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Year 5 Cardiology > MedEd > Flashcards

MedEd Flashcards

1
Q

A 75 year old male with known colorectal carcinoma presents to A&E
with chest pain and shortness of breath. The pain is worse on breathing
in and coughing. What other sign/symptom would aid your diagnosis?
a Gradual onset chest pain
b Absent peripheral pulses
c Collapsing Pulse
d Haemoptysis
e Abdominal Pain

A

d Haemoptysis

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2
Q

Mr B a 52 year old male presents to his GP with central, tight chest
pain. He has noticed the pain comes on when he is gardening or walking
to the bus stop in a hurry, but normally goes away when he rests. What
medication would the GP prescribe to treat his underlying condition?
a GTN spray
b Propanolol (Beta Blocker)
c Ramipril (ACEi)
d Aspirin
e Atorvastatin (Statin)

A

b Propanolol (Beta Blocker)

GTN is to control chest pain

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3
Q 
A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis?
a Aortic Dissection
b STEMI
c Teitze’s Syndrome
d Costochondritis
e Pulmonary Embolism
A

a Aortic Dissection

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4
Q 
A 54 year old gentleman with a BMI of 27kg/m2 presents with burning chest pain. He finds that it is often worse in the evening and has noted a strange taste in his mouth. What is the most likely diagnosis?
a Angina
b Teitze’s Syndrome
c Aortic Dissection
d GORD
e Pericarditis
A

d GORD

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5
Q

def of angina

A

chest pain due to myocardial ischaemia

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6
Q

what brings on angina

A

exercise

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7
Q

what relieves angina

A

rest

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8
Q

what is the pathophysiology of angina

A

atherosclerosis in coronary arteries (CAD)

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9
Q

what is decubitus angina

A

chest pain when lying down

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10
Q

what is printzmetal angina

A

chest pain due to coronary artery vasospasm

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11
Q

what is unstable angina

A

chest pain at rest

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12
Q

what is syndrome X

A

chest pain but with normal exercise tolerance and normal coronary angiograms

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13
Q

history of ACS or angina

A

sudden onset central chest pain which is crushing and tight in nature
radiates to L arm/jaw
associated with sweating, nausea, SOB
exacerbated by exertion, relieved by rest

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14
Q

how is angina diagnosed

A

triad of angina features
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN

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15
Q

what is typical angina?

A

all 3 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN

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16
Q

what is atypical angina?

A

2 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN

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17
Q

what should be done in the case of unstable angina

A

likely ACS

emergency admission into hospital required

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18
Q

what should be done with stable angina but without known CAD

A 
this could be an atypical angina
complete investigations
1 CT coronary angiography
2 functional imagina
3 invasive coronary angiography
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19
Q

how should atypical angina be investigated

A

exercise ECG or stress testing

or echo

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20
Q

what is the medical management for angina

A

anti-anginals such as BB/CCBs

preventative or episodic treatment such as GTN spray

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21
Q

when should an ambulance be called after adminstering GTN

A

If no relief after 5 minutes with 2nd spray

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22
Q

def of aortic dissection

A

tear in tunica intima resulting in blood between the inner and outer tunica media (false lumen)

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23
Q

what classification is used for aortic dissection

A

stanford classification

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24
Q

how are aortic dissections classified

A

type a - tear in ascending aorta

type b - tear in descending aorta (after left subclavian branch)

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25
Q

what are risk factors for aortic dissection

A

ABCD

Atherosclerosis/Ageing
Blood pressure high
CTDs (SLE, marfans, ehlers-danlos)
Drugs (cocaine)

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26
Q

history of aortic dissection

A

sudden onset central tearing chest pain which radiates to the back

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27
Q

what history would you expect with a false lumen occluding the carotids

A

black out

hemiparesis

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28
Q

what history would you expect with a false lumen occluding the coronary arteries

A

angina

MI

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29
Q

what history would you expect with a false lumen occluding the renal artery

A

AKI

renal failure

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30
Q

what history would you expect with a false lumen occluding the coeliac trunk

A

severe abdo pain

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31
Q

examination of aortic dissection

A

tachycardia
BP discrepancy >20mmHg between arms
WPP
murmur on the back radiated from the left scapulae to the abdomen

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32
Q

what are the signs of aortic insufficiency

A

WPP + collapsing pulse

EDM

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33
Q

what is the gold standard for aortic dissection

A

gold standard investigation for intimal flap

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34
Q

what would you see on a CXR with aortic dissection

A

widened mediastinum and aortic notch visible

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35
Q

what might you see on an ECG with aortic dissection

A

LVH hypertrophy

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36
Q

def of pericarditis

A

inflammation of the pericardial sac

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37
Q

what are causes of pericarditis

A 
CARDIAC RIND
Collagen vascular disease
Autoimmune/Aortic Aneurysm
Radiation
Drugs
Infection (viral or bacterial)
Acute renal failure
Cardiac infarction
Rheumatic Fever
Injury/idiopathic
Neoplasm
Dresslers syndrome
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38
Q

what are viral causes of pericarditis

A

Viral – coxsackie, flu, EBV, mumps

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39
Q

what are bacterial causes of pericarditis

A

pneumonia, strep, staph, TB, RF

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40
Q

history of pericarditis

A

sharp pleuritic central chest pain which can radiate to the neck and shoulders
associated with fever + SOB
worse when lying down, breathing in and coughing
better when leading forward

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41
Q

examination of pericarditis

A

pericardial friction rub “walking on snow”
soft S1
S4 gallop

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42
Q

complications of pericarditis

A

cardiac tamponade

pericardial effusion

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43
Q

def of PE

A

sudden occlusion of pulmonary vessel due to thrombus formation

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44
Q

is ventilation of perfusion affected in PE

A

perfusion

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45
Q

history of PE

A

sudden onset SOB and pleuritic chest pain which can be left or right sided depending on where the thrombus lodges
associated with haemoptysis, leg swelling
made worse by coughing or breathing in

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46
Q

examination of PE

A

tachycardia + tachypnoea
cyanosis (if large)
leg swelling

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47
Q

how should a PE be managed

A

dependent on the wells score
if high (>4) then give LMWH until INR>2
then give warfarin

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48
Q

how should a PE be managed if the patient is haemodynamically unstable

A

thrombolysis or embolectomy

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49
Q

def of GORD

A

reflux of gastric contents into the oesophagus often as a result of a reduced LOS tone or hiatus hernia

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50
Q

history of GORD

A

slow onset of central burning, retrosternal chest pain which may radiate to the stomach and neck
associated with an acidic taste in mouth, sore throat and cough
often comes on after meals or when lying down

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51
Q

RFs for GORD

A

stress
obesity
pregnancy

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52
Q

invesitgations for GORD

A

ECG to exclude cardiac causes

OGD, barium swallow

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53
Q

def of chostochondritis

A

temporary inflammation of the costal cartilages

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54
Q

causes of chostochondritis

A

idiopathic
strenuous lifting
infection

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55
Q

what sort of pain is chostochondritis

A

pleuritic chest pain with tenderness on the sides od the sternum

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56
Q

which chostosternal joints are typically affected in chostochondritis

A

3/4/5

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57
Q

what is teitzes syndrome

A

inflammation of the costal cartilage similar to chostochondritis however there is also palpable swelling

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58
Q

which chostosternal joints are typically affected in teitzes syndrome

A

2/3

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59
Q

what is the treatment for chostochondritis or teitzes syndromr

A

rest
NSAIDs
corticosteroid injections if severe

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60
Q 
A 60 year old patient presents to A&E with central crushing chest pain, radiating to the jaw. His ECG is normal. What is the next step?
a Creatine Kinase
b Repeat ECG
c Discharge
d Exercise ECG
e Troponin
A

e Troponin

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61
Q 
A 46 year old diabetic man presents to A&E following collapse. The patient is very distressed and is sweating.  On the way to the hospital, his wife had to stop the car to allow him to vomit. His ECG is normal but his 12 hour troponins are positive. What is the most likely diagnosis?
a Inferior STEMI
b Anterior STEMI
c NSTEMI
d Unstable Angina
e Ventricular Wall Aneurysm
A

c NSTEMI (ECG can be normal in NSTEMI)

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62
Q 
A 68 year old patient presents to A&E with sharp central chest pain. She was discharged 4 weeks ago following an MI. Her ECG shows saddle-shaped ST segments diffusely. What is the most likely diagnosis?
a Repeat MI
b Dressler’s Syndrome
c Pericarditis
d Ventricular Wall Aneurysm 
 e Heart Failure
A

b Dressler’s Syndrome

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63
Q 
A 56 year old overweight man with a history of high cholesterol comes in complaining of central crushing chest pain that came on at rest. He has had a similar pain before but only when playing tennis. His ECG shows ST depression and a 12 hour troponin is negative.
a Inferior STEMI
b Anterior STEMI
c NSTEMI
d Unstable Angina
e Ventricular Wall Aneurysm
A

d Unstable Angina (if troponin is negative it is unstable angina, even with ST depression)

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64
Q

what is ACS

A

an umbrella term for unstable, NSTEMI, STEMI

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65
Q

what is a STEMI

A

ST elevation MI

complete occlusion of coronary artery resulting in myocardial infarction

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66
Q

what would be seen on an ECG with a STEMI

A

ST elevation

new onset LBBB

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67
Q

what is a NSTEMI

A

non-ST elevation MI

partial occlusion of coronary artery resulting in myocardial ischaemia (permanent myocardial damage)

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68
Q

what is raised in a NSTEMI (and STEMI)

A

creatine kinase and troponin

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69
Q

what is not raised in unstable angina

A

troponin or CK

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70
Q

what would be seen on an ECG with NSTEMI

A

MAY have ST depression, T wave inversion or normal ECG

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71
Q

what are the ischaemic complications of MI

A

repeat MI

post-infarction angina

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72
Q

what should be measured if a repeat MI is suspected

A

CK-MB rather than troponins

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73
Q

what does post-infarction angina normally occur

A

hours to days post MI

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74
Q

what are the mechanical complications of MI

A

HF
papillary muscle rupture
ventricular aneurysm

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75
Q

why does HF occur post MI

A

damaged cardiac tissue

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76
Q

what are signs of papillary muscle rupture post MI

A

new and loud PSM (MR) which radiates to the axilla

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77
Q

how does ventricular aneurysm occur post MI

A

from weakened ventricular wall from damaged cardiac tissue

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78
Q

what can a ventricular aneurysm post MI cause

A

blocking blood from heart

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79
Q

what are the arrythmic complications of MI

A

infarcted and damaged tissue can change electrical characteristics leading to formation of re-entry circuits such as:
1 VT
2 VF
3 complete heart block

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80
Q

how is pericarditis associated with MI

A

often develops soon after MI due to a inflammatory response to necrotic tissue

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81
Q

how is dresslers syndrome associated with MI

A

occurs weeks after MI due to antibodies forming against circulating myocardial antigens

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82
Q 
A 50 year old man presents to his GP with central chest pain. The ECG shows a STEMI. His sats are 96%. What medication should the GP give whilst waiting for an ambulance?
a Fondaparinux 2.5mg
b Oxygen 
c Propanolol
d Aspirin/Clopidogrel 300mg
e Ramipril
A

d Aspirin/Clopidogrel 300mg

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83
Q 
A 70 year old female with known hypertension and hypercholesterolaemia presents with central crushing chest pain, which radiates to the left arm. The pain started 2 hours ago. Her ECG shows LBBB. What is the most appropriate management. 
a Thrombolysis
b Angiography
c Fibrinolysis
d PCI
e CABG
f Fondaprinux
A

d PCI

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84
Q 
A 78 year old woman is bought to A&E following chest pain. Her ECG shows ST depression and T-wave inversion. 12 hour troponins are positive. What is the most appropriate management?
a PCI
b Fibrinolysis
c Fondaparinux
d CABG
e Thrombolysis
f Angiography
A

c Fondaparinux

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85
Q 
A man is being discharged following an MI. Which of the following drugs should not make up a part of his post MI management?
a ACEi
b Aspirin
c Clopidogrel
d Heparin
e Statin
f B-Blocker
A

d Heparin

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86
Q

what is the management of ACS

A 
ABCDEFG
1 oxygen (if sats <90%)
2 3As
-antiplatelets (aspirin + clopidogrel)
-analgesic (morphine)
-anti-ischaemic (GTN)
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87
Q

what is the principle aim of STEMI management

A

coronary reperfusion therapy (open coronary vessels to allow blood flow to the myocardium)

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88
Q

what are therapies for coronary reperfusion after STEMI

A

PCI

fibrinolysis

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89
Q

when would PCI be used after a STEMI

A

if patient presents within 12hrs of onset of symptoms and it can happen before fibrinolysis could be given (within 2hrs)

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90
Q

what would fibrinolysis be used after a STEMI

A

patient presents within 1 hours of symptoms

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91
Q

what is the management of STEMI if a patient presents >12hrs after onset of symptoms

A

coronary angiography with follow up PCI if indicated

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92
Q

what is the management for an NSTEMI/unstable angina

A

IMMEDIATE aspirin + antithrombin therapy (fondaparinux with low bleeding risk, LMWH as an alternative if pts are undergoing coronary angiography within 24hrs of admission)

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93
Q

what is the score used to determine 6month mortality of NSTEMI patients

A

GRACE Risk

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94
Q

what is the treatment for high risk NSTEMI/unstable angina

A 
IV glycoprotein IIb/IIIa inhibitors
coronary angiography (+ follow on PCI if indicated)
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95
Q

what are names of IV glycoprotein IIb/IIIa inhibitors

A

tirofiban/eptifibatide

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96
Q

what is the treatment for low risk NSTEMI/unstable angina

A

conservative management without angiography

unless ischaemia demonstrated by persistant symptoms

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97
Q

what is the ongoing medical management for ACS

A

1 ACEi
2 Dual antiplatelet therapy (aspirin + clopidogrel)
3 statin
4 BB

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98
Q

what is the surgical management for ACS

A

CABG may indicated for triple vessel disease or left mainstem disease >50%

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99
Q

A 55 year old gentleman with a history of systemic hypertension presents to A&E with breathlessness on exertion & orthopnoea. Examination reveals cardiomegaly & a displaced apex beat to the left.

Myocardial Infarction
Left Ventricular Failure
Constrictive pericarditis
Right Ventricular Failure
Congestive Cardiac Failure
A

Left Ventricular Failure

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100
Q

A 62 year old gentleman presents with fatigue, breathlessness & anorexia. On examination his JVP is noted as being elevated, he has hepatomegaly & swollen ankles.

Myocardial Infarction
Left Ventricular Failure
Constrictive pericarditis
Right Ventricular Failure
Congestive Cardiac Failure
A

Congestive Cardiac Failure

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101
Q

definition of HF

A

cardiac output>body’s demands

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102
Q

what is low-output HF

A

decreased cardiac output

103
Q

what is high-output HF

A

increased body demand

104
Q

what causes low-output HF

A

excessive

105
Q

what are causes of LVF

A

IHD
HTN
dilated cardiomyopathy
MR

106
Q

what are causes of RHF

A

LVF
pulmonary HTN
lung disease
TR

107
Q

what three features are characteristic of LVF

A

SOB
orthopnoea
PND

108
Q

what are characteristic features of RVF

A

peripheral oedema
ascites
raised JVP

109
Q

what could pulsation in the neck and face indicate

A

TR

110
Q

what signs are there with LVF

A

stony dullness (pleural effusion)
bibasal crepitations
displaced apex beat (cardiomegaly)
S3

111
Q

what signs are there with RVF

A

raised JVP
hepatomegaly
pitting oedema

112
Q

what are the bedside investigations for HF

A

history + examination

peak flow + spirometry

113
Q

what bloods would be taken when investigating HF

A

BNP

NTproBNP (N-terminal pro BNP)

114
Q

what is N-terminal pro BNP

A

a prohormone for BNP

115
Q

what imaging investigations are taken when investigating HF

A

12 lead ECG
TTE echo doppler
CXR

116
Q

what are the diagnostic investigations of HF

A

BNP + echo

117
Q

what is done if investigating HF and the pt has a Hx of MI

A

only complete echo

118
Q

what is done if investigating HF and pt has no Hx of MI

A

BNP + echo

119
Q

what is BNP

A

brain natriuretic peptide

120
Q

what secretes BNP

A

ventricular myocardium in response to LV pressure

121
Q

what reflects myocyte stretch

A

increased GFR and reduced renal Na resorption

122
Q

what is the benefits and negatives of BNP testing

A

sensitive test - can rule out HF

poorly specific test - cannot diagnose HF

123
Q

what is the next step in investigations if BNP is high (investigating HF)

A

arrange echo

124
Q

what are features of HF on a CXR

A 
Alveolar oedema 'bat wings'
B (Kerley B lines)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
125
Q

what do kerley B lines indicate

A

interstitial oedema

126
Q

A 62 year old man, 3 months after an MI, taking aspirin, atenolol and simvistatin, whose echocardigram shows worsening left ventricular function. Select the single most appropriate means of reducing cardiovascular risk

Spironolactone
Anticoagulation Therapy
Sublingual Gtn
ACE inhibitor therapy
Furosemide
A

ACE inhibitor therapy

127
Q

what classification is used for HF

A

New York Heart Association Classification

128
Q

what are the gradings in hte NYHA Classification

A

NYHA I
NYHA II
NYHA III
NYHA IV

129
Q

what does NYHA I mean

A

HF present

no SOB

130
Q

what does NYHA II mean

A

HF present

comfortable at rest but SOB on ordinary activity

131
Q

what does NYHA III mean

A

HF present

SOB with less than ordinary activity

132
Q

what does NYHA IV mean

A

HF present

SOB at rest

133
Q

what is the first line medical management for HF

A

ACEi + BB

134
Q

what is the second line medical management for HF following ACEi + BB

A

ARB (mild-moderate HF)

spironolactone (moderate-severe HF or MI in past month)

135
Q

when would a Hydralazine/nitrate combo be used for second line HF treatment

A

moderate-severe afro-carribean

136
Q

what is the second line medical management for HF

A

digoxin

cardiac resynchronisation therapy

137
Q

what are the two groups of causes of HTN

A

primary (idiopathic)

secondary

138
Q

what are renal causes of HTN

A 
intrinsic
-glomerulonephritis
chronic pylonephritis
renovascular
-renal artery stenosis
139
Q

what is the cause of renal artery stenosis in young and old

A

old - atheromatous

young - fibromuscular

140
Q

what are endocrine causes of HTN

A 
cushings
conns
phaeo
acromegaly
hyperparathyroidism
141
Q

what does headache with or without visual disturbances indicate

A

malignant HTN

142
Q

what is the definition of malignant HTN

A

> 200/130 mmHg

143
Q

A 40 year old man with diabetes, proteinuria and hypertension of 148/98 mmHg

Β-blocker
Calcium Channel Blocker
Losartan
ACE-I
Thiazide Diuretic
A

ACE-I

144
Q

why are ACEi good in HTN with proteinuria

A

ACEi are renoprotective

145
Q

A 53 year old lady with hypertension was on an antihyperstive treatment by you, but has developed a dry cough and refuses to take the drug anymore. He is otherwise well. What is the Culprit?

Β-blocker
Calcium Channel Blocker
Losartan
Spironolactone
ACE-I
A

ACE-I

146
Q

what is a SE of CCB

A

peripheral oedema

147
Q

what is a SE of spironolactone

A

gynaecomastia

148
Q

what are SEs of ACEi

A

cough (increased bradykinin)
hyperkalaemia
renal failure (RAS)
angioedema

149
Q

what are SEs of ARB

A

vertigo, urticarial

150
Q

what are SEs of thiazides

A 
reduced K (ECG changes)
reduced Na (confusion)
151
Q

what are SEs of spironolactone

A

increased K

gynaecomastia

152
Q

what are SEs of BB

A

bronchospasm

HF

153
Q

what is the first line treatment for malignant HTN

A

IV labetalol

154
Q

what can malignant HTN cause

A

CCF

encephalopathy

155
Q

what are features of encephalopathy

A

headache
focal CNS
seizures
comas

156
Q

what is the most appropriate investigation to confirm diagnosis of stable angina

A

exercise ECG

157
Q

is CT coronary angiogram invasive or non-invasive

A

non-invasive

158
Q

is coronary angiogram invasive or non-invasive

A

invasive

159
Q

what are the most sensitive and specific cardiac enzymes (markers) of myocardial necrosis (MI)

A

troponin (T+I)

160
Q

what is happening to the troponin levels 3-12hrs post MI

A

rising

161
Q

what is happening to troponin levels for 24-48hrs post MI

A

peaked

162
Q

what is happening to troponing levels for the 5-14days post MI

A

decreasing

163
Q

when does CK-MB peak post MI

A

within 36hrs

164
Q

what is looked for in bloods with DVT/PE

A

d-dimer (sensitive but not specific)

165
Q

what imaging is completed for investigating DVT/PE

A

USS of proximal leg vein

166
Q

when is a DVT likely

A

> 2 on Wells score

167
Q

when is PE likely

A

> 4 on Well score

168
Q

what is the gold standard investigation for PE

A

CT pulmonary angiogram

169
Q

what is the Westermark-sign/Hampton Hump associated with

A

PE

170
Q

what might be seen on ECG with PE

A

normal
tachycardia
RBBB
inverted T waves in V1-4

171
Q

what is rarely seen on ECG with PE

A

S1Q3T3

172
Q

what is d-dimer

A

fibrin degradation product which is a breakdown product of a clot

173
Q

what does a new murmur and fever indicate until proven otherwise

A

infective endocarditis

174
Q

what is acute infective endocarditis

A

endocarditis on normal valves

175
Q

what is subacute infective endocarditis

A

endocarditis on abnormal valves

176
Q

what is streptococcus viridans infective endocarditis associated with

A

dental work

177
Q

what is s aureus infective endocarditis associated with

A

IVDU

178
Q

what is staphylococcus epidermidis infective endocarditis associated with

A

prosthetic valves

179
Q

what bloods are completed for infective endocarditis

A 
blood culture (x3)
FBC (raised WCC)
raised CRP
180
Q

what imaging is completed for infective endocarditis

A

echo

181
Q

what criteria is used to diagnose infective endocarditis

A

Dukes Criteria

182
Q

what are major positives of Dukes Criteria

A

positive blood culture (2 separate cultures)
positive echo (vegetations)
new valvular regurgitation

183
Q

what are minor positives of Dukes Criteria

A 
predisposition (dental work, IVDU)
fever >38 degrees
vascular or immunological signs (splinter haemorrhages etc)
positive blood culture
positive echo
184
Q

what is more sensitive out of TTE and TOE

A

TOE

185
Q

30 year old women returning from holiday. Sudden onset chest pain with shortness of breath, coughed blood. She has no other lung disease. What investigation would you do to confirm diagnosis?

12-lead ECG
CT Pulmonary Angiogram
D-dimer 
Spirometry
Chest X-ray
A

CT Pulmonary Angiogram

186
Q

A 35 year old lady presents with severe pain in her right calf. She has recently returned from a family holiday in Australia. She is taking no other medication other than the OCP. What investigation would you do first.

INR
Proximal Leg Vein USS
D-dimer 
FBC
Thrombophilia screen
A

D-dimer

187
Q

An 80 year old man with a history of ischaemic heart disease trips over a paving stone & fractures his hip. An ambulance takes him to A&E. 1 hour after arrival, he develops crushing central chest pain. Select the single most appropriate investigation

V/Q Scan
Cardiac Troponin
Chest X-ray
Coronary Angiogram
Transthoracic Echo
A

Cardiac Troponin

188
Q

50 yr old man attends A&E with SOB, fever and hyperdynamic regular pulse of 100. BP 160/60 mmHg. He has a murmur at the left sternal edge. On further enquiry it is found he attended for a routine dental procedure 2 months ago. Which 2 of these investigations could you use to confirm diagnosis.

CT Pulmonary Angiogram
Urinalysis
Blood Cultures 
Fundoscopy
TOE Echocardiogram
A

Blood Cultures

TOE Echocardiogram

189
Q

A lady with no history of a previous heart attack is complaining of swelling in her legs which goes all the way up to her thighs, and she feels may be extending into her lower stomach. She says she feels depressed and thinks these are side-effects of the medications she is on. You notice that she has pulsation in her neck and her face appears engorged.

Echocardiogram
BNP
CT Angiogram
Coronary Angiogram
Chest X-ray.
A

BNP

190
Q

what is the order in which all heart sounds occur

A 
S4
S1 - lub
Split S1
S2 - dub
Split S2
S3
191
Q

what causes HS1

A

closure of mitral and tricuspid valves

192
Q

what causes HS2

A

closure of aortic and pulmonary valves

193
Q

why can HS1 be heard as a split HS1

A

mitral valve closure followed very quickly by tricuspid valve closure

194
Q

why can HS2 be heard as a split HS2

A

closure of aortic valve followed very quickly by pulmonary valve closure

195
Q

what is paradoxical splitting of HS2

A

results from delayed onset or prolongation of LV systole (contraction)

196
Q

what is persistant splitting of HS2

A

results from delayed onset or prolongation of RV systole or shortened LV systole

197
Q

where is the normal HS sequence does HS3 occur

A

following HS2

198
Q

what causes HS3

A

passive LV filling when blood strikes a compliant LV

199
Q

‘tenessee’ is applied to which added HS

A

HS4

200
Q

‘kentucky’ is applied to which added HS

A

HS3

201
Q

where in the normal HS sequence does HS4 occur

A

just before HS1

202
Q

what causes HS4

A

forceful atrial contraction during pre-systole that ejects blood into a hypertrophied ventricle which cannot expand further

203
Q

Which of the following does not cause a systolic murmur?

Atrial septal defect
Ventricular septal defect
Hypertrophic obstructive cardiomyopathy (HOCM)
Aortic regurgitation
None of the above
A

Aortic regurgitation

204
Q

what are pan systolic murmurs

A

regurgitation murmurs
1 triscupid regurgitation
2 mitral regurgitation
3 VSD

205
Q

what are late systolic murmurs

A

valve prolapses

206
Q

what are early diastolic murmurs

A

regurgitation murmurs
1 aortic regurg
2 pulmonary regurg

207
Q

what are mid-diastolic murmurs

A

mitral stenosis

tricuspid stenosis

208
Q 
You perform a cardiovascular examination on an elderly gentleman who reports episodes of collapsing and often wakes up short of breath at night. Upon auscultation you discover an ejection systolic murmur, which radiates to the carotids.
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation 
Mitral stenosis
A

Aortic stenosis

209
Q

where does mitral regurg radiate to

A

axilla

210
Q

where does aortic stenosis radiate to

A

carotids

211
Q

what can aortic stenosis present with

A

SAD
syncope
angina
dyspnoea (exertional or PND)

212
Q

what is notable of the BP in aortic stenosis

A

NPP

213
Q

what would be seen on an ECG with aortic stenosis

A

LVH

214
Q 
A 53-year-old woman with Atrial Fibrillation is reviewed by her cardiologists. On inspection the patients cheeks appear quite flushed. Auscultation reveals a very loud S1 and a mid diastolic murmur. 
Mitral stenosis
Graham Steele
Mitral regurgitation
Aortic regurgitation
Austin Flint
A

Mitral stenosis

215
Q

what is a graham steell murmur

A

associated with pulmonary regurg

early diastolic mumur

216
Q

what is an austin flint murmur

A

severe aortic regurg
turbulent blood hits the anterior leaflets of mitral valve
mid-diastolic mumur

217
Q

what sort of murmur is heard in mitral stenosis

A

mid-diastolic murmur

218
Q

what three features/conditions is mitral stenosis commonly associated with

A

AF
RF
flushed cheeks

219
Q

which HS is loud in mitral stenosis

A

HS1

220
Q 
49-year-old women presents with 3 month history of increasing SOB on exertion. She has no chest pain, cough or ankle swelling. On examination: BP 158/61 and there are crackles at the bases of both lungs. On Auscultation you hear a diastolic decrescendo murmur loudest at the left sternal edge.
Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis
Tricuspid regurgitation
A

Aortic regurgitation

221
Q

what is notable of the BP in aortic regurg

A

WPP

222
Q

what symptoms does aortic regurg present with

A

similar symptoms to HF
SOB
PND
syncope

223
Q

what is notable of the pulse in aortic regurg

A

collapsing pulse AKA corrigans pulse AKA water hammer pulse

224
Q

what is quinckes sign

A

pulsation of the nail beds, associated with AR

225
Q

what is de mussets sign

A

bobbing of the head in synchrony with the heart rate associated with AR

226
Q

what is beckers sign

A

visible pulsations of the retinal arteries and pupils

227
Q

what does the P wave indicate

A

atrial depolarisation

228
Q

what does the PR interval indicate

A

time between beginning of atrial depolarisation and start of ventricular depolarisation

229
Q

what does the QRS indicate

A

depolarisation of ventricles

230
Q

what does the ST segment indicate

A

isoelectric segment representing time between the end of ventricular depolarisation and start of repolarisationw

231
Q

what does the T wave indicate

A

repolarisation of the ventricles

232
Q 
You perform a routine ECG on an elderly man and you find that the PR interval is 210ms in length. What does this recording suggest?
1st Degree Heart Block
Mobitz Type I
Mobitz Type II
Mobitz type B
Complete heart block
A

1st Degree Heart Block

233
Q

what is the definition of 1st degree heart block

A

PR>0.2seconds

234
Q

what are the symptoms associated with second degree heart block

A

syncope

dizziness

235
Q

what is second degree heart block mobitz I (wenkebach)

A

progressive elongation of PR interval until a QRS is dropped

irregular

236
Q

what commonly causes second degree heart block mobitz I?

A

BBs

inferior MI

237
Q

what is second degree heart block mobitz II

A

intermittent non-conducted P waves without progressive prolongation of the PR interval
regular

238
Q

what commonly causes second degree heart block mobitz II?

A

his-purkinje system disease often due to MI

239
Q

what is third degree heart block

A

complete heart block

complete dissociation between the p waves and the QRS complexes

240
Q

what are features of third degree heart block

A

bradycardia

hypotension

241
Q

what propagates the ventricles in third degree heart block

A

accessory pathway called His bundle acts as an independent pacemaker
this accounts for the bradycardia

242
Q 
A 10-year-old boy is brought to A&amp;E with palpitations. On examination his HR is 250. He is later diagnosed with Wolff-Parkinson-White syndrome. Which one of the following is a feature of WPW syndrome?
Severe chest pain
Accessory pathway bundle of Kent
Delta wave on ECG at admission
Long PR intervals
Narrow QRS
A

Accessory pathway bundle of Kent

Delta wave on ECG at admission is only found in sinus rhythm, not in tachycardia

243
Q

what is a supraventricular tachycardia

A

tachycardia arising from above the bundle of His

a re-entry circuit

244
Q

what are the different types of SVT

A

AV nodal reentry tachycardia

AV reentry tachycardia

245
Q

what is AVNRT

A

re-entry circuit around the AV node
tachycardia caused by electrical activity going round and round in the AV node, repeatedly activating and propagating down the ventricular pathways causing ventricular contraction

246
Q

what is AVRT

A

accessory pathway is bundle of kent
this is WPW syndrome
tachycardiac caused by electrical activity going round and round between the atria and the ventricles vias the accesory pathway (bundle of kent)

247
Q

what would be found on ECG with an SVT in tachycardia

A

regular
no p waves
narrow complex tachycardia

248
Q

what would be found on ECG with an SVT in sinus rhythm

A 
short PR interval
AVRT only (WPW syndrome) has a delta wave
249
Q

what is a ventricular tachycardia

A

tachycardia originating in the ventricles

250
Q

how does VT lead to VF

A

VT may impair cardiac output which may result in decreased myocardial perfusion with progression to VF

251
Q

what are signs of ventricular tachycardia on ECG

A

tachycardia

broad QRS

252
Q

what is AF

A

disorganised atrial electrical activity and contraction

253
Q

what is seen on ECG with AF

A

irregularly irregular rhythm
no p waves
fibrillatory waves may be seen

Year 5 Cardiology (42 decks)

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