Cardiology

Question 1

what are some signs of aortic stenosis?

Answer 1

narrow pulse pressure
slow rising pulse
ESM murmur loudest on expiration
soft S2 + S4

Question 2

what are some causes of aortic stenosis?

Answer 2

age related calcification
bicuspid valve - turners
rheumatic heart disease

Question 3

what are some general management options for valvular disease?

Answer 3

MDT approach - cardiologist

QRISK - statin and antiplatelete

Manage HTN, angina etc

Question 4

what are some signs of atrial regurgitation?

Answer 4

Beckers sign - pulsating retinal artery
Mullers - pulsating uvula
De Mussets - nodding head
Quinkes - pulsatile nail beds
Corrigans - carotid pulsation
Traube - pistol shot femoral

Question 5

what are some cardiac signs of aortic regurg?

Answer 5

wide pulse pressure
soft S2 + S3
displaced apex beat
Early diastolic murmur

Question 6

what are some causes of aortic regurg?

Answer 6

Chronic - bicuspid aorta, RHD, autoimmune (RhA, ankylosing spondilysis), connective tissue disease

Acute - IE, aortic dissection

Question 7

what is the management of aortic regurg?

Answer 7

General
Medical - ACEi, BBlocker, diuretics
Surgical

Question 8

what are some signs of mitral stenosis?

Answer 8

malar flush
irregular pulse (AF)
loud S1
Mid diastolic murmur

Question 9

what is the management of mitral stenosis?

Answer 9

RAD
RF prophylaxis - benzylpenicillin
AF prophylaxis - rate control + DOAC
Diuretic

severe - surgical ballon valvuloplasty

Question 10

what are some signs for mitral regurg?

Answer 10

irregular pulse AF
displaced apex beat
pansystolic murmur
soft S1

Question 11

what are some causes of mitral regurg?

Answer 11

chronic - mitral valve prolapse, RHD, calcifications, CDT

Acute - IE, IHD (post MI)

Question 12

what is the management for mitral regurg?

Answer 12

reduce afterload - ACEi, BB, diuretic
AF prophylaxis - rate control +DOAC

Question 13

what is the management for heart failure?

Answer 13

BASHed up heart

1. Beta blocker
   ACEi
2. Spironolocatone
3. Hydralazine
   Digoxin

Question 14

what is the first line investigation for angina?

Answer 14

CT coronary angiogram to determine calcium score

non invasive functional testing - stress echo

Question 15

what is the management of stable angina?

Answer 15

1. GTN, BB or CCB (verapamil RL)
2. GRN, BB and CCB (amlodipine NRL)
3. long acting nitrate - isosorbide mononitrate

Question 16

what are some causes of AF?

Answer 16

IHD, hyperthyroidism, MS, MR, bronchial cancer, alcohol, PE, infection

Question 17

when do you rhythm control AF?

Answer 17

heart failure, new onset, reversible cause

Question 18

how do you rhythm control AF?

Answer 18

1. anticoagulate 3 weeks before electrical cardioversion and 4 weeks after
2. chemical cardioversion - flecanide

Question 19

how do you rate control AF?

Answer 19

1. BB or rate limiting CCB verapimil
2. digoxin
3. amiodarone

Question 20

when do you anticoagulate someone with AF?

Answer 20

according to CHADSVASc score >2 in female or >1 in male
use apixaban

Question 21

what is the CHADSVASc score?

Answer 21

CHF
HTN
Age >75 2 points
Diabetes
Stroke - 2 points
Valvular disease
Age 65-74
Sex

Question 22

how do you manage sever HTN?

Answer 22

180/110

ECG, urine dipstick, blood test
- if positive then start anti hypertensives
- if neg then repeat BP in 7 days

Question 23

what is used first line in diabetic hypertensive pts?

Answer 23

ACEi (if afro-caribbean then use ARB candesartan)

Question 24

what are some side effects of ACEi?

Answer 24

angiodema (4weeks)
cough
elevated K+
1st dose = low BP

Question 25

what is the management ladder for HTN?

Answer 25

diabetic or <55yr
1. ACEi
2. CCB + ACEi
3. CCB+ACEi+ thiazide like diuretic

AC or >55yrs
1. CCB
2. CCB + ACEi
3. CCB + ACEi + thiazide diuretic

also start atorvastatin 20mg if CKD/T1DM or 80mg if PMH stroke or PVD

Question 26

what monitoring is required for HTN meds?

Answer 26

ACEi - U&E before and during
- increase in creatinine of up to 30% is acceptable
- increase in K+ up to 5.5 is okay (more than that STOP)

no thiazides in CKD 4/5, DM, SLE, gout

Question 27

which valves are normally affected in infective endocarditis?

Answer 27

normal valves - mitral
IVDU - tricuspid

Question 28

what are some causes of IE?

Answer 28

staph aureus
staph viridans
staph epidermis

Question 29

what is the dukes criteria?

Answer 29

2 major OR 1 major and 3 minor OR 5 minor (BE FEVER)

Bacterial culture 2, 12 hours apart
ECHO

Fever
ECHO findings
Vascular - janeway lesions, splinter haemorrhage, emboli
Evidence of microbacteria - only 1 culture needed
Risk factor - IVDU

Question 30

what are some signs and symptoms of I?

Answer 30

FROM JANE

Fever
Roth spots
Oslers nodes
Murmur new onset

Janeway lesions
Anaemia
Nail haemorhages - splinter
Emboli

Question 31

what is the management for IE?

Answer 31

IV benzylpenicillin 6 weeks

Question 32

what is the Jones criteria for RHD?

Answer 32

1. Evidence of group A strep infection AND
   positive throat swab
   step antigen +ve
   ISO titre

2 Majors
Carditis
Arthritis
Subcut nodules
Erythema marginatum
Sydenham chorea

1 Major and 2 minors
Fever
Raised CRP
Arthralgia
Prolonged PR
Previous RF

Question 33

how do you manage RHD?

Answer 33

bed rest until CRP normalises (usually 2 weeks)
analgesia - nsaids
phenoxymethlypenicillin

Question 34

what is seen on biopsy for HOCM?

Answer 34

myofibrillar hypertrophy with chaotic and disorganised myocytes

Question 35

what is seen on examination of HOCM?

Answer 35

jerky pulse
cannon A waves
ESM
or PSM of mitral regurg

Question 36

how do you manage HOCM?

Answer 36

Amiodarone
Beta blocker
Cardioversion
Dual chamber pacemaker
Endocarditis prophylaxis