cardio important

Question 1

Diagnosis of DVT

Answer 1

Ultrasound

D-Dimer if US negative

Question 2

Treatment DVT

Answer 2

apixaban/rivaroxaban first line

OR LMWH hep followed by dabigatran/edoxaban

Question 3

Aortic dissection signs/symptoms

Answer 3

• intense TEARING chest pain radiating to back
• nausea/vomiting
• ascending aortic dissections can cause aortic regurgitation

Question 4

diagnosis Aortic dissection

Answer 4

• CT angiography if haemodynamically stable
• Transesophageal Echo if haemodynamically unstable
• CXR: WIDENING of mediastinum

Question 5

Peripheral vascular disease symptoms

Answer 5

• claudication on exertion/elevation of limb
• ulceration
• colour changes

Question 6

peripheral vascular disease diagnosis

Answer 6

• Doppler US = first line
• bruit makes whoosing sound (listen with stethoscope)
• Ankle-brachial index- symptoms begin if ABPI is less than 0.9 (rest pain seen if 0.2-0.4, gangrene= up to 0.4)

Question 7

medical treatment for peripheral vascular disease

Answer 7

statin + clopidogrel

Question 8

hypertension management:

Answer 8

• Patient <55 y/o or DM:
  step 1: ACE-i/ARB
  step 2: add CCB OR Thiazide-like diuretic
  step 3: add Diuretic/CCB (whichever not added already)
• Patient >55 y/o or afro-Caribbean:
  step 1: CCB
  step 2: add Ace-i/ARB
  step 3: add Diuretic

step 4: if potassium<4.5mmol/L add spironolactone, if potassium >4.5mmol/L add beta blocker

Question 9

what is wolff-parkinson-white? What would you see on ECG? Treatment?

Answer 9

• cardiac arrhythmia caused by accessory pathway connecting atria and ventricles.
• Would see short PR interval + delta wave
• treatment: radiofrequency ablation of accessory pathway, sotalol/amiodarone/flecainide

Question 10

what electrolyte channel is associated with long-Qt syndrome

Answer 10

l-type calcium channels let in more calcium so membrane potential is more positive and harder to repolarise

Question 11

what can be the consequence of long-Qt syndrome

Answer 11

Torsade de pointes- a type of ventricular tachycardia. Can lead to sudden death

Question 12

S3 (third heart sound) pathological causes

Answer 12

left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

Question 13

Pulmonary valve location

Answer 13

Left second intercostal space, at the upper sternal border

Question 14

Aortic valve location

Answer 14

Right second intercostal space, at the upper sternal border

Question 15

Mitral valve location

Answer 15

Left fifth intercostal space, just medial to mid clavicular line

Question 16

Tricuspid valve location

Answer 16

Left fourth intercostal space, at the lower left sternal border

Question 17

S4 heart sound

Answer 17

forced atrial contraction due to stiffened ventricle which may be due to e.g. ventricular hypertrophy

Question 18

ejection systolic murmur causes

Answer 18

aortic stenosis
pulmonary stenosis, hypertrophic obstructive cardiomyopathy
atrial septal defect, tetralogy of Fallot

Question 19

Holosystolic (pansystolic) murmur causes

Answer 19

mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)
ventricular septal defect (‘harsh’ in character)

Question 20

Late systolic murmur causes

Answer 20

mitral valve prolapse

coarctation of aorta

Question 21

Early diastolic murmur causes

Answer 21

aortic regurgitation (high-pitched and 'blowing' in character)
Graham-Steel murmur (pulmonary regurgitation, again high-pitched and 'blowing' in character)

Question 22

Mid-late diastolic murmur causes

Answer 22

mitral stenosis ('rumbling' in character)
Austin-Flint murmur (severe aortic regurgitation, again is 'rumbling' in character)

Question 23

Continuous machine-like murmur cause

Answer 23

patent ductus arteriosus (may be accompanied by bounding pulse)

Question 24

aortic regurgitation signs

Answer 24

• collapsing pulse
• early decrescendo diastolic murmur
• BOUNDING PULSE - if severe can have head-bobbing and capillary beds of fingernails pulsate

Question 25

aortic stenosis signs

Answer 25

- ejection click - crescendo-descendo murmur (ejection systolic murmur) - slow rising small-volume pulse (best felt at carotid) - can have syncope - if blood restricted to coronary arteries, can cause angina. Can also lead to microangiopathic haemolytic anaemia

Question 26

most common cause of mitral valve stenosis

Answer 26

rheumatic fever most commo (can also be caused by left heart failure + damage to papillary muscles)

Question 27

mitral valve stenosis can cause

Answer 27

- pulmonary oedema- caused by blood backing up into pulmonary circulation (symptoms like dyspnoea) - right heart failure - dysphagia (left atrium gets too big and compresses oesophagus)

Question 28

aortic regurgitation signs

Answer 28

- collapsing pulse - visible carotid pulsation - head nodding with each pulse - loud femoral bruit

Question 29

acute rheumatic fever causative organanism

Answer 29

Streptococci

Question 30

acute rheumatic fever symptoms

Answer 30

- sort throat (1-5 weeks prior) - fever, abdominal pain, epistaxis (nosebleed) - polyarthritis starting in lower limbs (Due to joint swelling) - chorea (jerky involuntary movements)- difficulty writing and speaking, hyperextension of joints and diminished tendon reflexes, tongue fasciculation and relapsing grip - erythema marginatum- rash with outlines on trunk and limbs - subcutaneous nodules

Question 31

aschoff bodies

Answer 31

nodules found in the heart in patients with RHEUMATIC FEVER

Question 32

treatment acute rheumatic fever

Answer 32

IV benzylpenicillin 600mg iv stat, then penicillin 250mg/6h PO

Question 33

what is eisenmenger syndrome?

Answer 33

when the blood flow through original left-right cardiac shunt becomes reversed or bidirectional. It is a result of reactive pulmonary hypertension causing pulmonary pressure to exceed systemic pressure.

Question 34

Tetralogy of fallot- 4 components

Answer 34

1- pulmonary stenosis 2 - VSD 3 -overriding aorta 4- Right ventricular hypertrophy

Question 35

Drugs to be avoided in heart failure

Answer 35

- NSAIDs (ibuprofen, diclofenac, aspirin (not low dose), naproxen) - CCBs - diltiazem or verapamil -

Question 36

Heart failure- acute management

Answer 36

- oxygen - IV loop diuretics (e.g. furosemide) - opiates - vasodilators (hydralazine combined with nitrates) - ACEi/ARB, beta blockers, spironolactone (PRIMARY TREATMENT) - mechanical circulatory assistance - continuous positive airway pressure - inotropes (digoxin)

Question 37

NYHA classification of heart failure

Answer 37

Class I: no limitation of physical activity Class II: slight limitation of physical activity- symptoms with ordinary levels of exertion e.g. walking up stairs Class III: marked limitations on physical activity- symptoms with minimal levels of exertion (e.g. dressing) Class IV: symptoms at rest

Question 38

diagnosis heart failure

Answer 38

- CXR- pulmonary venous congestion, interstitial oedema, cardiomegaly - Echo- identifies any pericardial effusion/cardiac tamponade - BNP raised >100ml/litre

Question 39

typical symptoms and signs of heart failure

Answer 39

1- triad symptoms: SOB on exertion and rest, fatigue 2- signs: tachycardia, tachypnoea, raised jugular venous pressure, peripheral oedema & pulmonary congestion

Question 40

clinical features of chronic constrictive pericarditis

Answer 40

- Kussmauls sign (paradoxical rise in JVP on inspiration) - Freidrich's sign- raised JVP with sharp rise and y descent - pulsus paradoxus- abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. - Systemic venous congestion (ascites, oedema, hepatomegaly, raised JVP - Pulmonary venous congestion (dyspnoea, cough, orthopnoea, PND) - Reduced cardiac output (fatigue, hypotension, reflex tachycardia) - Rapid ventricular filling (pericardial knock) - Atrial dilation

Question 41

treatment for pericarditis

Answer 41

Bed rest + oral NSAIDs Aspirin for patents with recent MI Corticosteriods only for those with known immune cause because their use is linked to pericarditis recurrence

Question 42

angina pectoris management

Answer 42

- aspirin + statin - GTN to abort angina attacks - FIRST LINE beta blocker or calcium channel blocker (if both used then use nifedipine, if only CCB then use verapamil or diltiazem- NEVER GIVE VERAPAMIL WITH BETA BLOCKER AS RISK COMPLETE HERT BLOCK) - if monotherapy of BB or CCB not working, give both

Question 43

AF treatment

Answer 43

- patient not haemodynamically stable: DC cardioversion - patient haemodynamically stable: no history of ischaemic heart disease and patient under 65, fleccanide and second line amiodarone if history of ischaemic heart disease or over 65, then give beta blockers and second line digoxin

Question 44

management of torsades de pointes

Answer 44

IV magnesium sulfate

Question 45

ECG changes in leads

Answer 45

- V1-V4= left anterior descending (anterior MI) - I, V5-V6= left circumflex (lateral MI) - II, III, aVF= right coronary (inferior MI)