TCD questions

Question 1

A 25 year old lady comes to see her GP with symptoms consistent with myocardial ischaemia. Her GP uses the NICE guidelines to work out her risk of coronary artery disease is 10%. What might be the cause of her myocardial ischaemia? (Choose ALL that apply)

• Aortic Stenosis .
• Anaemia .
• Cocaine abuse .
• Hypertrophic Obstructive Cardiomyopathy (HOCM) .

Answer 1

Answer: All. A severe stenosis in the aortic valve causes poor blood flow out of the heart which can result in poor filling of the coronary arteries (which arise after the aortic valve from the aorta) and myocardial ischaemia. Cocaine is a powerful vasoconstrictor and can cause severe coronary artery spasm resulting in myocardial ischaemia and necrosis. Severe anaemia can cause poor oxygenation of cardiac muscle resulting in ischaemia. HOCM is a disorder which causes cardiac muscle to hypertrophy (overgrow). Hypertrophy of the interventricular septum can obstruct blood flow and cause poor filling of the coronary arteries and myocardial ischaemia. A severe stenosis in the aortic valve causes poor blood flow out of the heart which can result in poor filling of the coronary arteries (which arise after the aortic valve from the aorta) and myocardial ischaemia.

Question 2

What are the ECG criteria to diagnose a ST elevation MI?

• New LBBB.
• New RBBB.
• > /= 1 mm ST elevation in leads V4 and V5 .
• > /= 1mm ST elevation in leads II and III .

Answer 2

Answer: New left bundle branch block and >/= 1mm ST elevation in leads II and III.

Question 3

Are the statements below about the cardiac rehabilitation programme after a myocardial infarction, true or false?

1. Patients should be offered stress management including cognitive behavioural therapy
   □ True
   □ False
2. Patients should be advised not to drive for 1 year
   □ True .
   □ False .
3. Patients should be advised not to fly
   □ True .
   □ False .
4. The physical demands of the patient’s employment should be taken into account when advising when they should return to work.
   True .
   False .

Answer 3

Answer 1: False. Patients should be offered stress management but not complex psychological interventions, such as cognitive behavioural therapy routinely

Answer 2: False. Patients should be advised to seek the latest advice from the DVLA.

Answer 3 : False. patients should seek advice from the civil aviation authority

Answer 4: True

Question 4

Match these descriptions of cardiac murmurs to the valve lesion?
1. Ejection systolic murmur heard loudest in the aortic area radiating to the carotids.

2. Mid-diastolic rumbling murmur, heard best with the bell of the stethoscope at the apex with the patient in the left lateral position.
3. Pansystolic murmur heard loudest at the apex of the heart radiating to axilla.
4. Early diastolic murmur heard best at the left 4th intercostal space with the patient sat forward in expiration

Answer 4

1. Aortic stenosis
2. Mitral stenosis
3. Mitral regurgitation
4. Aortic regurgitation