Cardiology

Question 1

What are the ECG findings in hypokalaemia?

Answer 1

U waves
Small or absent T waves
Prolonged PR interval
ST depression
(in hypokalaemia you have no Pot and no Tea, but a long PR and a long QT)

Question 2

On an ECG, which are the inferior leads?

Answer 2

II, III, aVF

Question 3

On an ECG, which are the lateral leads?

Answer 3

I, aVL, V5, V6

Question 4

On an ECG, which are the anterior leads?

Answer 4

V3, V4

Question 5

On an ECG, which are the septal leads?

Answer 5

V1, V2

Question 6

Which scoring system determines the need for anti-coagulants in AF?

Answer 6

CHA2DS2-VASc

Question 7

Which scoring system identifies risk of stroke in patients who have had a TIA?

Answer 7

ABCD2

Question 8

Which scoring system estimates the risk of major bleeding for patients with AF and on an anti-coagulant?

Answer 8

HAS-BLED

Question 9

Which scoring system estimates the 10yr risk of a CV event?

Answer 9

QRISK3

Question 10

What is an inotrope and describe the different types.

Answer 10

Inotrope = medicine that changes the force of the heart’s contractions

• positive inotropes strengthen the force of the heart beat
• negative inotropes weaken the force of the heart bean

Question 11

What is Dressler’s syndrome?

Answer 11

Delayed secondary pericarditis following injury to the heart, e.g. MI, occurs 2-6 weeks post-injury

• -> fever, pleuritic pain, pericardial effusion, raised ESR
• treat with NSAIDs

Question 12

What is the Valsalva manoeuvre?

Answer 12

Forced exhalation against closed airway (by closing mouth and holding nose)

Question 13

In a stable patient with supraventricular tachycardia, what are the 1st and 2nd line treatment options?

Answer 13

1st = valsalva manoeuvre
2nd = IV adenosine

Question 14

What ECG finding would indicate SVT?

Answer 14

Narrow complex tachycardia (sudden onset)

Question 15

How does adenosine act on the heart?

Answer 15

Decreases heart rate and reduces conduction velocity, especially at the AV node

Question 16

What is the 1st-line investigation in suspected PE?

Answer 16

CT pulmonary angiogram

2nd = V/Q scan

Question 17

What ECG changes might you see in a patient with PE?

Answer 17

S1Q3T3
 - large S wave in lead 1
 - large Q wave in lead 3
 - inverted T wave in lead 3
RBBB
Right axis deviation

Question 18

What is Takotsubo cardiomyopathy?

Answer 18

‘Broken heart syndrome’, also ‘apical ballooning syndrome’
Cardiomyopathy induced by severe stressful triggers
It is a differential for ST elevation in a patient with no obstructive coronary artery disease

Question 19

Ototoxicity is a side effect of which medication?

Answer 19

Loop diuretics

Question 20

What ECG features are associated with hypothermia?

Answer 20

Bradycardia
J waves
1st degree heart block
Long QT interval
Atrial and ventricular arrhythmias

Question 21

On an ECG, what are Q waves indicative of?

Answer 21

Previous MI

Question 22

On an ECG, what are Delta waves a feature of?

Answer 22

Wolff-Parkinson White syndrome

Question 23

On an ECG, what is saddle ST elevation associated with?

Answer 23

Pericarditis

Question 24

Describe the murmur in aortic stenosis.

Answer 24

Ejection systolic
Aortic area
Radiating to carotids

Question 25

Describe the murmur in tricuspid regurgitation.

Answer 25

Pansystolic Tricuspid area Radiates to 4th intercostal space

Question 26

Describe the murmur in mitral regurgitation.

Answer 26

Pansystolic Mitral area Radiates to axilla

Question 27

Describe the murmur in mitral stenosis.

Answer 27

Mid-diastolic Mitral area Radiates to axilla

Question 28

Describe the murmur in aortic regurgitation.

Answer 28

Early diastolic | High-pitched and 'blowing' in character

Question 29

What is an Austin-Flint murmur?

Answer 29

Severe aortic regurgitation Mid-late diastolic 'Rumbling' in character

Question 30

What is a Graham-Steel murmur?

Answer 30

Pulmonary regurgitation | High-pitched and 'blowing' in character (like aortic stenosis)

Question 31

What heart murmur are you likely to find in Down's Syndrome?

Answer 31

Harsh pansystolic murmur best heard at the left sternal edge | - due to ventricular septal defect

Question 32

What is the treatment for Torsades de Pointes?

Answer 32

Magnesium sulphate

Question 33

Name four ECG changes that are normal variants in athletes.

Answer 33

Sinus bradycardia Junctional rhythm 1st degree heart block Wenckeback phenomenon

Question 34

What medication is contraindicated in aortic stenosis?

Answer 34

Nitrates (e.g. GTN spray) due to risk of hypotension

Question 35

Name five ECG changes seen in hypothermia.

Answer 35

``` Bradycardia J wave (small hump at end of QRS complex) Long QT interval First degree heart block Atrial and ventricular arrhythmias ```

Question 36

What is the reversal for warfain?

Answer 36

Prothrombin complex concentrate

Question 37

What is the first line treatment for stable angina?

Answer 37

Beta blocker

Question 38

What angina medication should be avoided with beta blockers?

Answer 38

Verapamil