Cardiology

Question 1

Aortic stenosis murmur
Signs of aortic stenosis

Answer 1

Across precordium, louder on expiration, radiating to carotids.
Severity - slow rising low volume pulse, muted second heart sound, long murmur, LV have, forceful apex beat

Question 2

Aortic stenosis causes

Answer 2

Young - bicuspid
Old - rheumatic, age

Question 3

Aortic stenosis differentials

Answer 3

HOCM
VSD
Aortic sclerosis - no radiation
Aortic flow + high output (pregnancy, anaemia)

Question 4

Aortic stenosis management
+ valve intervention work up

Answer 4

Conservative
Medical - four pillars heart failure, avoid vasodilators
Surgical - bioprosthetic or metallic valve replacement, TAVI via femoral artery if not fit for sternotomy

Valve workup - ECG, echo, carotid dopplers, angiogram, PFTs

Question 5

Mitral regurg causes

Answer 5

Degenerative
Prolapse
Connective tissue disorder
Papillary muscle rupture following MI
Infection - rheumatic, IE
Secondary - to cardiomyopathy

Question 6

Mitral regurg severity signs

Answer 6

Pulm hypertension - raised JVP, loud P2, gallop rhythm, RV heave, thrusting + displaced apex beat
Split second heart sound

Question 7

Aortic stenosis complications

Answer 7

Endocarditis
LVF
Pulm HTN and RVF - preterminal
Conduction issues

Question 8

Mitral regurg surgical options + indications for replacement

Answer 8

Percutaneous transcatheter edge to edge repair - if surgical high risk
Annuloplasty ring
Replacement

Symptomatic (but prior to LV dilatation)
Asymptomatic but worsening EF / LVF
Acutely following MI

Question 9

Aortic valve replacement indications

Answer 9

Severe + symptomatic aortic stenosis or regurgitation
Infective endocarditis
Valve involvement in aortic dissection

Question 10

Aortic regurg

Question 11

Valve replacement - bioprosthetic vs metallic

Answer 11

Bio - poor med compliance, child bearing age, > 65 mitral, > 75 atrial, risk of haemorrhage

Question 12

Valve replacement complications

Answer 12

Thromboembolus
Bleeding
Bioprosthetic dysfunction + LVF -> valve in valve
Haemolysis
Infective endocarditis - early staph epidermis, late strep viridans
AF

Question 13

Mitral stenosis

Question 14

Atrial fibrillation

Question 15

Mitral valve prolapse - signs, associations

Answer 15

Mid systolic click, and

Marfans - 90%
Ehlers dances
Osteogenesis imperfecta
Muscular dystrophy, PKD, SLE, cardiomyopathy

Question 16

Mixed aortic valve disease

Question 17

VSD

Question 18

Pulmonary stenosis murmur

Answer 18

Ejection systolic murmur
Loudest on inspiration
Radiates to infraclavicular area

If advanced ->
Large A waves
RV heave
Split second heart sound

Question 19

Noonans syndrome features

Answer 19

Phenotypic:
- Cubitus vulgaris, widely spaced nipples, short, LD, pactus excavatum

Eyes
- Proptosis, ptosis, strabismus

Cardiac
- Pulmonary stenosis
- HOCM
- Septal lesions

Question 21

Pulmonary valve disease causes

Answer 21

Rubella
Downs
Noonans
Turners
Tetralogy of Fallot

Question 22

Causes tricuspid incompetence

Answer 22

Congenital - abstains
Acute - IE
Chronic - functional (dilated RV), implantable device splinting TV open, carcinoid, rheumatic

Question 23

Duke’s criteria for endocarditis

Answer 23

Major - typical organism in two cultures, echo findings (abscess, vegetation, dehiscence)

Minor - fever, echo sugestive, predisposition (prosthetic), embolic phenomena, vasculitic phenomena, atypical organism

2 major, 1 major + 2 minor, or all 5 minor

Question 24

Tricuspid incompetence signs

Answer 24

Raised JVP with giant CV waves
Pan systolic murmur, best heard at tricuspid area in inspiration
Reverse split second heart sound

Question 25

Carcinoid - sx, valve issues, mx

Answer 25

Gut primary + liver mets secreting 5-HT Diarrhoea, where, flushing Tricuspid insufficiency + pulm stenosis Mx - somatostatin analogue and cytoreduction (ablation / embolisation / surgical resection)

Question 26

Marfans genetics

Answer 26

Autosomal dominant Chromsome 15 Fibrillin gene -> abnormal collagen generation

Question 27

Marfarns management

Answer 27

Serial echo Serial imaging aorta - dilatation BB + ARB slow aortic root dilatation progression Aortic root replacement if dilation > 55mm at aortic root or 45mm in history aortic dissection, or rapidly expanding Screen family

Question 28

PDA - concerning echo findings

Answer 28

Dilated pulmonary arteries with raised pressures RV dilatation

Question 29

Eisenmongers explanation + causes

Answer 29

ASD, VSD, PDA L->R shunt -> pulmonary hypertension -> increasing severity -> shunt balances or becomes R->L --> hypoxia

Question 30

Eisenmongers complications

Answer 30

IE Polycythaemia and viscosity sx - headache, visual, ulceration, angina Paradoxical emboli and stroke gallstones

Question 31

Eisenmongers mx

Answer 31

Pulmonary vasodilator therapy Anticoagulation Sx - iron, allopurinol, diuretics Supportive - contraception, avoid extremes temperature or dehydration Surgical - combined heart-lung transplant

Question 32

Cardiac causes clubbing

Answer 32

Cyanotic congenital heart disease Subacute infective endocarditis

Question 33

Split second heart sound causes

Answer 33

Mitral regurg / VSD RBBB Pulmonary stenosis - varies with resp Eisenmongers RVF