Cardiology

Question 1

S1 Heart sound:

1. What is the sound?
2. What does this sound indicate?
3. What valves of the heart are closing when this soudn occurs?

Answer 1

1. Lub
2. This sound marks the end of diastole or the start of systole
3. The sound is caused by the mitral and tricupsid valves closing

Question 2

S2 Heart sounds:

1. What is the sound?
2. What does this sound indicate is happening?
3. Which valves cause this noise?

Answer 2

1. Dub
2. This sound indicates the end of systole or the start of diastole
3. When the aortic and pulmonary valves close

Question 3

Abnormal S1 sounds:

1. What does a loud S1 sound indicate?
2. What does a soft S1 indicate?
3. What does a split S1 indicate?

Answer 3

1. Mitral stenosis
2. Mitral regurgitation
3. Right bundle branch block

Question 4

Abnormal S2 sounds:

1. What does a S2 split on expriation but not on inspiration indicate?
2. What does a loud S2 sound indicate?

Answer 4

1. Left bundle branch block

2. Pulmonary hypertension

Question 5

Added heart sounds:

1. What does a S3 sound indicate?
2. What does a S4 heart sound inidcate?

Answer 5

1. left ventricular faliure

2. hypertension, left ventricular hypertrophy, ischaemic cardiomyopathy

Question 6

Heart murmurs:

1. Where does aortic stenosis casue radiation?
2. Where does tricupsid regurgitation casue radiation?
3. Where does mitral regurgiation radiate?

Answer 6

1. Carotid arteries
2. anterior right thorax
3. left axilla

Question 7

Arotic stenosis:

1. Where is it best heard?
2. Describe what you would hear on auscillation?
3. How do the peripheral pulses feel?
4. What type of murmur is it?

Answer 7

1. Right sternal boarder, 2nd ICS
2. S1, Ejection click, crescendo-decrescendo murmur and then S2
3. weak and delayed
4. Systolic murmur

Question 7

Arotic stenosis:

1. Where is it best heard?
2. Describe what you would hear on auscillation?
3. How do the peripheral pulses feel?
4. What type of murmur is it?

Answer 7

1. Right sternal boarder, 2nd ICS
2. S1, Ejection click, crescendo-decrescendo murmur and then S2
3. weak and delayed
4. Systolic murmur

Question 8

Mitral regurgitation:

1. Where is it best heard?
2. Describe what you would hear?
3. What type of murmur is it?

Answer 8

1. the apex of the heart, 5th ICS along the mid-clavicular line
2. S1, flat (continous pitch), S2
3. systolic murmur

Question 9

Aortic regurgitation:

1. Where is it best heard?
2. Describe the sounds
3. What type of murmur is it?

Answer 9

1. left parasternal edge
2. S1,S2, Early disatolic decresendo then S1
3. Diastolic murmur

Question 10

Mitral stenosis :

1. Where is it best heard?
2. Describe the sounds
3. What type of murmur is it?

Answer 10

1. The apex
2. S1,S2, opening snap, decresendo mid diastolic rumble and atrial kick, S1
3. diastolic

Question 11

Parts of an ECG:

Explain what the… stands for…

1. P wave
2. PR interval
3. PR segment
4. QRS complex
5. T wave
6. QT interval
7. U wave

Answer 11

1. atrial depolarisation
2. time taken for the impulse form the sino atrial node to reach the venticles
3. end of P wave to start of QRS complex
4. ventricular depolarisation
5. ventricular repolarization
6. ventricular repolarization
7. purkinjie fibres replorazation

Question 12

Chest leads and thier anatomy:

What view…

1. V1, V2
2. V5 , V6
3. V3 , V4

Answer 12

1. Septal leads
2. Lateral leads
3. Anterior leads

Question 13

What arteries do each bit of the ECG correlate with?

1. Left decending artery
2. Right coronary artey /cicumflex artery
3. Left anterior descending

Answer 13

1. I, AVL, V6 and V5
2. II, III, AVF
3. V1, V2, V3, V4

Question 14

How do you calculate regular rhythm?

How to calculate irregular rhythm?

Answer 14

1. 300 divided by number of large squares between the Rs

2. The number of Rs multipied by 6

Question 15

What are signs of Atrial fibrillation on ECG ?

Answer 15

1. Irregularly regular
2. Tachycardic
3. Absent P waves
4. fine fibrillatory waves

Question 16

What are the signs of atrial flutter on ECG?

Answer 16

1. loss of the isoelectric line
2. tachycardia
3. regular ryhthem
4. saw tooth pattern
5. P wave

Question 17

What are the signs of a LBBB in ECG?

Answer 17

V1 - dominant S wave ‘W’

V6 - broad, notched R wave ‘M’

Question 18

What are the signs of RBBB on ECG?

Answer 18

V1 - RSR pattern - ‘M’

V6 - Widened, slurred S wave ‘W’

Question 19

What are the signs of a first degree AV block?

Answer 19

P wave followed by QRS. PR interval prolonged at a constant range.

Question 20

What is the difference between a second degree AV block type 1 and type 2 ?

Answer 20

Mobitz type 1:

• irregular
• P wave present followed but all followed by QRS
• PR progressively lengthens before QRS dropped completely

Mobitz type 2:

• irregular, maybe in set ratios
• P waves present but not all followed by QRS
• prolonged PR interval but not contiually getting longer

Question 21

What is seen on a third degree or complete heart block on an ECG?

Answer 21

no association between the atrial and ventricular activity

Question 22

Stable angina:

1. What is it?
2. What are some of the casues?
3. What are the risk factors?
4. How is it diagnosed?
5. What are the treatment options ?

Answer 22

1. Episodic chest pain caused by an inadequate blood supply to the heart
2. Atherosclerosis, pulmonary hypertension, genetic hypertrophic cardiomyopathy
3. Smoking, hypertension, high in fat diet, family history of CAD
4. ECG when taken during the epsiode of angina can sometimes show an ST segment depression and inversions of T waves
5. The first line of treatment includes offering patients with a sublingual short-acting nitrate and either a beta-blocker or a calcium channel blocker

Question 23

Unstable angina:

1. What is it?
2. What are some of the casues?
3. What are the symptoms/signs?
4. How is it diagnosed?
5. What are the treatment options ?

Answer 23

1. Episodic pain that occurs unpredicatbley and rapidly worsens.
2. The main casuses are linked to atherosclerotic plaques as a thrombosis is formed
3. Same as stable angina but occur at rest. Levine’s sign = clenched fist held over the chest
4. Serial tropnins and ECG. ECG - ST segment depression adn T wave inversions
5. Clopidogrel and aspirin

Question 24

Myocardial infarctions: 1. Pathology/Causes 2. Types 3. Complications 4. Diagnostics 5. Managment

Answer 24

1. Essentially the death of cardiac muscle cells due to the lack of oxygen rich blood. e.g. casued by athersclerotic plaques etc. 2. STEMI - The coronary artery is fully blocked, ECG shows ST elevation and possible pathological Q waves NSTEMI/unstable angina - the coronary artery is not fully blocked 3. DARTH VADER ``` D - Death A - Arrythmia R - Rupture of the paillary muscle T - Tamponade H - Heart faliure V - Valve disease A - Aneurysm of ventricle D - Dressler's syndrome E - thromboEmbolism R - Regurgitation mitral ``` ``` 4. Cardiac enzymes: -Troponin T (more specific) -Troponin I - CK-MB - detect reinfarction after an intial MI ``` ECG enzymes: - ST elevation, T wave inversion and Q waves 5. Managment: STEMI: 1. Urgent PCI to reperfuse the heart with either catheterization and thrombolysis Afterwards its managed with Heparin, aspirin and clopidrogel, beta blockers, ACE inhibitors and statins

Question 25

Peripheral disease is when either the arteries or veins aside of the coronary vasculaure narrow due to atherosclerosis. Explian the difference between arterial and venous peripheral disease. 1. Pulse 2. Appearence 3. Temprature 4. Cap refill time 5. Hardness 6. Edema 7. Sensation/pain

Answer 25

1. A - reduced/absent V - normal 2. A - Ulcers that are deep and regular boarders, mostly on bony prominences, skin is shiny and brittle nails. Elevation pallor. V - Ulcers with irregular boarders, most commonly near the medial malleolus, hemosiderin buildup under the skin leading to brawn skin 3. A - Cool V - warm 4. A - more than 3 seconds V - less than 3 seconds 5. A- Soft, thin skin V - Hardened, leathery skin 6. A - not present V - present 7. A - intermittent claudaication, painful ulcers V - dull ache releived by elevation, painful ulcers

Question 26

What are the management options for peripheral disease of the lower limbs ? 1. intermittent caludication 2. critical limb ischaemic pain

Answer 26

1. - supervised exercise - angioplasty 2. - angioplasty and stent placing - paracetamol