Cardio

Question 1

Hand signs in cardio exam

Answer 1

Quinckes sign
Osler nodes
Janeway lesion
Splinter haemorrhages
Clubbing
BM marks

Question 2

What looking for in eyes cardio exam

Answer 2

Fundoscopy for papilloedema and roth spots
Corneal arcus
Xanthelasma
Conjunctival pallor

Question 3

What looking for in mouth and face

Answer 3

Poor dental hygiene
High arched palate
Central cyanosis
De moussets sign
Flushing for MS

Question 4

What looking for in clubbing

Answer 4

To see if loss of schamroth window

Question 5

What to look for in inspection of chest in cardiac exam

Answer 5

Pacemaker
Sternotomy
Thoracotomy scars in particular under armpits

Question 6

In palpation of chest in cardio what need to do

Answer 6

Feel for apex beat and map out with fingers the location
Heaves- place palm of hand over left sternal edge- will show RVH if feel arm lifted
Thrills- place flats of fingers over each valve location with hand horizontal

Question 7

Difference in loudness of systolic vs diastolic

Answer 7

Systolic are loud whereas diastolic soft

Question 8

What does patient in AF point towards valve wise

Answer 8

Mitral valve pathology

Question 9

Most likely causes of absent left radial pulse

Answer 9

AV fistula
Radial artery graft
Not dissection and coarctation

Question 10

What happens to apex beat in hypertrophic vs diastolic ventricular disease

Answer 10

Hypertrophic- strong and heaving apex
Dilated- displaced

Question 11

Midline sternotomy indications

Answer 11

Open valve replacements
CABG
Transplant
Corrective of congenital defects

Question 12

Complications of midline sternotomy

Answer 12

Poor healing of scar in area
Chronic chest pain

Question 13

How manage a patient with chest pain

Answer 13

Related to heart, lungs, GI tract, musculoskeletal or anxiety
In terms of identifying which of these is cause work through
A-E assessment, salient points within assessment
B- sats, RR, examining lungs, CXR, ABG if struggling with breathing
C- BP, HR and ECG. Listening to heart more cardiac features Bloods importantly looking for troponin, BNP, perhaps FBC, identify anaemia or inflammatory markers, cultures for sepsis

Question 14

Causes of chest pain

Answer 14

Cardiac
- coronary problems
- valvular
- heart muscle- inflammation, infection or structural defect from cardiomyopathy
Resp
- PE, pneumonia, pneumothorax, effusion
GI
- boerhaves
- oesophagitis
- stomach pathologies
Musc
- costochondritis
- pulled muscle
- broken ribs

Question 15

Mitral regurg causes

Answer 15

Acute- infective such as IE, RF, post MI
Congenital- marfans, ehlers danlos, mitral valve prolapse in turners

Question 16

Mitral regurgitation mangement

Answer 16

Options vary from conservative where can follow-up patients who are asymptomatic or those who are not candidates for surgery
Medical treatment of heart failure or atrial fibrillation. For heart failure acei and beta blockers. for atrial fibrillation long term warfarin or rate control
Consider surgery in patients who are candidates and symptomatic, reduced LVEF (60%), pulmonary HTN, atrial fibrillation, end systolic diameter of left atrium

Question 17

Complications of valve replacements

Answer 17

Short term associated with procedure
- infection
- bleeding
- anaesthetic side effects
- DVT
- stroke
- arrythmias

Question 18

If had mitral valve replacement what will hear

Answer 18

S1 will be replaced with click

Question 19

If had aortic valve replacement what will hear

Answer 19

S2 will be replaced with click

Question 20

When do aortic valve replacement for aortic stenosis

Answer 20

Symptomatic and aortic gradient over 40mm of mercury, reduced LVEF under 60%, aortic valve area under 1cm
Asymptomatic and BNP raised to 2x limit, valve area under 0.6cm, LVEF under 55%

Question 21

Causes of aortic stenosis

Answer 21

Congenital- williams syndrome, bicuspid valve
Acquired- calcification worsened by CKD, DM and high lipids, endocarditis and RF, sclerosis

Question 22

Valve operations done for aortic stenosis

Answer 22

Open heart surgery with mechanical valves
Transcatheter aortic valve implant with bioprosthetic valves
Valve balloon valvulotomy in palliative patients

Question 23

Management of aortic stenosis

Answer 23

Conservative with regular follow up in asymptomatic patients with normal function and echo parameters. Symptomatic and unfit for surgery
Medical heart failure
Surgery if candidate and
Symptomatic and aortic gradient over 40mm of mercury, reduced LVEF under 60%, aortic valve area under 1cm
Asymptomatic and BNP raised to 2x limit, valve area under 0.6cm, LVEF under 55%

Question 24

Complications of mechanical heart valves

Answer 24

Haemolytic anaemia
Thrombous requiring warfarin with INR target 3.5 which higher than AF
Endocarditis

Question 25

Atrial fibrillation management

Answer 25

Initially depends on stability- HF, shock, collapse then cardiovert
Rhythm or rate control. Rhythm if
- under 48 hours
- causing HF
- identifiable cause
CHADVASC and ORBIT

Question 26

Options for rhythm control

Answer 26

DC cardioversion
Flecainide
Amiodarone

Question 27

Rate control AF options

Answer 27

Beta blockers
CCB like verapamil
Digoxin

Question 28

ICD indications

Answer 28

Previous VT/VF
Long QT
HOCM/arrythmogenic right ventricular cardiomyopathy

Question 29

Pacemaker indications

Answer 29

Symptomatic bradycardia
T2 mobitz or complete HB
Severe HF
Sick sinus
Ablation at AVN

Question 30

What are types of pacemaker

Answer 30

Single chamber in either RA or RV
Dual in both
Triple therapy

Question 31

Scar for pacemaker

Answer 31

Sub-clavicular scar

Question 32

Types of mechanical valve

Answer 32

Starr edwards
Tilting disc
St jude

Question 33

If had previous valve repalcement what do for next investigations

Answer 33

Review notes and imaging
ECG