Cardio

Question 1

cardiac tamponade pulse abnormality

Answer 1

In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus

Upon cardiovascular examination, it is notable that his radial pulse disappears during inspiration.

Question 2

Aortic regurgitation is associated with which syndrome?

Answer 2

Aortic regurgitation is associated with Marfan syndrome

Question 3

Electrical alternans is suggestive of

Answer 3

Electrical alternans is suggestive of cardiac tamponade

Question 4

Aortic stenosis management

Answer 4

Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg

Question 5

NSTEMI (managed conservatively) antiplatelet choice

Answer 5

NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

Question 6

Use rhythm control to treat AF if

Answer 6

Use rhythm control to treat AF if there is coexistent heart failure, first onset AF or an obvious reversible cause

Question 7

Electrical cardioversion is synchronised to which part of the ECG

Answer 7

Electrical cardioversion is synchronised to the R waves

Question 8

Quincke’s sign (nailbed pulsation) is a clinical sign of

Answer 8

Quincke’s sign (nailbed pulsation) is a clinical sign of aortic regurgitation

Question 9

All TIA patients should have which procedure

Answer 9

All TIA patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy

Question 10

In mitral stenosis,…indicates the leaflets still have some mobility

Answer 10

In mitral stenosis, an opening snap indicates the leaflets still have some mobility

Question 11

passmed typical cardiac tamponade presentation

Answer 11

Consider cardiac tamponade in elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma

Question 12

On the cardiology ward round, a 56-year-old man is seen three days post-myocardial infarction. He complains of worsening dizziness when mobilising. An ECG is performed, which shows a heart rate of 43 beats per minute, and features consistent with third-degree heart block.

What blood vessel was most likely to have been affected by his myocardial infarction?

Answer 12

Right coronary artery:
AV block can occur following an inferior MI

right coronary artery supplies AV node

Question 13

angina pectoris drug management

Answer 13

summary: BB or CCB prvention and GTN for symptomatic relief

Question 14

cause of a third heart sound

Answer 14

young patients- normal–> rapid ventricular filling

older patients: can indicate heart failure

Question 15

causes of S4

Answer 15

• (S4) is heard directly before S1.
• always abnormal and rare to hear.
• It indicates a stiff or hypertrophic ventricle and is caused by turbulent flow from that atria contracting against a non-compliant ventricle.

Question 16

Special manoeuvres can be used to emphasise certain murmurs:

Answer 16

Position the patient on their left side for mitral stenosis

Position the patient sat up, leaning forward and holding exhalation for aortic regurgitation

Question 17

mnemonic for describing features of a murmur

Answer 17

Question 18

how do mitral and aortic stenosis affect the heart muscle?

Answer 18

When pushing against a stenotic valve, the muscle has to try harder, resulting in hypertrophy:

Mitral stenosis causes left atrial hypertrophy
Aortic stenosis causes left ventricular hypertrophy

Question 19

how do mitral and aortic regurgitation affect the heart muscle?

Answer 19

When a leaky valve allows blood to flow back into a chamber, it stretches the muscle, resulting in dilatation:

Mitral regurgitation causes left atrial dilatation
Aortic regurgitation causes left ventricular dilatation

Question 20

Mitral stenosis definition

Answer 20

Mitral stenosis is a narrowed mitral valve restricting blood flow from the left atrium into the left ventricle.

Question 21

mitral stenosis murmur features and other signs

Answer 21

• mid-diastolic, low-pitched “rumbling” murmur heard best in expiration due to a low blood flow velocity.
• Loud S1 due to thick valves requiring a large systolic force to shut, then shutting suddenly.
• There is an opening snap after S2, which triggers the onset of the murmur.

other signs:
* Tapping apex beat, which is a palpable, prominent S1
* Malar flush
* Atrial fibrillation

Question 22

Causes of mitral stenosis:

Answer 22

Rheumatic heart disease
Infective endocarditis

Question 23

mitral regurgitation definition and consequence

Answer 23

Mitral regurgitation refers to an incompetent mitral valve, allowing blood to flow back from the left ventricle to the left atrium during systolic contraction of the left ventricle.

The leaking valve causes a reduced ejection fraction and a backlog of blood waiting to be pumped through the left side of the heart, resulting in congestive cardiac failure .

Mitral regurgitation is the second most common indication for valve replacement.

Question 24

signs of mitral regurgitation including murmur features

Answer 24

pan-systolic, high-pitched “whistling” murmur due to high-velocity blood flow through the leaky valve.
The murmur radiates to the left axilla.
You may hear a third heart sound.

Other signs of mitral regurgitation:

• Thrill in the mitral area on palpation
• Signs of heart failure and pulmonary oedema
• Atrial fibrillation (irregularly irregular pulse)

Question 25

Causes of mitral regurgitation:

Answer 25

* Idiopathic weakening of the valve with age * Ischaemic heart disease * Infective endocarditis * Rheumatic heart disease * Connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome

Question 26

Aortic stenosis definition

Answer 26

Aortic stenosis is the most common valvular heart disease and the most common indication for valve replacement surgery. It refers to narrowing of the aortic valve, restricting blood flow from the left ventricle to the aorta.

Question 27

Aortic stenosis signs and murmur features

Answer 27

**ejection-systolic, high-pitched murmur** due to the high blood flow velocity through the aortic valve. This has a **crescendo-decrescendo** character due to the speed of blood flow across the value during the different periods of systole. Flow during systole is slowest at the start and end and fastest in the middle. The murmur **radiates to the carotids** as the turbulence continues into the neck Other signs of aortic stenosis: * Thrill in the aortic area on palpation * Slow rising pulse * Narrow pulse pressure (the difference between systolic and diastolic blood pressure) * Exertional syncope (lightheadedness and fainting when exercising) due to difficulty maintaining a good flow of blood to the brain

Question 28

causes of aortic stenosis

Answer 28

* Idiopathic age-related calcification (by far the most common cause) * Bicuspid aortic valve * Rheumatic heart disease

Question 29

Aortic regurgitation definition

Answer 29

Aortic regurgitation refers to an incompetent aortic valve, allowing blood to flow back from the aorta into the left ventricle.

Question 30

aortic regurgitation signs and murmur features

Answer 30

**early diastolic, soft murmur** It can also cause an **Austin-Flint murmur**. This is heard at the apex as a diastolic “rumbling” murmur. This is caused by blood flowing back through the aortic valve and over the mitral valve, causing it to vibrate. Other signs of aortic regurgitation: * Thrill in the aortic area on palpation * Collapsing pulse * Wide pulse pressure * Heart failure and pulmonary oedema * Quincke's sign (nailbed pulsation) * De Musset's sign (head bobbing)

Question 31

Causes of aortic regurgitation:

Answer 31

* Idiopathic age-related weakness * Bicuspid aortic valve * Connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome

Question 32

Tricuspid regurgitation definition

Answer 32

Tricuspid regurgitation refers to an incompetent tricuspid valve, allowing blood to flow back from the right ventricle to the right atrium **during systolic contraction** of the right ventricle.

Question 33

tricuspid regurgitation signs and murmur features

Answer 33

* **pan-systolic murmur**. There is a **split second heart sound** due to the pulmonary valve closing earlier than the aortic valve, as the right ventricle empties faster than the left ventricle. Other signs of tricuspid regurgitation: * Thrill in the tricuspid area on palpation * Raised JVP with giant C-V waves (Lancisi’s sign) * Pulsatile liver (due to regurgitation into the venous system) * Peripheral oedema * Ascites

Question 34

Causes of tricuspid regurgitation

Answer 34

* Pressure due to left-sided heart failure or pulmonary hypertension (“functional”) * Infective endocarditis * Rheumatic heart disease * Carcinoid syndrome * Ebstein’s anomaly * Connective tissue disorders, such as Marfan syndrome

Question 35

Pulmonary stenosis definition

Answer 35

Pulmonary stenosis is a narrowed pulmonary valve, restricting blood flow from the right ventricle into the pulmonary arteries.

Question 36

Pulmonary stenosis signs and features of the murmur

Answer 36

**ejection systolic murmur loudest in the pulmonary area** with deep inspiration. There is a widely** split second heart sound**, as the left ventricle empties much faster than the right ventricle. Other signs of pulmonary stenosis: * Thrill in the pulmonary area on palpation * Raised JVP with giant A waves (due to the right atrium contracting against a hypertrophic right ventricle) * Peripheral oedema * Ascites

Question 37

Pulmonary stenosis causes

Answer 37

Pulmonary stenosis is usually congenital and may be associated with: * Noonan syndrome * Tetralogy of Fallot Tetralogy of Fallot is a congenital condition where there are four coexisting pathologies: * Ventricular septal defect (VSD) * Overriding aorta * Pulmonary valve stenosis * Right ventricular hypertrophy

Question 38

Aortic regurgitation management

Answer 38

medical management of any associated heart failure surgery: aortic valve indications include: * symptomatic patients with severe AR * asymptomatic patients with severe AR who have LV systolic dysfunction

Question 39

aortic stenosis management

Answer 39

Question 40

mitral stenosis management

Answer 40

Question 41

mitral regugitation investigations and management

Answer 41

Question 42

most common cause of mitral stenosis

Answer 42

rheumatic fever

Question 43

Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of

Answer 43

Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit - by far the most common cause is atherosclerotic disease in arteries supplying the GI tract

Question 44

cardiac tamponade triad

Answer 44

Beck's triad: hypotension raised JVP muffled heart sounds

Question 45

AAA diameter diagnosis

Answer 45

Question 46

Critical limb ischaemia presents as

Answer 46

Critical limb ischaemia presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia