of mitral valve S2. Closure of aortic valve FIXED WIDE SPLITTING OF S2. Atrial septal defect S3. Associated with ventricular filling S4. Associated with ventricular hypertrophy ```

Question 37

What is the management of acute heart failure?

Answer 37

``` Sit up Oxygen Furosemide IV GTN infusion Treat underlying cause ```

Question 38

How do you treat VF or pulseless VT?

Answer 38

* Shock * CPR (2 min) * Assess rhythm * Adrenaline every 3‐5 min * Amiodarone after 3 shocks * Correct reversible causes

Question 39

How do you treat Asystole or PEA?

Answer 39

* CPR (2 min) * Adrenaline every 3‐5 min * Correct reversible causes

Question 40

What are the differentials of pleuritic chest pain?

Answer 40

* Pericarditis * PE * Pneumonia * Pneumothorax * Pleural pathology * Sub‐diaphragmatic pathology