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MRCP 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

What’s type A aortic dissection

A

Ascending aorta
2/3 cases

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2
Q

What’s type B aortic dissection

A

Descending aorta
1/3 of cases

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3
Q

What’s DeBakey’s type 1 aortic dissection

A

Originates in ascending aorta
Propagates to at least aortic arch
Possibly beyond it

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4
Q

What is DeBakey’s type 2 aortic dissection

A

Originates in and is confined to ascending aorta

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5
Q

What is DeBakey’s type 3 aortic dissection

A

Originates in descending aorta
Rarely extends proximally
Can extend distally

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6
Q

Management of type A dissection

A

Surgical management
Maintain BP over 100mmHg

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7
Q

Management of Type B aortic dissection

A

Conservative
Bed rest
Reduce BP with IV labetalol

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8
Q

Features of mitral stenosis

A

Dyspnoea
Haemoptysis
Mid-late diastolic murmur (best heard in expiration)
Loud S1
Opening snap
Low volume pulse
Malar flush
AF

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9
Q

Management of mitral stenosis

A

With AF as well - warfarin used with moderate/severe
Can use DOAC’s
Asymptomatic - regular echos
Symptomatic - percutaneous mitral balloon valvotomy or surgery

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10
Q

What is LBBB

A

Cardiac conduction abnormality due to slow or absent conduction through left bundle. Means left ventricle takes longer to fully depolarise. Wide QRS complexes.

Can be due to MI, HTN, cardiomyopathy

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11
Q

What is ventricular tachycardia

A

Broad complex tachy originating from a ventricular ectopic focus. Can go to VF.

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12
Q

What are the two types of VT?

A

Monomorphic - from MI
Polymorphic - torsades, long QT

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13
Q

Management of VT

A

Adverse signs - low bp, chest pain, heart failure - immediate cardioversion

Meds - amiodarone, lidocaine, procainamide

NEVER VERAPAMIL

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14
Q

What creates heart sound S1

A

Closure of mitral and tricuspid valves

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15
Q

When is S1 soft?

A

Long PR
Mitral regurg

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16
Q

When is S1 loud?

A

Mitral stenosis

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17
Q

What causes S2 heart sound?

A

Closure of aortic and pulmonary valves

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18
Q

When is S2 soft?

A

Aortic stenosis

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19
Q

What causes S3?

A

Diastolic filling of ventricle
Heard in LVF, constrictive pericarditis and mitral regurg

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20
Q

What causes S4?

A

Atrial constriction against a stiff ventricle

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21
Q

When is S4 heard?

A

Aortic stenosis
HOCM
HTN

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22
Q

Drug management of angina pectoris

A

Aspirin and statin if not CI
Sublingual GTN for attacks
Beta blocker or calcium channel blocker

If only ccb then verapamil or diltiazem
If in combination with bb then amlodipine or nifedipine.

Only add 3rd drug if waiting for PCI or CABG

3rd drugs - long acting nitrate, ivabradine, nicorandil, ranolazine

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23
Q

How does Flecainide work?

A

Blocks the Nav1.5 sodium channels in the heart

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24
Q

How does bisoprolol work

A

Blocks beta one adrenergic receptors in heart muscle

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25
Q

How does procainamide work

A

Induces rapid blocking of batrachotoxin activated sodium channels rapidly

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26
Q

What is S3 also known as?

A

Gallop rhythm

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27
Q

Aetiology of acute pericarditis

A

Viral infections - coxsackie
TB
Uraemia
Post MI - early (1-3d) fibrinous, late (weeks-months) Dressler’s
Radiotherapy
Connective tissue disease - SLE, RA
Hypothyroidism
Malignancy - lung and breast
Trauma

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28
Q

Features of acute pericarditis

A

Chest pain, pleuritic, relieved by sitting forwards
Non productive cough, dyspnoea, flu like symptoms
Pericardial rub

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29
Q

Acute pericarditis investigations

A

ECG changes - global and widespread not territories, saddle shaped ST elevation, PR DEPRESSION

TTE

Bloods - inflammatory markers, trop

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30
Q

Management of acute pericarditis

A

Majority as outpatient unless high risk (fever, raised trop)
Treat underlying cause
Avoid strenuous physical activity
Combination of NSAID’s and colchicine with idiopathic or viral

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31
Q

Common bugs of endocarditis

A

S aureus

S epidermidis if <2 months post valve surgery

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32
Q

Pathophysiology of arrhythmogenic right ventricular cardiomyopathy

A

Autosomal dominant
Right ventricular myocardium is replaced by fatty and fibrofatty tissue

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33
Q

Presentation of arrhythmogenic right ventricular cardiomyopathy

A

Palpitations
Syncope
Sudden cardiac death

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34
Q

Investigations of arrhythmogenic right ventricular cardiomyopathy

A

ECG - V1-3 anomalies, usually TWI,
Echo changes subtle - enlarged hypokinetic right ventricle
MRI to show fibrofatty tissue

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35
Q

Management of arrhythmogenic right ventricular cardiomyopathy

A

Drugs - sotalol
Catheter ablation
ICD

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36
Q

What’s Naxos disease

A

Autosomal recessive form of arrhythmogenic right ventricular cardiomyopathy

Triad of ARVC, palmoplantar keratosis, woolly hair

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37
Q

Congenital causes of Long QT syndrome

A

Jervell-Lange-Nielsen syndrome (included deafness)

Romano-Ward syndrome (no deafness)

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38
Q

Drug causes of prolonged QT interval

A

Amiodrarone, Dora lol
TCA’s, SSRI’s
Methadone
Chloroquine
Terfenadine
Erythromycin
Haloperidol
Ondansetron

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39
Q

Other causes of long qt interval

A

Electrolyte - hypocalcaemia, hypokalaemia, hypomagnasaemia
Acute MI
Myocarditis
Hypothermia
Subarach

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40
Q

MI complications

A

Cardiac arrest.
Cardiogenic shock
Chronic heart failure
Tachyarrhythmia
Bradyarrhythmia
Pericarditis
Left ventricular aneurysm
Ventricular septal defect
Acute mitral regurg

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41
Q

Why does cardiac arrest mostly happen after MI

A

Developing ventricular fibrillation

42
Q

Common tachyarrhythmias after MI

A

Ventricular fibrillation
Ventricular tachycardia

43
Q

Which bradyarrhythmia follows MI?

A

AV block follows inferior MI

44
Q

What is Dressler’s syndrome and when does it occur?

A

2-6 weeks after MI
Pericarditis
Fever, pleuritic pain, pericardial effusion and raised ESR.
Treat with NSAID’s

45
Q

Describe ventricular septal defect after MI

A

Occurs in first week
1-2% of patients
Acute heart failure and pan systolic murmur
Echo is diagnostic
Urgent surgical correction

46
Q

Describe acute mitral regurgitation

A

More common with infero-posterior infarction and may be due to ischaemia or rupture of papillary muscle

Acute hypotension & pulmonary oedema
Early to mid systolic murmur
Treat with vasodilator therapy then surgery

47
Q

When do you get a slow rising/plateau pulse?

A

Aortic stenosis

48
Q

When do you get a collapsing pulse

A

Aortic regurgitation
Patent ductus arteriorsus
Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)

49
Q

Describe bisferiens pulse and when is it seen

A

‘Double pulse’ - two systolic peaks
Seen in mixed aortic valve disease

50
Q

When do you get a jerky pulse??

A

HOCM

51
Q

When do you get pulsus paradoxus

A

Severe asthma
Cardiac tamponade

52
Q

When do you get pulsus paradoxus?

A

Severe Asthma
Cardiac Tamponade

53
Q

Describe Eisenmenger’s syndrome

A

Reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.

Occurs when an uncorrected left-to-right leads to a remodelling of the pulmonary microvasculature causing obstruction and pulmonary hypertension

54
Q

What is Eisenmenger’s syndrome associated with

A

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus

55
Q

Features of Eisenmenger’s

A

Original murmur may disappear
Cyanosis
Clubbing
Right ventricular failure
Haemoptysis, embolism

56
Q

Management of Eisenmenger’s

A

Heart-lung transplantation

57
Q

When are ejection systolic murmurs louder on inspiration?

A

Pulmonary stenosis
Atrial septal defect

58
Q

When are ejection systolic murmurs louder on expiration?

A

Aortic stenosis
HoCM

59
Q

When are pansystolic murmurs herd

A

Mitral/tricuspid regurgitation - tricuspid louder during inspiration

Ventricular septal defect (harsh in character)

60
Q

When do you get late systolic murmurs?

A

Mitral valve prolapse

Coarctation of aorta

61
Q

When do you get early diastolic murmurs?

A

Aortic regurgitation (high pitch and blowing)

Graham-Steel murmur - pulmonary regurg

62
Q

When do you get mid-late diastolic murmurs

A

Mitral stenosis (rumbling)
Austin-Flint murmur (severe aortic regurgitation)

63
Q

When do you get a continuous machine-like murmur

A

Patent ductus arteriosus

64
Q

Features of cardiac Tamponade

A

Becks triad -
Hypotension, Raised JVP & Muffled heart sounds

Other -
Dyspnoea & Tachycardia
Absent Y on descent of JVP
Pulsus paradoxus, Kussmaul’s
ECG - electrical alternans

65
Q

Management of cardiac Tamponade

A

Urgent pericardiocentesis

66
Q

What are the centrally acting antihypertensives?

A

Methyldopa - pregnancy
Moxonidine - essential HTN when conventional therapy failed
Clonidine - alpha-2 adrenoreceptors in vasomotor centre

67
Q

What is the most common cardiac tumour?

A

Atrial myxoma

68
Q

Where do you normally find atrial myxoma

A

Most in left atrium
Commonly attached to fossa ovalis
More common in females

69
Q

Features of atrial myxoma

A

Systemic - dyspnoea, fatigue, weight loss, pyrexia of unknown origin, clubbing
Emboli
Atrial Fibrillation
Mid diastolic murmur - tumour plop
Echo - pedunculated heterogenous mass

70
Q

Which sign best indicates severe calcified aortic stenosis

A

Displaced apex beat

71
Q

Which features of a broad complex tachycardia suggests VT rather than SVT

A

AV dissociation
Fusion or capture beats
Positive QRS concordance in chest leads
Marked left axis deviation
History of IHD
lack of response to adenosine or carotid sinus massage
QRS > 160ms

72
Q

What is the role of dipyridamole?

A

Antiplatelet used in combination with aspirin after ischaemic stroke or TIA

73
Q

How does dipyridamole work?

A

Inhibits phosphodiesterase elevating cAMP which reduce intracellular calcium

Reduced cellular uptake of adenosine and inhibition of thromboxane synthase

74
Q

Features of severe MS

A

Length of murmur increases
Opening snap becomes closer to S2

75
Q

Features of cholesterol embolism

A

Eosinophilia
Purpura
Renal failure
Livedo reticularis

76
Q

Causes of cholesterol emboli

A

Secondary to vascular surgery or angiography

Also - severe atherosclerosis

77
Q

Management of torsades de pointes

A

IV mag sulf

78
Q

What is torsades de pointes

A

A form of polymorphic ventricular tachycardia associated with long QT interval.

May lead to VF then sudden death

79
Q

Management of HOCM

A

Amiodarone
Beta blockers or verapamil
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

80
Q

Drugs to avoid in HOCM

A

Nitrates
ACEi
Inotropes

81
Q

HOCM inheritance pattern

A

AD
1 in 500
Defect in genes encoding contractile proteins

82
Q

Anteroseptal region ECG changes and artery involved

A

V1-V4
Left Anterior Descending

83
Q

Inferior region ecg changes and artery involved

A

II, III & aVF
Right coronary

84
Q

Anterolateral region ecg changed and artery involved

A

V1-V6, I & aVL
Proximal left anterior descending

85
Q

Lateral region ecg changes and artery involved

A

I, aVL +/- V5-6
Left circumflex

86
Q

Posterior region ecg changes and artery involved

A

V1-3
Left circumflex (also right coronary)

Horizontal ST depression
Upright T waves
Broad R waves
Dominant R wave in V2

87
Q

ECG features of hypokalaemia

A

U waves
Small or absent T waves (occasionally inversion)
Prolonged PR interval
ST depression
Long QT

88
Q

What is Ebstein’s anomaly

A

Congenital heart defect with low insertion of tricuspid valve resulting in large atrium and small ventricle

89
Q

What is Ebstein’s anomaly associated with

A

Patent Foramen Ovale or Atrial Septal Defect
Wolff-Parkinson White syndrome

90
Q

Clinical features of Ebstein’s anomaly

A

Cyanosis
Prominent ‘a’ wave in distended JVP
Hepatomegaly
Tricuspid regurgitation- pansystolic murmur, worse on inspiration
RBBB - widely split S1 and S2

91
Q

Causes of ST depression on ecg

A

Secondary to abnormal QRS (LVH, LBBB, RBBB)
Ischaemia
Digoxin
Hypokalaemia
Syndrome X

92
Q

Features of Takayasu’s arteritis

A

Systemic features of vasculitis - malaise, headache
Unequal blood pressure in upper limbs
Carotid bruit and tenderness
Absent or weak peripheral pulses
Upper and lower limb clarification on exertion
Aortic regurgitation

93
Q

What is Takayasu’s arteritis associated with

A

Renal artery stenosis

94
Q

Management of Takayasu’s arteritis

A

Steroids

95
Q

Investigations into Takayasu’s arteritis

A

Vascular imaging of arterial tree either MRA or CTA

96
Q

Features of aortic stenosis

A

Chest pain
Dyspnoea
Syncope/pre syncope

Murmur - ESM, radiates to carotids, decreases following valsalva

97
Q

Features of severe aortic stenosis

A

Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
S4
Thrill
LVH

98
Q

Causes of aortic stenosis

A

Degenerative calcification
Bicuspid aortic valve
William’s
Post-rheumatic disease
Subvalvular - HOCM
Fabry’s, SLE, Uraemia

99
Q

Management of aortic stenosis

A

Valve replacement if symptomatic

100
Q

Which anti hypertensive drugs need to be used cautiously in aortic stenosis?

A

Beta blockers

MRCP 1 (14 decks)

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