MRCP – Cardiology exam
questions and answers
Heart Murmurs - Loud S2
Hypertension - systemic (loud A2), pulmonary (loud P2),
hyperdynamic states, atrial septal defect without pulmonary
hypertension
Heart murmurs - soft S2
Aortic stenosis
Heart murmurs - fixed split S2
Atrial septal defect
Heart noises - widely split S2
Deep inspiration, RBBB, pulmonary stenosis, severe mitral
regurgitation
Heart noises - Reversed split S2 (P2 before A2)
LBBB, severe aortic stenosis, right ventricle pacing, WPW type B,
Patent ductus arteriosus
Cardiac enzymes in MI
Myoglobin then CK-MB, then troponin, then LDH
Orbit score
0-2 low risk, 3 medium risk, 4-7 high risk
,JVP waves
A wave - Atrial contraction (absent in afib)
C wave - Contraction of R ventriCle (closed tricuspid valve bulges
into right atrium)
V wave - Villing of atrium against closed tricuspid Valve
Pregnancy with pulmonary hypertension
Women with pulmonary hypertension should avoid becoming
pregnant due to high mortality
Abx for endocarditis if organism unknown
Amoxicillin + consider low dose Gent
If pen allergic, MRSA or severe sepsis - Vanc + Gent
If prosthetic valve - Vanc + Gent + Rifampicin
Confirmed staph native valve - Flucloxacillin
Staph prosthetic valve - Flucloxacillin + rifamp + low dose Gent,
swap fluco for vanc if pen allergic
Streptococci - Benzylpenicillin if fully sensitive, Benzyl + low dose
Gent is less sensitive. If pen allergic vancomycin + low dose Gent
HOCM - Drugs to use
A - amiodarone
B - Beta blocker
C - Cardioverter defib
D - dual chamber pacemaker
E - Endocarditis prophylaxis
HOCM - drugs to avoid
Nitrates, ACE inhibitors, inotropes
INR targets
VTE - 2.5, recurrent 3.5
AF - 2.5
S3 and S4
, S3 - Diastolic filling of ventricle. Normal <30, can persist in women
up to 50. Also in left ventricular failure (dilated cardiomyopathy),
constrictive pericarditis, mitral regurgitation.
S4 - Atrial contraction against stiff ventricle. Aortic stenosis, HTN,
HOCM
Congenital Heart disease
Acyanotic - VSD (30%), ASD, patent ductus arteriosus, coarctation of
aorta, aortic stenosis
Cyanotic - Tetralogy of fallot, transposition of great arteries,
tricuspid atresia
Electrical cardioversion synchronised to which wave
R wave
Endocarditis - indications for surgery
Severe valvular incompetence, aortic abscess (lengthening of PR
interval), resistant infections, cardiac failure, recurrent emboli after
abx
Heart block after inferior MI
Common and can be managed conservatively if asymptomatic and
haemodynamically stable. After anterior MI will need pacing
Fondaparinux mode of action
Activates antithrombin III
Furosemide mode of action
Inhibits the Na-K-CI cotransporter in thick ascending limb of loop of
henle
Thiazide mode of action
Inhibition of NaCI symporter at the distal convuluted tubule
Rheumatic heart fever Histology
Aschoff bodies
Tricuspid regurgitation
Signs - pan systolic murmur, prominent V waves in JVP, pulsatile
hepatomegaly, left parasternal heave.
Causes = right ventricular infarction, pulomnary hypertension,
endocarditis, ebsteins anomaly, carcinoid syndrome
questions and answers
Heart Murmurs - Loud S2
Hypertension - systemic (loud A2), pulmonary (loud P2),
hyperdynamic states, atrial septal defect without pulmonary
hypertension
Heart murmurs - soft S2
Aortic stenosis
Heart murmurs - fixed split S2
Atrial septal defect
Heart noises - widely split S2
Deep inspiration, RBBB, pulmonary stenosis, severe mitral
regurgitation
Heart noises - Reversed split S2 (P2 before A2)
LBBB, severe aortic stenosis, right ventricle pacing, WPW type B,
Patent ductus arteriosus
Cardiac enzymes in MI
Myoglobin then CK-MB, then troponin, then LDH
Orbit score
0-2 low risk, 3 medium risk, 4-7 high risk
,JVP waves
A wave - Atrial contraction (absent in afib)
C wave - Contraction of R ventriCle (closed tricuspid valve bulges
into right atrium)
V wave - Villing of atrium against closed tricuspid Valve
Pregnancy with pulmonary hypertension
Women with pulmonary hypertension should avoid becoming
pregnant due to high mortality
Abx for endocarditis if organism unknown
Amoxicillin + consider low dose Gent
If pen allergic, MRSA or severe sepsis - Vanc + Gent
If prosthetic valve - Vanc + Gent + Rifampicin
Confirmed staph native valve - Flucloxacillin
Staph prosthetic valve - Flucloxacillin + rifamp + low dose Gent,
swap fluco for vanc if pen allergic
Streptococci - Benzylpenicillin if fully sensitive, Benzyl + low dose
Gent is less sensitive. If pen allergic vancomycin + low dose Gent
HOCM - Drugs to use
A - amiodarone
B - Beta blocker
C - Cardioverter defib
D - dual chamber pacemaker
E - Endocarditis prophylaxis
HOCM - drugs to avoid
Nitrates, ACE inhibitors, inotropes
INR targets
VTE - 2.5, recurrent 3.5
AF - 2.5
S3 and S4
, S3 - Diastolic filling of ventricle. Normal <30, can persist in women
up to 50. Also in left ventricular failure (dilated cardiomyopathy),
constrictive pericarditis, mitral regurgitation.
S4 - Atrial contraction against stiff ventricle. Aortic stenosis, HTN,
HOCM
Congenital Heart disease
Acyanotic - VSD (30%), ASD, patent ductus arteriosus, coarctation of
aorta, aortic stenosis
Cyanotic - Tetralogy of fallot, transposition of great arteries,
tricuspid atresia
Electrical cardioversion synchronised to which wave
R wave
Endocarditis - indications for surgery
Severe valvular incompetence, aortic abscess (lengthening of PR
interval), resistant infections, cardiac failure, recurrent emboli after
abx
Heart block after inferior MI
Common and can be managed conservatively if asymptomatic and
haemodynamically stable. After anterior MI will need pacing
Fondaparinux mode of action
Activates antithrombin III
Furosemide mode of action
Inhibits the Na-K-CI cotransporter in thick ascending limb of loop of
henle
Thiazide mode of action
Inhibition of NaCI symporter at the distal convuluted tubule
Rheumatic heart fever Histology
Aschoff bodies
Tricuspid regurgitation
Signs - pan systolic murmur, prominent V waves in JVP, pulsatile
hepatomegaly, left parasternal heave.
Causes = right ventricular infarction, pulomnary hypertension,
endocarditis, ebsteins anomaly, carcinoid syndrome
