Cardio

Question 1

ECG ST elevation in II, III and avF - which artery and territory?

Answer 1

inferior - right coronary

Question 2

ECG ST elevation in I, AVL, V5 and V6 - which artery and territory?

Answer 2

lateral - left circumflex, distal LAD or right coronary

Question 3

ECG ST elevation in V1 and V2 - which artery and territory?

Answer 3

septal - proximal LAD

Question 4

ECG ST elevation in V3 and V4 - which artery and territory?

Answer 4

anterior - proximal LAD

Question 5

ACS - which drugs?

Answer 5

M - morphine (+ antiemetic e.g. metoclopramide)
O - oxygen
N - Nitrates
A - aspirin 300mg

Question 6

Describe aortic stenosis in murmur terms?

Answer 6

• ejection systolic
• best heard in right sternal edge - louder on expiration.
• radiates to carotids/apex

Question 7

Signs of aortic stenosis?

Answer 7

• Slow-rising pulse
• Narrow pulse pressure
• Heaving apex beat (pressure-loaded)
• Soft or absent S2 (depending on AS severity)
• May be signs of LVF (S3, pulmonary oedema)

Question 8

Describe mitral regurgitation in murmur terms?

Answer 8

• Character: pansystolic
• Best heard: apex; loudest on expiration
• Radiation: left axilla

Question 9

Signs of mitral regurgitation?

Answer 9

• AF
• Displaced thrusting apex (volume-loaded)
• Soft S1
• Signs of pulmonary hypertension (RV heave, loud P2)
• May be signs of LVF (S3, pulmonary oedema)

Question 10

How to differentiate tricuspid regurgitation from mitral regurgitation?

Answer 10

• louder on inspiration because it’s on the right
• Giant JVP
• Non-displaced apex

Question 11

Describe aortic regurgitation in murmur terms?

Answer 11

• Character: Early diastolic (sounds like a breath)
• Best heard: upper right sternal edge (or lower left sternal edge sitting forwards); loudest on expiration

Question 12

Signs of aortic regurgitation?

Answer 12

• Collapsing pulse
• Wide pulse pressure
• Very displaced thrusting apex (volume-loaded)

Question 13

Describe mitral stenosis in murmur terms?

Answer 13

• Character: low rumbling mid-diastolic with opening snap
• Best heard: apex in left lateral position; loudest on expiration using bell of stethoscope

Question 14

Signs of mitral stenosis?

Answer 14

• Malar flush (due to low cardiac output)
• AF
• Tapping apex (palpable S1)
• Loud S1
• Signs of pulmonary hypertension (RV heave, loud P2)

Question 15

ECG ST elevation in V4-5, I and avL - what kind of which artery?

Answer 15

anterolateral, left anterior descending or left circumflex

Question 16

How does a posterior MI look on ECG?

Answer 16

Dominant R wave V1-2, horizontal ST↓ V1-3