Which part of the jugular venous waveform may be exaggerated in tricuspid regurgitation?
Correct Answer B:
JVP: giant v waves in tricuspid regurgitation.
Jugular venous pulse:
As well as providing information on right atrial pressure, the jugular vein waveform may provide clues to underlying valvular disease. A non-pulsatile JVP is seen in superior vena caval obstruction. Kussmaul's sign describes a paradoxical rise in JVP during inspiration seen in constrictive pericarditis.
'a' wave = atrial contraction:
Cannon 'a' waves:
'c' wave:
'v' wave:
'x' descent = fall in atrial pressure during ventricular systole.
'y' descent = opening of tricuspid valve.
A 72-year-old male is admitted to the Emergency Room following a collapse at church. ECG reveals dissociation between the P and QRS complexes with a rate of 40 / minute.
Which one of the following clinical findings may also be found?
Correct Answer D:
Complete heart block:
Features:
A 61-year-old woman who is normally fit and well is admitted with chest pain. An ECG shows anterolateral T wave inversion. The troponin T value at 12 hours is 0.54. On discharge her medications include aspirin, atorvastatin, bisoprolol and ramipril.
Which one of the following statements best describes the role of clopidogrel in this situation?
Correct Answer C:
NICE NSTEMI/unstable angina guidelines are based on 6 month mortality risk:
Please see the 2010 NICE unstable angina and NSTEMI guidelines for more details. The 6 month mortality may be calculated using a risk model such as GRACE.
Myocardial infarction: secondary prevention:
NICE produced guidelines on the management of patients following a myocardial infarction (MI) in 2007. Some key points are listed below: All patients should be offered the following drugs:
Clopidogrel:
Aldosterone antagonists:
*this can be calculated using scoring systems such as GRACE.
Which one of the following is least likely to cause dilated cardiomyopathy?
Correct Answer A:
Haemochromatosis is more commonly associated with restrictive cardiomyopathy but a dilated pattern may also be seen. There is a known association between Wilson's disease and cardiomyopathy but this is extremely rare and not often clinically significant.
Dilated cardiomyopathy:
Dilated cardiomyopathy (DCM) basics:
Causes often considered separate entities:
Other causes:
Inherited Dilated Cardiomyopathy:
*These causes may also lead to restrictive cardiomyopathy.
Each one of the following is associated with atrial myxoma, except:
A 'J' wave is seen in hypothermia.
Atrial myxoma:
Overview:
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