Other

Question 1

What are features of an atrial septal defect? (2)

Answer 1

• Ejection systolic murmur, fixed splitting of S2
• Embolism may pass from venous system to left side of heart causing a stroke

Question 2

What are the 2 types of atrial septal defect and which is most common?

Answer 2

○ Ostium secundum (most common)
○ Ostium primum

Question 3

What are the ecg abnormalities in ostium secundum?

Answer 3

RBB with RAD

Question 4

What are the ecg abnormalities in ostium primum?

Answer 4

RBBB with LAD and prolonged PR interval

Question 5

What is digoxin mainly used for? (2)

Answer 5

Rate control in management of AF
Has positive ionotropic properties so sometimes used for improvement of symptoms in HF

Question 6

What is the action of digoxin? (3)

Answer 6

Decreases conduction through AVN .: slows ventricular rate in AF

Increases cardiac force of contraction due to inhibition of Na+/K+ ATPase pump

Stimulates vagus nerve

Question 7

If you suspect digoxin toxicity when should digoxin concentrations be measured from?

Answer 7

Within 8-12 hours of last digoxin dose

Question 8

What are the features of digoxin toxicity? (8)

Answer 8

• Generally unwell
• Lethargy
• Nausea & vomiting
• Anorexia
• Confusion
• Yellow-green vision
• Arrhythmias (e.g. AV block, bradycardia)
• Gynaecomastia

Question 9

What are the ecg changes seen in digoxin toxicity? (4)

Answer 9

• Down-sloping ST depression (‘reverse tick’, ‘scooped out’)
• Flattened/inverted T waves
• Short QT interval
• Arrhythmias e.g. AV block, bradycardia

Question 10

What is the management of digoxin toxicity? (3)

Answer 10

• Digibind
• Correct arrhythmias
• Monitor potassium