Cardiovascular

Question 1

Coronary artery disease risk factors

Answer 1

Hypertension
Hypercholesterolemia
Smoking
DM
MI
CVA
CRF
CKD
Smoking
Poor diet
Sedentary lifestyle
Family History of CV disease

Question 2

Valvular disease risk factors

Answer 2

Age
CAD
Rheumatic heart disease
Congenital heart disease

Question 3

Arrhythmia risk factors

Answer 3

CAD, HT, DM, thyroid disease, OSA, congenital heart disease, cardiac surgery, valvular heart disease, electrolyte disturbances, medications, excess alcohol/illicit drugs/caffeine

Question 4

Common complications of cardiovascular diseases

Answer 4

Heart failure, myocardial ischemia or infarction, shock, stroke or TIA, aneurysm formation, peripheral artery disease, arrhythmias or sudden cardiac arrest

Question 5

Causes of syncope/presyncope

Answer 5

• Reduced cardiac output (arrhythmia, stenosis0
• Postural hypotension
• Vasovagal cause
• Hypoglycemia
• Low BP (hypovolemia)

Question 6

SOB types in heart failure

Answer 6

• SOBOE early sign
• Orthopnea later sign - increased blood volume to heart due to resdistribution from lower extremities, heart struggles to compensate)
• PND later sign (caused by resorption of peripheral oedema at night while lying down - patient typically opens window to breathe and can only sleep sitting up)

Question 7

6 Ps of peripheral vascular disease (signs of arterial insufficiency)

Answer 7

Pain
Pallor
Paraesthesia
Pulseless
Perishingly cold
Paralysed

Question 8

First heart sound corresponds with

Answer 8

Closure of the mitral and tricuspid valves

Question 9

Second heart sound corresponds with

Answer 9

Closure of aortic and pulmonary valves

Question 10

Where is first heart sound louder

Answer 10

Apex (mitral and tricuspid areas)

Question 11

What is the physiological splitting of the second heart sound due to

Answer 11

Split during inspiration as blood is drawn into the chest which increases venous return and delays the closure of the pulmonary valve

Question 12

Pathological cause of third heart sound (S3)

Answer 12

Due to exaggerated early diastolic filling into a ventricle with reduced compliance. Occurs during heart failure or valvular regurgitation

Question 13

Physiological cause of third heart sound (S3)

Answer 13

Children and adults under 40yo, due to very rapid early diastolic filling

Question 14

Cause of fourth heart sound (S4)

Answer 14

Always pathological - HTN, IHD (including angina and acute MI, or advanced age

Question 15

What happens to respiratory system and heart sounds during inspiration

Answer 15

Intrathoracic and intrapericardial pressure decrease, resulting in augmented RV filling and stroke volume and, as the total pericardial space is limited, a compensatory decrease in left ventricular stroke volume occurs in early inspiration.

Lungs pull blood in inspiration. Left Ventricle pulls blood in diastole.

Question 16

Explain the valsalva maneuver

Answer 16

Reduces the filling of the right and then the left side of the heart. Stroke volume and blood pressure falls, while the HR increases.

Valsalva initially creates a low intra-aortic pressure which stimulates the sympathetic nervous system. Following the release of the breath, a vagal response is triggered to decrease the heart rate. This vagal influence is what may break the SVT and lower the heart rate, or cause a decrease in cerebral perfusion pressure and cause the patient to have a syncopal episode while straining to have a bowel movement.

Question 17

What causes heart murmur during pregnancy?

Answer 17

An abnormally large amount of blood flowing past a normal valve

Question 18

Types of systolic murmur

Answer 18

Aortic stenosis
Mitral regurgitation

Question 19

How can you tell if a murmur is systolic or diastolic?

Answer 19

Systolic:
- Between S1 and S2
- By palpating radial or carotid pulse, systolic comes with or just before this
- More common

Diastolic:
- Harder to hear and have a different rhythm

Question 20

Describe the course of the Internal Jugular vein into the heart

Answer 20

Enters the neck behind the ear, just behind the mastoid process, next to the angle of the jaw, it is not superficial but runs deep to the sternomastoid at the sternoclavicular joint.

Question 21

What does the ‘a’ wave in JVP represent?

Answer 21

Contraction the right atrium

Question 22

When and why might an ‘a’ wave in JVP absent?

Answer 22

In AF - due to disorganised contraction of right atrium

Question 23

What is the ‘v’ wave in JVP? When is it more prominent

Answer 23

Atrial filling during ventricular systole. If there is an incompetent tricuspid valve, there is blood flow back into the right atrium at systole so that the ‘v’ wave is more prominent.