Cardio

Question 1

Familial lipid disorders of triglycerides

Answer 1

1/ Familial hypertriglyceridaemia - assoc. pancreatitis and retinal vein thrombosis
2/ Lipoprotein lipase deficiency - childhood with eruptive xanthomas and lipiamia retinalis
3/ Apoprotein C deficiency - TG improves w FFP

Rx Fibrates

Question 2

Familial lipid disorders of LDL

Answer 2

1/ Heterozygous familial hypercholesteremia - early CVD, tendon xanthomas. Genetic defect of LDL-R
2/ Homozygous familial hypercholesteremia
3/ Apoprotein B100 gene mutation
4/ Polygenic hypercholesterolemia

Rx Statins +/- Ezetimibe

Question 3

Familial lipid disorders of HDL

Answer 3

Tangier disease - ABC1 gene mutation

Rx fibrates

Question 4

ECG features of arrhythmogenic RV dysplasia

Answer 4

Post excitation epsilon wave in V1-3 with QRS >110ms, TWi +/- LBBB or RBBB

Autosomal dominant
Fibrofatty infiltration of RV leading to poor R function. Angio gold standard dx

Question 5

Indications for PPM/ICD (3):

Answer 5

NYHA class 3-4 HF
EF <35%
QRS >120ms

Sx benefit and reduced mortality

Question 6

Features of Congenital Long QT syndrome LQTS?

Answer 6

Recurrent syncope triggered by activity
QTc >500
FHx early sudden death

Rx treat with beta blockers even if ASx
ICD if syncope/arrest on beta blockers

Question 7

Genetics of LQTS?

Answer 7

LQTS1 - most common. KCNQ1 delayed K ch subunit. Beta blockers most protective. Occurs while swimming

LQTS2 - KCNH2/HERG gene, rapid K ch. Ppt by exercise, loud noises, emotional arousal

LQTS3 - SCN5A gain function mutation in Na ch. Events during sleep

Question 8

Features of Brugada??

Answer 8

Autosomal dominant
Peak SCD 4th decade
Pseudo RBBB with ST elevation - can be elicited with flecainide challenge
- Loss of function SCN5A gene mutation in 30%

Question 9

Short QT syndrome

Answer 9

Autosomal dominant.
Short QT - AF young.

Question 10

WPW features?

Answer 10

Short PR interval, delta wave
Prone to AF -> VF

Question 11

ECG features of Lown Ganong Levin syndrome?

Answer 11

Short PR <120ms, normal QRS and sinus

Question 12

HOCM features?

Answer 12

Autosomal dominant
Mutation cardiac beta-myosin heavy chain
SCD risk high if LV thickness >30mm

Rx beta blocker improves diastolic filling. Avoid digoxin and diuretics

Question 13

ECG flecainide toxicity

Answer 13

PR prolongation, widening of QRS. Possible heart failure. Can cause Torsades.

No QT prolong.

Question 14

Symptoms of mitral stenosis

Answer 14

SOB - LA pressure, reduced lung compliance
Haemoptysis - increased pulm pressure
PE - LA thrombus
Chest pain - RV hypertrophy, pulm HTN
Hoarseness - compression of laryngeal nerve from LA

Question 15

Coronary angio - radial access :

Answer 15

• Lowers vascular complications
• Non inferior to death, MI, stroke, bleeding

Question 16

venous pulse - what do “a x c x v y” represent

Answer 16

a - atrial contraction - absent in AF, large ‘cannon’ in pulm HTN, TS, RV hypertrophy, complete heart block
c - closure of tricuspid valve
v - volume filling into atrium - large in TR
x - fall in atrial pressure during vent systole
y - opening of tricuspid valve

Question 17

Contraindications to percutaneous mitral balloon valvotomy

Answer 17

1/ Mitral area >1.5cm
2/ LA thrombus
3/ Moderate-severe MR
4/ Severe/bicommissural calcification
5/ Absence of commissural fusion
6/ Severe aortic valve disease or severe TS/TR

Question 17

Contraindications to percutaneous mitral balloon valvotomy

Answer 17

1/ Mitral area >1.5cm
2/ LA thrombus
3/ Moderate-severe MR
4/ Severe/bicommissural calcification
5/ Absence of commissural fusion
6/ Severe aortic valve disease or severe TS/TR
7/ CAD requiring bypass -> mitral valve repair

Question 18

Types of MI?

Answer 18

Type 1- atherothrombosis
Type 2 - hypoperfusion
Type 3 - Sudden death without trop/ECG confirmed
Type 4a - due to PCI
Type 4b - due to thrombosis of stent
Type 5 - CABG

Question 19

Timing of systolic murmurs

Answer 19

Early systolic - MR, TR, VSD
Midsystolic - AS, aortic sclerosis
Holo/pansystolic - MR, TR, VSD
Late systolic - MVP, TVP

R murmurs louder on Inspiration
L murmurs louder on expiration

Question 20

Timing of diastolic murmurs

Answer 20

Early - AR, PR
Mid - MS (earlier in severe), TS, Atrial myxoma
Late - MS (mild, TS, Atrial myxoma, complete heart block

Question 21

Factors of GRACE score used to estimate mortality at 0, 6m, 3y mortality

Answer 21

Age
HR
BP
Renal
CHF
ST
cardiac arrest
High trops

Question 22

Features of complete heart block

Answer 22

Syncope
HF
Brady 30-50bpm
Wide pulse pressure
JVP cannon waves
Variable intensity of S1

Question 23

Factors for mitral stenosis management

Answer 23

Moderate - area 1.0-1.5, mean gradient 5-10mmHg
PASP - 30-50

Severe - area <1.0, mean gradient >10, PASP >50

Percutaneous mitral balloon valvotomy for sx severe MS without mod/severe MR

If Asx, still do it if there is pulm HTN