Cardio

Question 1

A 22 yr old man presents for a check up and you hear a left scapula bruit
Dx?

Answer 1

scapula bruit = coarctation of the aorta

Question 2

What is coarctation of the aorta associated with?

Answer 2

Bicuspid aortic valve and turners syndrome
+ increased risk of IE
Once repaired they have a risk of ao aneurysm

Question 3

What also causes raised troponin other than MI?

Answer 3

CCF, myocarditis, endocarditis, pericarditis, HB, tachy/brady arrhythmias
Non-Cardiac causes: PE severe pulmonary HTN, renal failure, COPD

Question 4

In PAD you can do a bestride test to show the limb ischaemia.
Describe this test and what is its name

Answer 4

In PAD you can do a bestride test to show the limb ischaemia.
= Buerger’s test
= with the patient supine, bring their legs up 45 degrees for 2 mins. Then hang their legs off the bed. If +ve the legs go blue –> red due to reactive hyperaemia from post-hypoxic vasodilatation.

Question 5

What does an ABPI <0.9 mean?

Answer 5

That they have PAD

AMBP should be 1

Question 6

How should you investigate intermittent claudiation?

Answer 6

Duplex USS + CT angioplasty - these should be used to assess the revascularisation options

Question 7

What are the treatment options for intermittent claudication?

Answer 7

Supervised exercise program
Angioplasty or stenting
Bypass surgery or graft (only when angioplasty has failed)
Vaso-dilator therapy - naftidrofuyl oxalate

Question 8

How do you treat critical limb ischaemia?

Answer 8

Revascularisation (angioplasty or bypass surgery)

Analgesics - paracetamol + weak/strong opioids

Question 9

Give 3 organisms that cause infective endocarditis and RF associated with them

Answer 9

Staph Aureus - IVDU/invasive procedures
Strep Viridans - dental work
Enterococcus - pelvic surgery or infections

Question 10

What are the management options for SVT?

Answer 10

Valsalva manoeuvre
Adenosine 6mg–>12mg–>12mg
Electrical cardioversion

Question 11

What are the management options for atrial flutter?

Answer 11

• Convert back to SR - pharmaceutically or electrically
• Rate control - CCB/BB/Digoxin
• Anti-coag

Question 12

What are the key features of AF on ECG?

Answer 12

No P waves,
Narrow QRS,
Irregularly irregular
No isoelectric baseline

Question 13

What are the ECG changes of WPW?

Answer 13

Short PR
Delta wave
Long QRS
ST segment and T wave discordant changes (T wave the opposite direction to the QRS)

Question 14

How does AS present?

Answer 14

Murmur = ESM 
SAD 
Syncope 
Angina 
Dyspnoea

Question 15

How can you define heart failure?

Answer 15

A state where the heart is unable to pump enough blood to satisfy the needs of metabolising tissues
A symptomatic condition where breathlessness, fluid retention and fatigue are associated with a cardiac abnormality that reduces cardiac output

Question 16

How do you treat heart failure?

Answer 16

ABS
ACE-I
BB
Spironolactone (aldosterone antagonist)

Question 17

What are the 3 main causes of HF?

Answer 17

Ischaemia HD
Cardiomyopathy
HTN

Question 18

Give the stepwise treatment ladder for HTN

Answer 18

<45 >45/BAC
1 = ACEI CCB
2= ACE-I + CCB
3 = ACE-I + CCB + Diuretic (thiazide like)
4 = ? spironolactone//more diuretic or ab/bb

Question 19

Give an example of a thiazide-like diuretic?

Answer 19

Indapamide

Chlortalidone

Question 20

Give some secondary causes of HTN

Answer 20

1) Renal = CKD, renal vascular disease

2) Endocrine = Cushings, Conns, hyperthyroid, hyperparathyroid, aromegaly, pheochromocytoma

Question 21

A 55yr old man presents to A&E with syncope, dizziness, breathlessness and he is experiencing palpitations. His HR is 38. How would you treat this bradycardia?

Answer 21

Atropine IV

Anti-cholinergic = muscarinic antagonists which reduces the vagal tone

Question 22

What is a 3rd degree block usually caused by?

Answer 22

Myocardial fibrosis

Question 23

What are the causes of atrial flutter?

Answer 23

CAD, HTN, hyperthyroidism, obesity, alcohol and COPD

Question 24

What are the ECG changes seen in atrial flutter?

Answer 24

Saw-toothed waves
Narrow T waves
Atrial rate around 300 and VR around 150 - usually 2:1 block

Question 25

``` Give causes of sinus tachycardia: Physiological Pathological Endocrine Pharmacological ```

Answer 25

Physiological - exertion, anxiety, pain Pathological - fever, anaemia, hypovolaemia Endocrine - thyrotoxicosis, phaeochromocytoma Pharmacological - adrenaline, alcohol, caffeine

Question 26

Define Torsades de Point

Answer 26

Broad QRS ventricular tachycardia Its a type of polymorphic ventricular tachycardia in which the cardiac axis rotates over a sequence of 5-20 points. The QRS amplitude varies giving a twisting appearance

Question 27

Describe the ECG changes seen in ventricular fibrillation?

Answer 27

Chaotic QRS complexes with varied amplitude No obvious P, QRS, T waves Rate 150-500bpm Amplitude decreases with duration: coarse --> fine

Question 28

What are the SE of Statins?

Answer 28

Myalgia Stiffness Weakness Cramping

Question 29

How would you repair a thoracic aortic aneurism?

Answer 29

TEVAR = thoracic endovascular aneurysm repair

Question 30

In someone with Mitral Stenosis, what signs would you see?

Answer 30

Malar flush (CO2 retention) Raised JVP RVH - laterally displaced apex and RV heave Signs of RHF - Mid-late diastolic murmur heard best at the left lateral sternal edge

Question 31

What might you see on an ECG with MS?

Answer 31

P mitrale - bifid P wave | often in lead II

Question 32

How can you treat MS?

Answer 32

M/symptomatic - AF: anticoagulant - Dysponoea: diuretics/nitrates - SOBOE: BB/NDHPCCB S = valve balloon

Question 33

Which is the most common and 2nd most common valve disease?

Answer 33

AS | MR

Question 34

Give some causes of MR

Answer 34

- Degenerative - IE - Post MI/ischaemic damage of the chordae tendinae or papillary muscles - Rheumatic fever

Question 35

How does rheumatic fever cause valvular disease?

Answer 35

Group A beta haemolytic strep (Pyogenes) | - Antigen mimicry - abs reacts to the glycoproteins and cardiac myocytes causing inflammation and scarring

Question 36

What is Frank-Starlings law?

Answer 36

As larger volumes of blood flow into the ventricles, the blood stretches the myocytes leading to an increased force of contraction Increased stroke volume of the heart in response to increased blood volume in the ventricles

Question 37

What is starlings law in relation to fluid shifts

Answer 37

Fluid movement due to filtration across a capillary wall is dependant on a balance of: 1. Hydrostatic pressure gradient (fluid density) 2. Oncotic pressure gradient (a form of osmotic pressure that is exerted by proteins that pulls water into the circulatory system)

Question 38

What ECG changes would you see in a PE?

Answer 38

``` Sinus tachycardia S1Q3T3 * Deep S wave in 1 * Deep Q wave and Deep/inverted T wave in 3 Associated RBBB ```

Question 39

Other then MI, give other causes of a raised troponin

Answer 39

``` CCF Trauma Myocarditis/pericarditis Aortic dissection Aortic valve disease PE Arrhythmias Stroke ```

Question 40

What is the universal definition of a STEMI?

Answer 40

New ST segment elevation at the J point (the point between the S wave and the ST segment) in 2 continuous leads with the cut off points V2 and V3 >0.3mV men and >0.15mV women and over >0.1 in other leads

Question 41

If the lateral wall of the left ventricle is affected by STE where is the occlusion and in which leads would the STE be?

Answer 41

Leads I, VL and V6 (lateral leads) Left circumflex coronary artery

Question 42

What ECG changes would you see in a posterior MI?

Answer 42

* Dominant R wave in V1 * Ischaemic ST depression in V2-V4 * Q waves and ST segment elevation in leads V7-V9

Question 43

Give some causes of LBBB

Answer 43

Ischaemia HTN Cardiomyopathy Myocarditis

Question 44

What do you see on a ECG with Left ventricular hypertrophy?

Answer 44

Sinus rhythm Tall R wave in V5-V6 Inverted T waves in lateral leads

Question 45

Give some other causes of raised BNP other than HF

Answer 45

LVH, ischaemia COPD DM Cirrhosis of the liver