CVS General

Question 1

What is Beck’s triad?

What is it a sign of?

Answer 1

• Hypotension
• Raised JVP
• Muffled heart sounds
  Sign of cardiac tamponade

Question 2

What would you hear in pericardial effusion?

Answer 2

Pericardial friction rub

Question 3

Which artery supplies the SA node in most people?

What about in the other 40%?

Answer 3

• 60% - RCA

- 40% - LCA

Question 4

Which artery (or arteries) supplies the AV node?

Answer 4

AV nodal branch from posterior RCA

Question 5

Which artery supplies the RA?

Answer 5

RCA

Question 6

Which arteries supply the RV?

Answer 6

• Right marginal

- LAD

Question 7

Which artery supplies the LA?

Answer 7

Circumflex branch of LCA

Question 8

Which arteries supply the LV?

Answer 8

• Left marginal

- LAD

Question 9

Where is S1 heard best?

What about S2?

Answer 9

• Apex - using bell

- Pulmonary area - diaphragm

Question 10

What are the 4 defects found in Tetralogy of Fallot?

What is the anatomical anomaly underlying all 4?

Answer 10

1) RV hypertrophy
2) Over-riding aorta
3) Pulmonary stenosis
4) VSD
Due to IV septum being too anterior

Question 11

What is the difference between aortic stenosis and coarctation of the aorta?

Answer 11

Aortic stenosis = narrowing of the aortic valve

Coarctation of the aorta = narrowing of the aorta in the region of the ligamentum arteriosum

Question 12

What signs relating to the pulses would you see in coarctation of the aorta? Why?

Answer 12

Radial-radial pulses synchronous, but radial-femoral delay as blood flow to upper limbs/head fine as subclavian/carotid arise before narrowing, but blood flow to rest of body compromised

Question 13

What are the 3 classic symptoms of aortic stenosis?

Answer 13

• Chest pain
• Dyspnoea
• Syncope

Question 14

Give two signs of aortic stenosis apart from murmur

Answer 14

Slow-rising pulse

Thrill

Question 15

What would be the character of the pulse in aortic regurgitation?

Answer 15

Collapsing

Question 16

Give some clinical features of mitral stenosis

Answer 16

• Dyspnoea
• Palpitations
• Malar flush
• Tapping apex beat

Question 17

Why might mitral stenosis lead to AF?

Answer 17

Increased LA pressure due to resistance to flow into LV

Therefore LA hypertrophy - can cause AF

Question 18

What is systolic blood pressure a measure of?

What about diastolic?

Answer 18

• Systolic = max arterial pressure

- Diastolic = min arterial pressure

Question 19

How is mean arterial pressure calculated?

Answer 19

Diastolic pressure + 1/3rd pulse pressure

Question 20

What is stroke volume?

How is it calculated?

Answer 20

Volume of blood leaving LV with each contraction

End diastolic volume minus end systolic volume

Question 21

What influences BP?

Answer 21

TPR and CO as BP = TPR x CO

Question 22

Describe Starling’s law of the heart

Answer 22

In basic terms, the more blood in, the more blood out
Hence stroke volume increases with end diastolic volume (up to a point)
The greater the stretch, the harder the myocytes can contract - hence greater output

Question 23

What is contractility?

Answer 23

The extent by which SV increases with venous pressure

Question 24

What is preload?

What is afterload?

Answer 24

Preload = end diastolic stretch
Afterload = resistance against which the LV has to pump

Question 25

What is a murmur?

Answer 25

Extra/abnormal sound during the heartbeat cycle, caused by turbulent blood flow

Question 26

What causes S1? What about S2? What are their characters?

Answer 26

- AV valves closing at the beginning of ventricular systole - crescendo-decrescendo - Outflow valves closing at the end of ventricular systole - shorter duration, higher frequency

Question 27

Which sound does the pulse occur with?

Answer 27

S1

Question 28

What ECG changes would you see in stable angina?

Answer 28

At rest, none!

Question 29

How would you determine whether someone was having unstable angina or an NSTEMI?

Answer 29

- Unstable angina - ST depression but no necrosis biomarkers | - NSTEMI - ST depression with necrosis biomarkers

Question 30

What are the diagnostic criteria for a STEMI?

Answer 30

Rise of necrosis biomarkers, PLUS one or more of: - Ischaemic symptoms - Pathological Q waves on ECG - ECG changes indicative of ischaemia - Coronary artery intervention

Question 31

What ECG changes would you expect to see in a STEMI?

Answer 31

- Tall T waves - ST elevation - Prolonged PR interval - T wave inversion after a couple of days - Long-term - pathological Q waves

Question 32

What changes on an ECG would be seen in hypokalaemia?

Answer 32

- ST depression | - U waves

Question 33

What changes would you expect to see on an ECG in hyperkalaemia?

Answer 33

- Tall (tented) T waves - Prolonged PR interval - Widened QRS - Absent P wave

Question 34

Give some changes you would see in AF on an ECG

Answer 34

- Irregularly irregular rhythm - Tachycardia - Absent P waves - Oscillating baseline

Question 35

Where would you place the 6 chest leads for a 12 lead ECG?

Answer 35

- V1 - 4th ICS, right sternal edge - V2 - 4th ICS, left sternal edge - V3 - Between V2 and V4 - V4 - 5th ICS, MCL - V5 - Between V4 and V6 - V6 - 5th ICS, MAL

Question 36

What is the difference between systolic and diastolic heart failures? Which is more likely to occur alone?

Answer 36

- Systolic - problem with ventricular contraction - Diastolic - problem with filling - Diastolic more likely to occur alone

Question 37

What is congestive heart failure?

Answer 37

HF where both right and left sides are affected

Question 38

What is the major cause of RHF?

Answer 38

Secondary to lung conditions - cor pulmonale

Question 39

Give some clinical features of RHF

Answer 39

- Fatigue - Dyspnoea - Increased JVP - Ascites, hepatomegaly - Peripheral oedema

Question 40

What is the major cause of LHF?

Answer 40

Ischaemic heart disease - results in hypertension which increases afterload on LV

Question 41

List some clinical features of LHF

Answer 41

``` Pulmonary oedema Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Minial peripheral oedema ```