Learning Cardiology

Q. A 65-year-old comes to the clinic for a review of his symptoms. He has been following up for aortic stenosis for the last 10 years. Over the past three months he has been complaining of fatigue and has lost 8 kg in weight. A full blood count was requested: Hb 9.2 g/dl    MCV 65 fl Plt 360 x 10 9 /l WBC 5.0 x10 9 /l Blood film Hypochromic, microcytic picture. An upper GI endoscopy and duodenal biopsy was normal.  What is the most appropriate next investigation? A- Transthoracic echocardiogram B- Bone marrow biopsy C- Colonoscopy D- Faecal occult blood E- Mesenteric angiography    Answer: C. Colonoscopy Explanation: Patient might be having GI angiodysplasia which can be seen in association with aortic stenosis. This syndrome is known as Heyde's syndrome.  Patient presents with anemia due to chronic blood loss. UGI endoscopy is usually normal. Colonoscopy should be next investigation in this case. Definitive treatment is surgical replacement of aortic va

Q. A 25 years old gentleman is brought to emergency with the complaint of fever for 7 days. He drinks five units of alcohol per day and admitted to regular intravenous drug abuse. On examination, he is febrile, has tachypnea and tachycardia. Blood pressure is 108/70. JVP is elevated and there is a murmur all over the precordium. What will be most likely cause of infection in this patient? A. Staphylococcus epidermidis B. Streptococcus viridans C. Staphylococcus aureus D. Pneumocystis carinii Answer: Staphylococcus aureus Explanation: With given history and abuse of i/v drugs, tricuspid valve endocarditis is most likely diagnosis. Among, i/v drug abusers, Staphylococcus aureus is most common cause. 

Q. Branham's sign is seen in? A. Anemia B. Arteriovenous fistula C. Hyperthyroidism D. Beri-beri Answer: Arteriovenous fistula Explanation:  It is also known as Nicoladoni-Branham's sign. Seen in systemic AV fistula Occurs when compression is applied just proximal to AV fistula, there is reflex bradycardia due to increase in peripheral vascular resistance and afterload.

Q. Eisenmenger’s physiology will result from an unoperated: a. Small atrial septal defect b. Tetralogy of Fallot c. Large patent ductus arteriosus d. Coarctation of the aorta e. Pulmonary stenosis Answer: Option c Explanation: Large left to right shunts (e.g. Large PDA, VSD, ASD) lead to excessive pulmonary blood flow and irreversible changes in pulmonary capillaries which cause pulmonary arterial hypertension and ultimately reversal of cardiac shunt. Small left to right shunts usually don’t cause Eisenmenger’s syndrome. TOF and PS have decreased pulmonary blood flow and COA is a left sided obstructive lesion which do not cause Eisenmenger’s syndrome.

Q. Gorlin’s formula requires all of the following to calculate aortic valve area in aortic stenosis patient except? a. Cardiac output b. Pulmonary capillary wedge pressure c. Heart rate d. Systolic ejection period Answer: Option b Gorlin's formula to calculate aortic valve area Aortic valve area= CO / {SEP x HR x 44.3(MG) 1/2 } Where, CO= Cardiac output SEP= Systolic ejection period HR= Heart rate MG= Mean pressure gradient Simplified Hakki’s formu la for calculation of aortic valve area Aortic valve area= CO / (MG) 1/2 Where, CO= Cardiac output MG= Mean pressure gradient Note: Peak gradient can also be used in place of mean gradient in case of Hakki's equation.

Q.  A young man in late his late 20s, case of rheumatic heart disease has a blood  pressure of 160/70 on examination. His mean arterial pressure  is: a. 100 mm Hg b. 110 mm Hg c. 90 mm Hg d. 120 mm Hg e. Can not be determined without knowing the heart rate Answer: Option a  Mean arterial pressure= (Systolic blood pressure + 2 x Diastolic blood pressure)/ 3