Principle In Cardiology

Question 1

Symptoms of Cardiac Disease

Answer 1

1. Heart Failure Symptoms
2. Chest Pain
3. Arrhythmia Symptoms
4. Cyanosis
5. Infective Symptoms

Question 2

Heart Failure Symptoms

Answer 2

1. Symptoms of Pulmonary Venous Congestion
2. Symptoms of Systemic Congestion
3. Symptoms of Low Cardiac Output

Question 3

Cause of pulmonary venous congestion symptoms

Answer 3

Stagnation of blood in pulmonary veins

Question 4

Symptoms of pulmonary venous congestion

Answer 4

1. Dyspnea
2. Orthopnea
3. Paroxysmal Nocturnal Dyspnea
4. Cough
5. Hemoptysis

Question 5

Cause of systemic congestion symptoms

Answer 5

Stagnation of blood behind a right ventricular lesion

Question 6

Symptoms of systemic congestion

Answer 6

1. Lower limb swelling
2. Abdominal distension

Question 7

Cause of low cardiac output symptoms

Answer 7

Hypoperfusion

Question 8

Symptoms of low cardiac output

Answer 8

1. Reduced effort tolerance
2. Dizziness
3. Syncope

Question 9

Chest pain cardiac causes

Answer 9

1. Coronary artery disease
2. Pericarditis
3. Aortic Aneurysm
4. Dissecting aneurysm

Question 10

Cardiac arrhythmia cause

Answer 10

Electrophysiological abnormalities in conduction pathway

Question 11

Symptoms of cardiac arrhythmia

Answer 11

1. Palpitation
2. Syncopal attack

Question 12

Cause of palpitation in cardiac arrhythmia

Answer 12

Tachyarrhythmia

Question 13

Cause of syncopal attack in cardiac arrhythmia

Answer 13

Poor cardiac output due to poor heart contractility

Question 14

Cardiac causes of cyanosis

Answer 14

1. Cyanotic heart diseases (ASD, VSD, Tetralogy of Fallot)
2. Cor pulmonale

Question 15

Why cyanotic heart disease causes cyanosis

Answer 15

Right to left cardiac shunting

Question 16

Non cardiac causes of cyanosis

Answer 16

1. ILD
2. COPD
3. Methemoglobinemia

Question 17

Causes of infective symptoms

Answer 17

1. Infective endocarditis
2. Pericarditis
3. Rheumatic fever

Question 18

Signs of cardiac disease on general examination that shouldn’t be missed

Answer 18

1. Heart Failure sign
2. Atrial Fibrillation sign
3. Infective Endocarditis Stigmata
4. Aortic Regurgitation peripheral signs
5. Overwarfarinisation signs

Question 19

Infective endocarditis stigmata

Answer 19

1. Splinter hemorrhages
2. Janeway lesions
3. Osler’s nodes
4. Conjunctival hemorrhages

Question 20

Characteristic of Janeway lesions

Answer 20

1. Painless spots
2. On palm/soles of feet

Question 21

Characteristic of Osler’s nodes

Answer 21

1. Painful nodules
2. In pulp of fingers/toes

Question 22

Peripheral signs of aortic regurgitation

Answer 22

MCD TQ

1. Muller sign
2. Corrigan pulse
3. De-Musset sign
4. Traube sign
5. Quincke sign

Question 23

Corrigan pulse

Answer 23

Rapid and forceful distension of arterial pulse with quick collapse

Question 24

De-Musset sign

Answer 24

To and fro head bobbing

Question 25

Muller sign

Answer 25

Visible pulsation of uvula

Question 26

Quincke sign

Answer 26

Capillary pulsations seen on light compression of nail bed

Question 27

Traube sign

Answer 27

Systolic and diastolic sounds (pistol shots) over the femoral artery

Question 28

Thoracic scars can be found during inspection

Answer 28

1. Midline sternotomy scar 2. Pacemaker scar 3. Anterolateral thoracotomy scar 4. Axillary thoracotomy scar 5. Posterolateral thoracotomy scar

Question 29

Apex beat character & interpretation

Answer 29

1. Normal: Gentle tapping 2. Volume Overload (AR, Anemia, Thyrotoxicosis) - Hyperdynamic - Strong - Forceful - Displaced - Non sustained 3. Pressure Overload (AS, LVH, HPT) - Heaving - Forceful - Localized - Sustained

Question 30

Points for auscultation

Answer 30

L 5th ICS: Mitral valve LLSE (4th ICS): Tricuspid valve L 2nd ICS: Pulmonary valve R 2nd ICS: Aortic valve

Question 31

Investigations in cardiology

Answer 31

1. ECG 2. Cardiac Biomarkers 3. Cardiac Imaging 4. Stress Test 5. Invasive Study

Question 32

ECG can be used to detect: @ ECG Indication

Answer 32

1. Arrythmia 2. Acute Coronary Syndrome 3. Clue about heart structural abnormality

Question 33

Cardiac biomarkers

Answer 33

1. Cardiac enzymes: Trop I, CK-MB, LDH, AST 2. Natriuretic peptides: Pro-BNP, NT Pro-BNP

Question 34

Elevated cardiac enzymes indicates:

Answer 34

Myocardial damage

Question 35

Elevated natriuretic peptides indicate:

Answer 35

Heart failure

Question 36

Modalities of cardiac imaging

Answer 36

1. Echocardiography (Transthoracic/ Transesophageal) 2. CTA Coronary 3. Cardiac MRI 4. Cardiac Nuclear Scan

Question 37

What can echocardiography assess

Answer 37

1. Structural abnormality 2. Severity of valvular heart disease 3. Cardiac function 4. Hemodynamic of the heart

Question 38

What can CTA Coronary assess

Answer 38

1. Coronary artery anatomy for: Aneurysm, dissection.. 2. Coronary artery patency for: Stenosed/ Not stenosed

Question 39

What can MRI cardiac assess

Answer 39

1. Cardiac anatomy 2. Myocardial tissue characterization : MRI T1, MRI T2 3. Myocardial tissue perfusion

Question 40

Purpose of stress test

Answer 40

1. Evaluate cardiac function during exertion 2. To screen for - coronary artery disease - exercise induced arrythmia

Question 41

Modalities of stress test

Answer 41

1. Exercise stress test 2. Cardiac MRI stress test 3. Exercise stress echocardiography 4. Dobutamine stress echocardiography

Question 42

Invasive cardiac investigation example

Answer 42

1. Coronary angiography 2. Cardiac electrophysiological study