Meeran Finals Day - Cardiology

Question 1

infective endocarditis

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3 hand signs
1 chest sign
2 abdominal signs
1 systemic sign
4 bonus signs
~~~

Answer 1

hand - clubbing, splinter haemorrhages, petechiae

changing / new heart murmur

abdo - splenomegaly, microscopic haematuria

fever

(Roth spots, Janeway lesions, Osler’s nodes, arthralgia)

Question 2

main 2 causes of infective endocarditis

Answer 2

viridans strep

staph after IV drug use

Question 3

summarise acute rhematic fever

5 main criteria

Answer 3

Carditis
Erythema marginatum
Subcutaenous Nodules 
Polyarthritis 
Sydenham's chorea

Question 4

what is acute rheumatic fever?

Answer 4

occurs following strep throat or scarlet fever

nowadays would only occur if these weren’t treated well
rasied ASO, group A strep (pyogenes)

Question 5

why is rheumatic fever relevant?

Answer 5

chronically can cause heart murmurs (MS, AR)

Question 6

7 key features of mitral stenosis

Answer 6

malar flush
middle aged female
AF
tapping apex
non displaced apex
right ventricular heave
blowing mid diastolic murmur

Question 7

3 features of mitral stenosis CXR

Answer 7

straightening of atrial appendage / aortic arch due to dilatation of left atrium

widespread pulomonary oedema

evidence of haemosiderosis

Question 8

mitral regurgitation 6 features from slides

Answer 8

displaced apex
apical thrill
quiet first heart sound 
pansytolic murmur with axillary radiation
S3 present (rapid ventricular filling)
check for valvulotomy scar

Question 9

9 features of aortic regurgitation

Answer 9

collapsing pulse
Corrigan's sign (visible neck pulsation)
De Musset's sign (head nods with pulse)
Quincke's sign (capillary bed pulsation)
dynamic apex
end diastolic murmur louder leaning forward
systolic flow murmur 

patient may be marfanoid, ank spond, reactive arthritis

Question 10

give a selection of causes of AF (7 to be found!)

Answer 10

ischaemic heart disease
rheumatic heart disease
thyrotoxicosis 
PE
cardiomyopathy
cancer of the bronchus 
alcohol

Question 11

AF 3 key ECG findings

Answer 11

irregularly irregular rhythm with narrow QRS complexes and absent p waves

Question 12

left bundle branch block ECG findings, view the ECG too

Answer 12

loose W shape in v1, loose M shape in v6

also:
widening of QRS
loss of R wave progression
upward QRS deflection lead 1 + left chest leads (v4-6)
downward QRS deflection in right chest leads (v1-3)

picture why!!

Question 13

right bundle branch block ECG findings, view the ECG too

Answer 13

loose M shape in v1, loose W shape in v6

also:
widening of QRS
downward QRS deflection in left chest leads (v4-6)+ lead 1
upward QRS deflection in right chest leads (v1-3)

Question 14

pericarditis ECG, view the ECG too

Answer 14

ST elevation across most leads with PR depression

Question 15

explain the groupings of the ECG leads in terms of which view of the heart they offer

Answer 15

II, III, and aVF: inferior surface of the heart

V1 to V4: anterior surface

I, aVL, V5, and V6: lateral surface

V1 and aVR: right atrium and cavity of left ventricle

Question 16

view first degree heart block ECG, say what you’re expecting and ensure can identify

Answer 16

-

Question 17

view second degree Mobitz 1 heart block ECG, say what you’re expecting and ensure can identify

Answer 17

-

Question 18

view second degree Mobitz 2 heart block ECG, say what you’re expecting and ensure can identify

Answer 18

-

Question 19

view third degree heart block ECG, say what you’re expecting and ensure can identify

Answer 19

-

Question 20

summarise MI treatment + complications

Answer 20

sit up, o2 only if sats low
Beta blocker unless HF
Aspirin 300mg stat
Ticragrelor 180mg stat
Morphine 5-10mg 
Anticoagulate (enoxaparin 1mg/kg)
Nitrates - GTN 

STEMI obviously has PCI or if not had one in 2 hours, give alteplase thromobolysis agent

Question 21

complications of MI

Answer 21

arrhythmias
heart failure
embolism
pericarditis 
aneurysm
rupture of muscle / valve

6 weeks post - Dressler’s

Question 22

late changes in MI ECG

Answer 22

pathological Q waves after 6 hours (look up pic)

T wave inversion after ST normalises

Question 23

look at PE imaging

Answer 23

angiogram
VQ scan
CTPA

Question 24

ECG changes in PE

Answer 24

sinus tachycardia
right ventricular strain pattern (T inversion in v1-4)
clockwise rotation in R/S transition point

(the ‘classic’ but rare thing is S1Q3T3)

look up if can’t picture

Question 25

define cardiogenic shock

Answer 25

acute heart failure leading to inability to perfuse heart+brain

Question 26

define shock

Answer 26

severe life-threatening hypotension

Question 27

define heart failure

Answer 27

cardiac output insufficient to meet tissue demands

Question 28

SVT

Answer 28

narrow complex tachycardia

adenosine