MLA Cardiology

Question 1

What is a Q wave on an ECG?

Answer 1

A negative deflections before the QRS complex

It’s a sign of present/ old MI

Question 2

What does ST elevation indicate?

Answer 2

A complete occlusion of the epicardial coronary artery

An NSTEMI is a partial occlusion

Question 3

What is primary percutaneous intervention (PCI)?

Answer 3

AKA angioplasty with stent
- It opens up the coronary arteries

Question 4

What is unstable angina?

Answer 4

When there is no evidence of myocardial damage or raised troponin yet the patient will suffer with:
- prolonged (>20 minutes) angina at rest
- new onset of severe angina
angina that is increasing in frequency, longer in duration, or lower in threshold
- angina that occurs after a recent episode of myocardial infarction

Question 5

What is peripheral arterial disease?

Answer 5

A build-up of fatty deposits in the arteries restricts blood supply to leg muscles

Question 6

When does screening for AAA begin?

Answer 6

When the man turns 65

Question 7

What are key symptoms of an AAA?

Answer 7

Pulsing in the stomach
Nausea/vomiting
clammy skin

Question 8

What are the key symptoms of an aortic dissection?

Answer 8

A sudden severe pain felt mostly at the back between the shoulder blades

Question 9

What is the presentation of aortic stenosis disease on examination?

Answer 9

(Left heart disease)

Reduced S2
Ejection systolic murmur, loudest at aortic area
Radiates to the carotids

Question 10

What is the presentation of mitral regurgitation of examination?

Answer 10

(Right heart disease)

Pansystolic murmur, loudest at mitral area
Radiates to the axilla

Question 11

What is the most common valve disease?

Answer 11

Mitral valve regurgitation

Question 12

What are some causes of aortic valve disease?

Answer 12

Rheumatic fever
Endocarditis
Marfan syndrome
Syphilis
Rheumatoid arthritis
Systemic lupus erythematosus, Ankylosing spondylitis
High blood pressure

Question 13

What are some causes of mitral valve disease?

Answer 13

Age
Rheumatic fever
Autoimmune disease like SLE
Endocarditis
MI’s

Question 14

What are arterial ulcers?

Answer 14

Usually occur in legs and feet due to inadequate blood flow

Question 15

What is the difference between essential and secondary hypertension?

Answer 15

Essential: no cause

Secondary: clear, fixable cause

Question 16

What are some presentations of heart failure?

Answer 16

SOB on activity/ laying flat
Fatigue
Oedema

Question 17

How does haemochromatosis affect the heart?

Answer 17

The excess iron can build up and damage the muscles and vessels to cause heart failure and arrhythmias

Question 18

How is haemochromatosis diagnosed?

Answer 18

Iron studies
Abnormal liver enzymes

Question 19

What is the pathophysiology of myocarditis?

Answer 19

When the heart muscle becomes inflamed

Caused by common infections

Question 20

What is pericardial disease?

Answer 20

Inflammation of the sac that contains the heart
Usually goes away by itself, but can be life threatening

Caused by common infections

Question 21

What is the classic presentation of a PE?

Answer 21

Abrupt onset of pleuritis chest pain, SOB, and hypoxia

Question 22

What is pleuritic chest pain?

Answer 22

Pain on inspiration

Question 23

What are some causes of pulmonary hypertension?

Answer 23

Heart failure
PE
HIV
Autoimmune damage to the lungs

Question 24

What type of stroke is most common?

Answer 24

Ischaemic stroke (80%)

Question 25

How does atrial fibrillation present on ECG?

Answer 25

Irregularly irregular with no P waves

Question 26

What is atrial flutter?

Answer 26

When the atria beat too quickly Caused by hight bp, congenital, lung disease, thyroid disease, diabetes, alcoholism

Question 27

How does atrial flutter present on an ECG?

Answer 27

Flutter lines with no isoelectric lines between QRS complexes 'saw-tooth' pattern

Question 28

What is AV node re-entrant tachycardia (AVNRT)?

Answer 28

An arrhythmia caused by a re-entry circuit confined to the AV node and perinodal atrial tissue A type of supraventricular tachycardia

Question 29

What are the different types of supraventricular tachycardia?

Answer 29

Focal: - Sinus - Atrial - Multifocal atrial - functional Re-entry: - Atrial flutter - Atrial fibrillation - AVNRT - Atrio-ventricular

Question 30

What is the management of focal tachycardias?

Answer 30

Treat with meds like beta-blockers, ivabradine, or calcium channel blockers Or treat cause like sepsis

Question 31

How are re-entry tachycardias managed?

Answer 31

Rate or rhythm control with meds like beta-blockers, calcium channel blockers, digoxin, amiodarone, or flecainide Offer ablation for cure

Question 32

What is the clinical presentation of a supraventricular tachycardia?

Answer 32

Anxiety, palpitations, chest discomfort, light-headedness, syncope, dyspnoea

Question 33

What is a ventricular tachycardia?

Answer 33

High HR that prevents blood from circulating to the body and can cause death by cardiac arrest

Question 34

How does ventricular fibrillation present on an ECG?

Answer 34

Disorganised electrical activity with no identifiable QRS complexes It will develop into asystole if not treated

Question 35

What is pulseless ventricular tachycardia?

Answer 35

When the contractions of the heart are so rapid that the heart doesn't have time to fill causing an undetectable pulse It's a shockable rhythm

Question 36

What is Torsade de pointes?

Answer 36

A type of ventricular tachycardia characterised by long QT interval Usually caused by electrolyte imbalances

Question 37

What causes heart block?

Answer 37

AV node blocking drugs like beta-blockers, calcium channel blockers, and digoxin Or idiopathic degeneration of the conducting system

Question 38

What are the different types of heart block?

Answer 38

1st degree: consistent PR interval >0.20s 2nd degree type 1: progressive PR interval prolongation until a QRS is dropped 2nd degree type 2: consistent PR interval with intermittently dropped QRS 3rd degree: no communication between atria and ventricles

Question 39

What is the clinical presentation of heart block?

Answer 39

first degree and 2nd type 1 are usually asymptomatic second degree and 3rd may present with palpitations, syncope, confusion, SOB, chest pain

Question 40

What is the management of heart block?

Answer 40

- Stop AV node blocking drugs - If symptomatic, may require pacemaker insertion 3rd degree urgently requires pacing or permanent pacemaker

Question 41

What is sick sinus syndrome?

Answer 41

Causes a slow HR and pauses or irregular beats Requires a permanent pacemaker

Question 42

What are the different types of heart failure?

Answer 42

Systolic (reduced ejection fraction) - Muscle is too weak to pump enough blood Diastolic (preserved ejection fraction) - muscle is too stiff to relax and fill with blood

Question 43

What is the clinical presentation of pericarditis?

Answer 43

Pain centrally or on left Worse on coughing, lying down, or taking a deep breath

Question 44

What are some causes of pericarditis?

Answer 44

Infection (normal + HIV,TB) Autoimmune (lupus, rheumatoid arthritis) Meds like blood thinners Cancer Immune mediated