Cardiology

Question 1

What Pathologies classically cause a Ejections systolic murmur?

Answer 1

Aortic Stenosis
HOCM
Pulmonary Stenosis
ASD
Tetralogy of Fallow

Question 2

ASD causes what type of murmur?

Answer 2

Ejections systolic murmur
louder on inspiration

Question 3

What pathology classically causes a continuous machine-like murmur

Answer 3

patent ductus arteriosus

Question 4

HOCM causes what type of murmur?

Answer 4

Ejections systolic murmur
louder on expiration

Question 5

RILE stands for what in relation to murmurs?

Answer 5

Right-sided murmur → heard best on Inspiration
Left-sided murmur → heard best on Expiration

Question 6

Aortic regurg causes what type of murmur?

Answer 6

high-pitched and ‘blowing’ Early Diastolic murmur

Question 7

Mitral Regurg causes what type of murmur?

Answer 7

Pansystolic/holosytolic high-pitched and ‘blowing’
Best hear on Expiration

Question 8

TOF causes what type of murmur?

Answer 8

Ejections systolic murmur

Question 9

Pulmonary Stenosis causes what type of murmur?

Answer 9

Ejections systolic murmur
louder on inspiration

Question 10

Aortic Stenosis causes what type of murmur?

Answer 10

Ejections systolic murmur
louder on expiration

Question 11

What pathologies classically cause an early diastolic murmur?

Answer 11

Aortic regurg
Pulmonary Regurg

Question 12

VSD causes what type of murmur?

Answer 12

Harsh Pansystolic Murmur

Question 13

Pulmonary Regurg causes what type of murmur?

Answer 13

high-pitched and ‘blowing’ Early Diastolic murmur

Question 14

What pathologies classically cause a late systolic murmur

Answer 14

mitral valve prolapse
coarctation of aorta

Question 15

Tricupsid Regurg causes what type of murmur?

Answer 15

Pansystolic Murmur (high-pitched and ‘blowing’ in character)
Becomes louder during inspiration

Question 16

Austin Flint Murmur causes what type of murmur?

Answer 16

Mid late diastolic rumbling murmur due to severe aortic regurgitation

Question 17

coarctation of aorta causes what type of murmur?

Answer 17

late systolic murmur

Question 18

mitral valve prolapse causes what type of murmur?

Answer 18

late systolic murmur

Question 19

What Pathologies classically cause a Holosystolic (pansystolic) Murmur?

Answer 19

mitral/tricuspid regurgitation
VSD

Question 20

Mitral Stenosis causes what type of murmur?

Answer 20

rumbling Mid-late diastolic murmur

Question 21

patent ductus arteriosus causes what type of murmur?

Answer 21

Continuous machine-like murmur

Question 22

What pathologies classically cause a Mid-late diastolic murmur?

Answer 22

Mitral Stenosis
Austin Flint Murmur

Question 23

What does a non-pulsatile JVP indicate?

Answer 23

Superior vena caval obstruction

Non-pulsatile JVP is a specific finding that suggests underlying vascular issues.

Question 24

What does Kussmaul’s sign describe?

Answer 24

A paradoxical rise in JVP during inspiration seen in constrictive pericarditis

Kussmaul’s sign is an important clinical finding in assessing constrictive pericarditis.

Question 25

What does the 'a' wave represent in the jugular vein waveform?

Answer 25

Atrial contraction ## Footnote The 'a' wave is a key component of the JVP waveform related to atrial activity.

Question 26

When is the 'a' wave large in the JVP?

Answer 26

If atrial pressure is high, e.g. tricuspid stenosis, pulmonary stenosis, pulmonary hypertension ## Footnote Elevated pressures in the right atrium can lead to larger 'a' waves.

Question 27

What happens to the 'a' wave in atrial fibrillation?

Answer 27

Absent ## Footnote Atrial fibrillation disrupts normal atrial contraction, leading to the absence of the 'a' wave.

Question 28

What are Cannon 'a' waves caused by?

Answer 28

Atrial contractions against a closed tricuspid valve *complete heart block, *ventricular tachycardia/ectopics, *nodal rhythm, *single chamber ventricular pacing ## Footnote Cannon 'a' waves indicate a mismatch between atrial contraction and ventricular response.

Question 29

In which conditions are Cannon 'a' waves seen?

Answer 29

* Complete heart block * Ventricular tachycardia/ectopics * Nodal rhythm * Single chamber ventricular pacing ## Footnote These conditions disrupt the normal conduction system, leading to Cannon 'a' waves.

Question 30

What does the 'c' wave represent in the JVP?

Answer 30

Closure of the tricuspid valve ## Footnote The 'c' wave is typically not visible in the JVP waveform.

Question 31

What does the 'v' wave indicate in the JVP?

Answer 31

Passive filling of blood into the atrium against a closed tricuspid valve ## Footnote The 'v' wave can be significantly enlarged in cases of tricuspid regurgitation.

Question 32

What are giant 'v' waves associated with?

Answer 32

Tricuspid regurgitation ## Footnote Giant 'v' waves reflect increased atrial pressure during the passive filling phase.

Question 33

What does the 'x' descent represent in the JVP waveform?

Answer 33

Fall in atrial pressure during ventricular systole ## Footnote The 'x' descent is important for understanding the dynamics of atrial pressure changes.

Question 34

What does the 'y' descent indicate in the JVP?

Answer 34

Opening of the tricuspid valve ## Footnote The 'y' descent reflects the rapid drop in atrial pressure as blood flows from the atrium to the ventricle.

Question 35

What is pulsus paradoxus?

Answer 35

Greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration, leading to faint or absent pulse in inspiration ## Footnote Commonly associated with severe asthma and cardiac tamponade

Question 36

What conditions cause Pulsus paradoxus?

Answer 36

severe asthma, cardiac tamponade

Question 37

What condition is indicated by a slow-rising or plateau pulse?

Answer 37

Aortic stenosis ## Footnote This type of pulse reflects a gradual increase in pressure over time.

Question 38

What does a collapsing pulse indicate?

Answer 38

Aortic regurgitation, patent ductus arteriosus, hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy) ## Footnote This pulse is characterized by a rapid rise and fall.

Question 39

Define pulsus alternans.

Answer 39

Regular alternation of the force of the arterial pulse ## Footnote Typically seen in severe left ventricular failure.

Question 40

What causes Pulsus alternans?

Answer 40

Severe LVF

Question 41

What is a bisferiens pulse?

Answer 41

'Double pulse' - two systolic peaks ## Footnote Often associated with mixed aortic valve disease.

Question 42

What causes a bisferiens pulse?

Answer 42

mixed aortic valve disease Occasionally HOCM

Question 43

What cause a 'jerky' pulse?

Answer 43

Hypertrophic obstructive cardiomyopathy ## Footnote This pulse presents with an abrupt rise and fall.