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MRCP Part II > Cardio > Flashcards

Cardio Flashcards

1
Q

‘global speckled’ pattern on ECHO

A

Cardiac amyloidosis

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2
Q

Psuedoinfarction pattern on ECG appears as

A

Low-voltage complexes with poor R wave progression

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3
Q

Pseudoinfarction pattern on ECG associated with

A

Cardiac amyloidosis

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4
Q

Normal PR interval

A

120 - 200 ms

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5
Q

Anteroseptal - ECG changes

A

V1 - V4

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6
Q

Inferior - ECG changes

A

II, III, aVF

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7
Q

Anterolateral - ECG changes

A

V4-V6, I, aVL

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8
Q

Lateral - ECG changes

A

I, aVL +/- V5-V6

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9
Q

Posterior - ECG changes

A

Tall R waves V1-V2

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10
Q

Coronary artery affected: Anteroseptal changes

A

Left anterior descending

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11
Q

Coronary artery affected: Inferior changes

A

Right coronary

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12
Q

Coronary artery affected: Anterolateral changes

A

Left anterior descending,
or,
Left circumflex

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13
Q

Coronary artery affected: Lateral changes

A

Left circumflex

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14
Q

Coronary artery affected: Posterior changes

A

Usually left circumflex, also right coronary

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15
Q

Long QT1

A

Adrenergic surge due to physical activity

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16
Q

Long QT2

A

Adrenergic surge due to intense emotion

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17
Q

Long QT3

A

Death during sleep

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18
Q

Kussmaul’s sign looks like

A

JVP rises during inspiration

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19
Q

Kussmails sign associated with

A

Constrictive pericarditis

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20
Q

Definition of pulmonary arterial hypertension

A

Resting mean pulmonary artery pressure is >= 25 mmHg

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21
Q

Wellen’s syndrome - appearance on ECG

A

Deeply inverted/biphasic T waves in V2 - V3

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22
Q

Wellen’s syndrome - suggests

A

Critical LAD stenosis

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23
Q

Aortic stenosis - Criteria for aortic valve surgery

A

Symptomatic

Valvular gradient > 40 mmHg and features of LV systolic dysfunction

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24
Q

Dabigatran MOA

A

Inhibits thrombin

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25
Q

Dabigatran reversal agent

A

Idarucizumab

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26
Q

Blood pressure target - patient with hypertension without other comorbidity

A

< 140/90 mmHg

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27
Q

Blood pressure target - patient with diabetes and end organ damage

A

< 130/80 mmHg

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28
Q

Normal QRS duration

A

< 120 ms

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29
Q

INR > 8.0 with No bleeding

A

Oral Vitamin K 1-5 mg

Repeat dose vitamin K if INR still too high after 24hr

Restart warfarin when INR < 5

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30
Q

ECG findings associated with ostium primum

A

RBBB + LAD, prolonged PR

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31
Q

ECG findings associated with ostium secundum

A

RBBB + RAD

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32
Q

Heart failure - 1st-line management for all patients

A

ACEi + beta-blocker

start one, then add other

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33
Q

Heart failure - 2nd-line

A 
Aldosterone antagonist 
(spironolactine/eplerenone)
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34
Q

Heart failure - 3rd-line options

A

Ivabradine

Sacubitril-valsartan

Digoxin

Hydralazine with nitrate

Cardiac resynchroniziiton therpy

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35
Q

Heart failure management – criteria for ivabridine

A

Sinus rhythm >75 bpm +

LVEF <35%

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36
Q

Heart failure management - criteria for sacubitril-valsartan

A

LVEF <35%

Initiate following ACEi, ARB washout period

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37
Q

Heart failure management - indication for digoxin

A

Coexistant AF

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38
Q

Heart failure management - indication for hydralazine with nitrate

A

Afro-Caribbean patient

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39
Q

Heart failure management - indication for cardiac resynchronization therapy

A

Widened QRS complex >130ms

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40
Q

Infective endocarditis- empiric treatment for prosthetic valve

A

Vancomycin + rifampicin + low-dose gentamicin

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41
Q

Infective endocarditis- empiric treatment for native valve

A

Amoxicillin + consider low-dose gentamicin

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42
Q

Infective endocarditis- empiric treatment for native valve (Penicillin allergy)

A

Vancomycin + low-dose gentamicin

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43
Q

Mitral regurgitatiion with new AF - management?

A

Refer for mitral valve replacement

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44
Q

Features of cholesterol embolism

A
  • Eosinophilia
  • Purpura
  • Renal failure
  • Livedo reticularis
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45
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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46
Q

Epsilon wave looks like

A

Small positive deflection at end of QRS complex

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47
Q

Infective endocarditis - treatment for prosthetic valve, caused by staphylococci

A

Flucloxacillin + rifampicin + low-dose gentamicin

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48
Q

Prolonged QTc in men

A

> 450ms

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49
Q

Infective endocarditis - treatment for native valve, caused by staphylococci (PEN ALLERGIC)

A

Vancomycin + rifampicin

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50
Q

Acceptable increase in creatinine when starting AECi

A

Up to 30% increase

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51
Q

Infective endocarditis - treatment for prosthetic valve, caused by MRSA

A

Vancomycin + rifampicin + low-dose gentamicin

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52
Q

Secundum atrial septal defects occur where

A

Middle of atrial septum

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53
Q

Infective endocarditis - treatment if caused by fully-sensitive streptococci eg viridans (PEN ALLERGIC)

A

Vancomycin + low-dose gentamicin

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54
Q

Infective endocarditis - treatment if caused by less-sensitive streptococci (PEN ALLERGIC)

A

Vancomycin + low-dose gentamicin

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55
Q

Infective endocarditis - treatment if caused by less-sensitive streptococci

A

Benzylpenicillin + low-dose gentamicin

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56
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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57
Q

Culture-negative causes of infective endocarditis

A 
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
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58
Q

Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex

A

Lown-Ganong-Levine syndrome

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59
Q

ECG findings in Wolff-Parkinson-White syndrome

A

Short PR interval, wide QRS complex with slurred upstroke (delta wave)

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60
Q

PMH contraindications to adenosine use in SVT

A

Asthma

Taking dipyridamole

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61
Q

ECG findings in dextrocardia

A

Inverted P wave in lead I
RAD
Loss of R wave progression

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62
Q

Patient with WPW in AF - which medication for cardioversion

A

Flecainide

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63
Q

Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex

A

Amyloidosis

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64
Q

Digoxin contraindication

A

Cardiac amyloidosis (digoxin binds to amyloid > toxicity)

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65
Q

1st line management of acute idiopathic/viral pericarditis

A

NSAID + colchicine

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66
Q

HACEK agents

A 
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
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67
Q

Culture-negative causes of infective endocarditis

A 
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
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68
Q

Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex

A

Lown-Ganong-Levine syndrome

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69
Q

Contraindication to adenosine use in SVT

A

Asthma

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70
Q

ECG findings in dextrocardia

A

Inverted P wave in lead I
RAD
Loss of R wave progression
Shift of p axis (+120 degrees)

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71
Q

Patient with WPW in AF - which medication for cardioversion

A

Flecainide

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72
Q

Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex

A

Amyloidosis

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73
Q

Digoxin contraindication

A

Cardiac amyloidosis (digoxin binds to amyloid > toxicity)

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74
Q

1st line management of acute idiopathic/viral pericarditis

A

NSAID + colchicine

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75
Q

ECG findings in dextrocardia

A

Small complexes in chest leads vs the limb leads

Inverted complexes in I and aVL

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76
Q

ECG findings in Second-degree AV block type 1 (Mobitz I, Wenckebach)

A

Progressive prolongation of PR interval until a dropped beat occurs

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77
Q

ECG findings in Second-degree AV block type 2 (Mobitz II)

A

P waves are often not followed by a QRS complex.

Where a QRS complex does follow, the PR interval is NORMAL

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78
Q

CHA2DS2-VASc

A

CCF - 1

HTN - 1

Age:
=>75 - 2
65-74 - 1

DM - 1

Stroke/TIA - 2

IHD/PAD - 1

Female - 1

79
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l

A

Add low-dose spironolactone

80
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l

A

Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)

81
Q

Beta-blockers in systemic sclerosis

A

May worsen Raynauds

82
Q

Hypertension - 3rd line management, already taking ACEi + CCB

A

Thiazide-like diuretic (Indapamide)

83
Q

Hypertension - 1st line management <55 years old and not AFC

84
Q

Hypertension - 1st line management any age, with T2DM, not AFC

85
Q

Hypertension - 1st line management >55 years old not T2DM

A

Calcium channel blocker (amlodipine)

86
Q

Hypertension - 1st line management any age, AFC, not T2DM

A

Calcium channel blocker (amlodipine)

87
Q

Hypertension - 2nd line management - already taking ACEi/ARB

A

Add:
CCB (amlodipine)
or
TLD (indapamide)

88
Q

Hypertension - 2nd line management - already taking CCB

A

Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)

89
Q

Hypertension - 3rd line management, already taking ACEi + TLD

90
Q

Patient with AF, already on dual anti-platelet

A

Still needs formal anticoagulation (Warfarin/DOAC)

91
Q

Which anti-coagulant for AF, in patient with CKD?

A

Rivaroxaban

Reduced dose if GFR 15-50

92
Q

Dabigatran in renal impairment

A

Not safe, high risk of bleeding

93
Q

Cardiac monitor shows ‘short runs of polymorphic VT’

A

Torsades de pointes

94
Q

Management of Torsades de pointes

A

IV Magnesium sulphate

95
Q

Causes of long QT (therefore increase risk of Torsades de pointes)

A 
Amiodarone, sotalol
Erythromycin/clarithromycin
Low Ca, K, Mg
TCA/antipsychotics
Chloroquine
Fluconazole
96
Q

Management of monomorphic VT - no adverse signs

A

Amiodarone/
Lidocaine/
Procainamide

97
Q

Management of monomorphic VT - with adverse signs

A

DC cardioversion

98
Q

ECG findings in Brugada syndrome

A

Coved ST elevation in >1 of V1-V3 followed by negative T wave

99
Q

Diagnostic tool for Brugada

A

Fleicanide challenge

100
Q

Management of Brugada syndrome

101
Q

Long-term management of WPW

A

Radiofrequency ablation

102
Q

Medical management of SVT in WPW

A

Sotalol, adenosine, fleicanide, amiodarone

103
Q

CI to use of sotalol/adenosine in for SVT in WPW

A

Possible underlying AF

104
Q

Which type of atrial septal defect is most common

A

Ostium secundum defect

105
Q

ST elevation without reciprocal depression, shortly after myocardial infarction, suggests

A

Left ventricle aneurysm

106
Q

Feature that suggests vascular claudication (over neurogenic claudication)

A

No relief from leaning forward/sitting down.

Only relieved with rest

107
Q

ABPI > 1.2

A

Calcified stiff arteries

May be PAD or normal in old age

108
Q

ABPI 1.0 - 1.2

109
Q

ABPI 0.9 - 1.0

A

Acceptable

110
Q

ABPI < 0.9

A

Likely PAD

111
Q

ABPI < 0.5

A

Severe PAD - urgent referral

112
Q

ABPI required for compression bandaging

113
Q

ECG features of trifascicular block

A

RBB + LAD/RAD + prolonged PR

114
Q

Management of sick sinus syndrome with bradarrhythmia

A

Pacemaker (AAIR)

115
Q

Inherited long QT and sensorineural hearing loss seen in

A

Jervell & Lange-Nielson syndrome

116
Q

Congenital syndrome with long QT (no hearing loss)

A

Romano-Ward syndrome

117
Q

Most helpful distinguishing feature of pericarditis on ECG?

A

PR segment depression (best seen in Lead II and V6)

118
Q

Drugs to avoid in restrictive cardiomyopathy?

A

Digoxin, Nitrates, Atropine, Inotropes, Diuretics (unless LVF)

119
Q

Minor Criteria for Rheumatic Fever?

A 
Fever
Arthralgia
Raised ESR/CRP
ECG showing heart block
Previous Rheumatic Fever
120
Q

Prophylaxis against further episodes of paroxysmal Atrial Fibrillation?

A

1) Beta Blockers (e.g Bisoprolol)
2) Diltiazam can be used if there is no evidence of structural heart disease on Echo or if patients have severe asthma

NB: due to long term commitment with the medications most patients now opt for electrophysiological studies and ablation

121
Q

What ECG abnormality is seen in ARVC?

A

T-wave inversions in V1-V3

122
Q

Criteria for Aortic Valve Replacement in AR?

A
  1. All symptomatic patients
  2. Asymptomatic patients with EF < 55% or LV dilations (end-diastolic dimension > 70mm and end systolic dimension > 50mm)
    3) Significant enlargement of ascending aorta
123
Q

Anticoagulation in patients with HF and low EF should be considered especially if they have what properties?

A
  1. previous VTE event
  2. Intracardiac thrombus
  3. Left ventricular aneurysms

But consider bleeding vs clotting risk

124
Q

What are the recommendations for follow up in patients with AR?

A
  1. Asymptomatic patients with severe AR and normal LV function: every year
  2. First diagnosis or LV diameter close to surgery threshold: 3-6 months
  3. Can consider BNP as increased BNP during follow up related to deterioration in LV function

Mild/Moderate AR: review on yearly basis and echo every 2 years

125
Q

How long should you continue LWMH for when bridging for warfarin?

A

Until INR > 2

126
Q

Features of Eikenella?

A

Gram negative bacilli

part of human commensal in mouth

127
Q

When is percutaneous mitral balloon valvotomy recommended in patients with mitral stenosis?

A

Severe MS (area 1.5mm^2), favourable valve morphology in the absence of intra-atrial thrombus

128
Q

When is surgery recommended for mitral valve in patients with mitral stenosis?

A 
Mitral valve area < 1 
Severely symptomatic patients (NYHA class III-IV), who are not at risk of surgery, or who have failed mitral balloon valvotomy before.
129
Q

What is the anticoagulation guidelines for mitral valve surgery or valvotomy?

A

Valvular AF- warfarin

130
Q

what is the anticoagulation guidelines for successful outpatient cardioversion?

A

Continue for one month then review

131
Q

Secondary prevention of MI?

A

Dual Antiplatelet, ACEi, Beta Blockers, Statins

132
Q

Lifestyle advice for secondary prevention of MI?

A

Diet: Mediterranean, switch butter and cheese for plant oil products. Don’t routinely offer omega 3 supplements and fish oil

Exercise: 20-30 mins until patients are “slightly breathless”

133
Q

DAPT after ACS event?

A

Aspirin + Ticagrelor, Stop Ticagrelor after 12 months

134
Q

DAPT after PCI?

A

Aspirin + Ticagrelor/Prasugrel, stop 2nd antiplatelet after 12 months

135
Q

People with MI who have heart failure/evidence of LVF?

A

Initiate aldosterone antagonist after 3-14 days of MI (preferably after ACEi)

136
Q

How should you refer a patient with current chest pain or chest pain in last 12 hours with abnormal ECGs?

137
Q

How should you refer a patient with chest pain in last 12-72hours?

A

Same day assessment

138
Q

If someone has chest pain > 72 hours how should you proceed?

A

ECG + Troponin

139
Q

What are the 3 features of anginal pain?

A
  1. constricting pain in front of chest radiating to arm/jaw
  2. Precipitated by physical activity
  3. Relieved by rest/GTN spray within 5 minutes

3 symptoms = typical angina pain
2 symptoms= atypical angina pain
1/0 symptoms= NOT ANGINA

140
Q

Organisms associated with colonic carcinoma and bowel resection?

A 
Strep Bovis 
Bacteroides fragilis (Mx= Metronidazole)
141
Q

Hypertensive Encephalopathy Rx

A

Sodium Nitroprusside

Aim of Rx: lower BP to 110-115 DIASTOLIC within 2-4hrs

142
Q

Cut off for SBP and DBP for orthostatic hypotension?

A

Fall in Systolic by >20mmHg
Fall in diastolic > 10 mmgHg
All within 3 minutes

143
Q

If a patient has peripheral arterial disease (i.e very high CV risk) hat is the LDL cholesterol goal?

A

< 1.8mmol/l

144
Q

What is the Simon Broome Criteria to diagnose Familial Hypercholesterolaemia?

A

Total Cholesterol >7.5 and LDL > 4.9
Tendon Xanthomata or evidence of these in 1st or 2nd degree relative or
DNA evidence of an LDL receptor mutation, familal defective apo-b100 or a PCSK9 mutation

145
Q

BP target for < 80 years in clinic?

146
Q

BP target for < 80 years at home?

147
Q

BP target for > 80 years in clinic?

148
Q

BP target for > 80 years at home?

149
Q

Female patient with ASD, Left axis deviation and RBBB. WHat is the risk to pregnancy?

A

No significant increase in risk compared to the general population.

NB: in the presence of Eisenmener syndrome maternal mortality is approximately 40% and pregnancy is contraindicated

150
Q

For marfant’s when is intervention indicated as per ESC guidelines for thoracic aneurysms?

A

Dilated aortic root >50mm

Dilated aortic root > 45mm in presence of other risk factors

151
Q

If patient comes to clinic at what level of BP would it be reasonable to commence HTN medications without home monitoring?

A

> 160/100

If 140-160/90-100 then offer home BP

152
Q

Diagnostic Criteria for RBBB?

A

Broad QRS >120, RSR atter in leads V1-3 and wide, slurred S wave in lateral leads

153
Q

Carotid sinus Hypersensitivity Rx?

A

Dual Chamber Pacemaker

154
Q

Criteria for valve replacement in aortic stenosis?

A

1) Symptomatic

2) valve gradient >40 (50-60)mmHg

155
Q

Time frame for peripartum cardiomyopathy?

A

last month of pregnancy- 6 months postpartum

156
Q

The systemic use of B2 agonists like terbutaline and salbutamol to interrupt preterm labour is associated with what cardiac complication?

A

Tocolysis-associated pulmonary oedema

157
Q

Tissue vs Metallic valve- when to use each?

A

Young Patient- Metallic

Older patient- tissue (lasts about 10 years)

158
Q

Treatment for Xanthelasma?

A

Topical Trichloracetic acid

159
Q

accelerated idioventricular rhythm is common after what

160
Q

accelerated idioventricular rhythm ECG findings?

A

P waves present but not associated with QRS, wide QRS (>120) rate 50-100bpm.

NB: p waves can or cannot be present

161
Q

What is the MIBG test used for?

A

Phaeochromocytoma.

uses radioactive iodine as a tracer which is detected through the use of a gamma camera

162
Q

Long QT treatment?

A

1s line Beta blockers

If further palpitations then ICD

163
Q

Ventricular Tachycardia secondary to Digoxin

what is the treatment?

A

Lignocaine

164
Q

Management of prosthetic valve thrombus in an haemodynamically unwell patient?

A

Ideally urgent surgery

If surgery not immediately available–> IV alteplase

165
Q

Managment of prosthetic valve thrombus in a haemodynamically well patient?

A

Heparin +/- aspirin with regular follow up

166
Q

What is the range for normal Central Venous Pressure (CVP)

A

8 to 12 mmHg

167
Q

First line treatment for Bradycardia and haemodynamic compromise?

A

Atropine.

Initially 500 microgram IV and repeated to a maximum for 3mg

168
Q

How to differentiate post MI VSD vs Mitral Regurg?

A

Mitral Regurgitation- Pansystolic murmur heard loudest at apex

VSD- heard loundest at lower left sternal edge + parasternal thrill

169
Q

Causes of J wave?

A

Hypothermia, Hypercalcaemia, subarachnoid haemorrhage

170
Q

Patient < 75 years with mitral valve prolapse, atrial fibrillation or echo of LVF- what is the management?

A

Refer for valve replacement!

171
Q 
In a patient with congestive heart failure, which of the following carries the worst prognosis?
A) Cardiomegaly on CXR 
B) Mitral Regurgitation on Echo
C) Ejection Fraction < 50% on echo
D LVH on ECG 
E) Serum Sodium of 129 mmol/l
A

Serum Sodium of 129- indicates significant fluid overload

172
Q

Thallium scan vs dobutamine stress echo

which one is more sensitive and specific for CAD?

A

Thallium- sensitive

Dobutamine- specific

173
Q

Indications for a CABG?

A

More than 50% narrowing of coronary artery plus:

  • angina refractory to medical management
  • ST depression on exercise ECG
  • Left Main Stem narrowing
  • Severe Triple vessel disease
  • Angina with Left ventricular dysfunction
174
Q

NSTEMI Mx?

A

Aspirin, Ticagrelor and Fondaparinux

175
Q

NSTEMI Mx in renal impairment (GFR <20)

A

Aspiri, ticagrelor + LMWH (1mg/kg)/ unfractionated heparin (doesn’t require dose reduction)

if GFR < 15 then don’t use LMWH

176
Q

Post infarct which is more common; Ruptured ventricular septum or ventricular free wall rupture?

A

Ventricular free wall rupture more common (occurs 10 times more frequently than post infarction ventricular septal rupture)

177
Q

Indications for ICD?

A

1) Familial cardiac conditions with high risk of sudden cardiac death, e.g Long QT, HOCM, Brugada, ARVC and following repair of Tetralogy of Fallot

2) Primary prevention of sudden cardiac death in patients who have a history of prior MI and ALL OF THE FOLLOWING:
- Non sustained VT
- Inducible arrythmia on EP testing
- LV EF < 35% and no worse than New York Class III functionally

178
Q

Indications for permanent pacemaker?

A
  • Persistent SYMPTOMATIC bradycardia (e.g sick sinus)
  • complete heart block
  • Mobitz type II AV block
  • Persistent AV block after MI
179
Q

Indications for temporary pacemaker?

A
  • Symptomatic/haemodynamically unstable bradycardia not responding to atropine
  • Post Anterior MI (type 2 or CHB)
  • Trifasicular block prior to surgery

Post-inferior MI CHB is common and can be managed conservatively if asymptomatic and haemodynamically stable

180
Q

What is the Rx for patient with Long QT syndrome not responding to beta blockers and receiving frequent shocks from the ICD?

A

Left stellate cardiac ganglionectomy

181
Q

HOCM and outflow gradient < 50mm rx?

A

Beta Blocker

182
Q

HOCM and outflow gradient > 50mm Rx?

A

Myomectomy

183
Q

Criteria for Left Ventricular Hypertrophy?

A

S wave in V1 + R wave in V5/6 > 40mm (7/8 boxes)

184
Q

Normal Capillary Wedge pressure?

185
Q

How is the mitral valve gradient calculated?

A

Capillary wedge pressure (left atrial pressure) MINUS diastolic left ventricular pressure

186
Q

Normal mitral valve gradient?

187
Q

What vaccination would you offer to someone with heart Failure?

A

1) Annual Influenza vaccine

2) one-off pneumococcal vaccine

188
Q

Treatment for Orthostatic hypotension and their MoA?

A

Midodrine (alpha 1 agonist)

Fludrocortisone

189
Q

Contraindication for CCBs in angina?

A

First degree heart block and relative bradycardia

190
Q

When should reperfusion therapy considered in patients with angina?

A

In patients requiring more than 2 antiangials

191
Q

Contraindication for ivabradine?

A

Sick Sinus Syndrome

192
Q

Contraindication for Ranolazine?

A

liver dysfunction (think if patient has been a heavy alcohol drinker)

193
Q

Contraindication for nicorandil?

A

LV failure and cardiogenic shock

MRCP Part II (15 decks)

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