Teaching with Prof Collins

Question 1

Jones criteria is for?

Answer 1

Rheumatic heart disease

Question 2

Rheumatic heart disease - Jones criteria - what’s part of this?

Answer 2

Carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules

raised ESR/CRP - look this up

Question 3

Endocarditis - what is the screening criteria

Answer 3

Duke’s criteria

Question 4

Can you rule our endocarditis with a normal echo?

Answer 4

No - you can’t see vegetations on this all the time

Question 5

What is libman-sacks endocarditis

Answer 5

You get this with autoimmune conditions like SLE

Question 6

What urinary sign do you get in endocarditis and why?

Answer 6

Immune glomerulonephritis secondary to endocarditis - should be resolved upon IE treatment

Question 7

What would you give in someone with AF if they need rate control but have asthma?

Answer 7

Avoid BB
Give Verapamil instead

Try not to give amiodarone as it might convert her

Then anticoag
Apixaban - twice a day
Edoxaban 60mg once a day

Question 8

SVT management

Answer 8

If haemodynamically unstable - DC cardioversion

If haemodynamically stable - IV adenosine 6mg

Question 9

Commonest cause of SVT

Answer 9

AVNRT

Question 10

Amiodarone SE

Answer 10

Hepatitis
Hypo or hyper thyroidism
Lung fibrosis

Question 11

How do you treat complete heart block?

Answer 11

If haemodynamically unstable - transcutaneous pacing

If stable - pacemaker

Question 12

What is a physiological pacemaker?

Answer 12

Physiological pacemaker - dual chamber - one lead in right atrium to sense P wave, which will then send to the lead in the ventricle will see if the wave has been conducted, if not it will contract

Answer 13

VVI

ICD - internal defib

Resynchronised pacemaker to improve synchronisation

Answer 14

Defib - higher shock

DC cardioversion

unsynchronised - for VF/VT????

synchronised - for AF

Question 15

What is the hear of the MS

Answer 15

The tap in MS is a palpable murmur

Answer 16

Forceful apex - hypertrophy
Displaced apex - dilated

Question 17

PE ECG changes

Answer 17

S1 Q3 T3

Question 18

Aortic stenosis

Answer 18

Most common in over 65s

Question 19

Mitral stenosis

Answer 19

Most commonly caused by rheumatic fever
Tapping S1
Opening snap
You get heart failure

Manage with diuretics, BB/CCB for AF
Anti coag

Question 20

Mitral regurg - classificaiton and causes

Answer 20

Primary - valve degeneration
Secondary - left ventrcular remodelling causing MR

Acute - after infective endocarditis, rheuamtic fever
Chronic

Answer 21

Barlow’s valve
Mitral valve prolapse - more common in women
More lax tissue

Question 22

MR heart sound

Answer 22

holosystolic murmur

Question 23

Pulmonary stenosis

Answer 23

Louder at left upper sternal border - doesn’t radiate into carotids
S2 split - because aortic valve closes first, and then the pulmonary valve closes later

JVP - prominent A waves
RVH - possibly with heave

Question 24

VSD

Answer 24

Acquired, or after MI

Holosystolic murmur - loudest at left lower sternal edge
Eisenmenger if there is a reversal of the shunt from left to right and right to left

R to L

Question 25

Tricuspid regurg

Answer 25

Holosystolic murmur - retrograde blood flow during contraction

RHF
Can be caused by
Ebstein anomaly - the valve is pushed down so can’t close as well

Tricuspid repair