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MRCP - Part 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

Definition of MI

A

Myocardial necrosis due to an occlusion of a coronary artery

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2
Q

3 conditions of ACS

A

STEMI
NSTEMI
Unstable angina

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3
Q

Definition of angina

A

Sudden acceleration of anginal symptoms on minimal activity

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4
Q

Pathophysiology of a STEMI

A

Vessel entirely occluded by plaque rupture and subsequent thrombus formation

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5
Q

Differentials for ACS

A

PE
Acute pericarditis
Aortic dissection
Pneumonia
GORD
Oesophageal spasm
Cholecystitis
MSK
Pancreatitis
GU

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6
Q

What is needed on an ECG for a STEMI?

A

> 2mm in two contigous chest leads
1mm in two or more limbs

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7
Q

What is a new onset LBBB with a typical history considered to be?

A

STEMI until proven otherwise

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8
Q

Diagnostic criteria of LBBB on ECG

A

Heart rhythm must be supraventricular in origin
QRS >120
QS or rS complex in lead V1
notched (M shaped) R wave in lead 6
The T wave should be deflected opposite the terminal deflection of the QRS complex; a concordant T wave may suggest ischaemia or MI
Partial blocks of the LBB - left anterior fasicular block and left posterior fasciular block; this refers to bifrucation of the LBB

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9
Q

NSTEMI includes

A

ST depression
T wave inversion
Troponin rise

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10
Q

In unstable angina - there may be ECG changes but no what?

A

No troponin rise

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11
Q

Physiology of troponin

A

Released by damaged myocardial cells
The level of troponin is directly related to the amount of cardiac damage and is assosiated with the likelihood of later adverse outcomes

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12
Q

Absaloute contradindications to thrombolysis

A

Active internal bleeding
Uncontrontrolable external bleeding
Recent head trauma (<2 weeks)
Suspected aortic dissection
Intracranial neoplasms
History of proved haemorrhagic stroke or cerebral infarct < 2 months ago
Uncontrollable high BP

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13
Q

Relative contraindications to thrombolysis

A

Traumatic prolonged CPR
Bleeding disorders
Recent surgery
Probable intracardiac thrombus (e.g. AF with mitral stenosis)
Active diabetic haemorrhagic retinopathy
Anticoagulation or INR > 1.8
Pregnancy

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14
Q

Complications of anterior infarctions

A

Late VT/VF
Left ventricular aneurysm
Left ventricular thrombus and systemic embolism (usually 1-3 weeks post MI)
Complete heart block (rare)
Ischaemic mitral regurg
Congestive cardiac failure
Cardiac rupture
VSD with septal rupture
Pericarditis and pericardial effusion

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15
Q

Complications of inferior infarctions

A

Higher re infarction rate
Inferior aneurysm with mitral regurg (rare)
PE (rare)
Complete heart block and other degrees of heart block
Papillary muscle dysfunction and MR

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16
Q

What is indicated in an anterior MI complicated by heart block?

A

Temporary pacing

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17
Q

What has happened when you get heart block post MI?

A

The ischaemic damage has disrupted the myocardial innervation from the nerves leading to abnormal myocardial contraction

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18
Q

Occlusion of which artery can cause complete heart block and why?

A

Right coronary artery
It is the dominant vessel which supplies the AVN and SA nodes

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19
Q

Possible origins of aberrant conductions

A

Atrial
Ventricular
Junctional (AV node)

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20
Q

Definition of AF

A

Supraventricular tachycardia (atrial arrythmia)
Assosiated with irregular, disorganised electrical activity, ineffective contraction of the atria, chaotic firing of the AV node and resulting irregular contractions of the ventricles

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21
Q

Defintion of paroszymal AF

A

Recurrent episodes lasting longer than 30 seconds but less than 7 days

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22
Q

What is used for pharmacological conversion of AF if no structural heart disease?

A

Amiodarone
Flecanide

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23
Q

What is warfarin?

A

A vitamin K antagonist

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24
Q

Virchows triad of VTE

A

Hypercoagulable state
Endotherlial damage
Blood stasis

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25
Q

Pathophysiology of HFpEF

A

Diastolic heart failure
Impaired cardiac relaxation due to increased ventricular stiffness from a range of causes, resulting in poor cardiac filling and elevated diastolic pressures
This results in signs of fluid overload and peripheral oedema, typical of right sided or biventricular failure because the blood effectively backs up into the circulatory system

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26
Q

Defintition of HFrEF

A

Systolic heart failure
EF <35-40%

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27
Q

When is BNP secreted?

A

Secreted by cardiac myocytes and elevated levels are observed when they are overstretched

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28
Q

What is the first heart sound produced by (S1)?

A

Closing of mitral and tricuspid valves

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29
Q

Where is the mitral valve auscultated?

A

Left 5th IC space, mid clavicular line

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30
Q

Where is the tricuspid valve auscultated?

A

4th IC space, left sternal edge

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31
Q

Where is the mitral valve?

A

Between the left atria and ventricle

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32
Q

Where is the tricuspid valve?

A

Between the right atria and ventricle

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33
Q

What is the second heart sound produced by? (S2)

A

Closing of aortic and pulmonary valves

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34
Q

Where is the aortic valve auscultated?

A

2nd IC space, right sternal border

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35
Q

Where is the pulmonary valve auscultated?

A

2nd IC space, left sternal border

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36
Q

What is the third heart sound? (S3)

A

Caused by rapid ventricular filling

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37
Q

Who can S3 be a normal variant in?

A

Children
Adults up to 40 years old

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38
Q

Causes of the third heart sound

A

Ventricular dysfunction
- ischaemic heart disease with ventricular dysfunction
- cardiomyopathy
- myocarditis
- valve regurgitation
- cor pulmonale
Increased volume load on the ventricle
- Valve regurgitation
- high output states (e.g. pregnancy)
- left to right cardiac shunts
- volume overload

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39
Q

Two main types of implantable cardiac devices

A

Pacemakers
Defibrillator

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40
Q

In temporary pacing, what may be seen on ECG?

A

LBBB due to the nature of electrode placement

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41
Q

In heart failure, pacing is indicated when all of the following are present;

A

NYHA classification 3/4
QRS > 130
LV EF < 35% with dilated ventricle
Patient on optimal medical therapy

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42
Q

What is PHTN?

A

A progressive increase in resistance in the pulmonary circulation, eventually leading to right heart failure (cor pulmonale)

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43
Q

What is the most common cause of PHTN and why?

A

COPD
Airway rigidity leads to increased circulatory pressures to maintain blood flow

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44
Q

What systemic diseases are related to PHTN?

A

Collagen vascular disease (e.g. scleroderma)
HIV
SLE
Cirrhosis

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45
Q

What happens to the right ventricle secondary to PHTN?

A

Hypertrophy

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46
Q

Rules re INR (for patients on long term warfarin therapy) and procedures

A

As long as INR not >2, the procedure may take place in the standard way

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47
Q

Most common organism of IE

A

Strep Viridans

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48
Q

Murmur of MS

A

Long diastolic murmur
Apical thrill
Soft first heart sound

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49
Q

Murmur of MR

A

Prescence of S3
Pansystolic murmur
Displaced and hyperdynamic apex

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50
Q

Murmur of TS

A

S4
Late peaking of a long murmur

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51
Q

Which of the murmurs has a collapsing radial pulse and what is this called

A

Corrigans pulse
Aortic regurg

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52
Q

Other clinical signs of IE

A

Splinter haemorrhages
Oslers nodes (painful)
Janeway lesions (non-painful)
Clubbing (late)
Retinopathy (roths spots)
Hepatosplenomegaly

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53
Q

Causes of mid/late systolic murmur

A

Innocent murmur
Aortic stenosis or sclerosis
Coarctiation of the aorta
Pulmonary stenosis
Hypertrophic cardiomyopathy
Papillary muscle dysfunction
ASD
Mitral valve prolapse

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54
Q

Causes of mid-diastolic murmur

A

Mitral stenosis
Rheumatic fever
ASD, VSD, PDA, MR, TR
Atrial tumours

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55
Q

Causes of continous murmurs

A

PDA
Rupture of sinus of valsalvas aneurysm
ASD
Large AV fistula
Anomalous left coronary artery
Intercostal AV fistula
ASD with MS
Bronchial collaterals

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56
Q

What is the most common isolated congenital heart defect?

A

VSD

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57
Q

Two parts of the ventricular septum

A
  1. Superior membranous component - which contains the AV node
  2. Inferior muscle componentt
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58
Q

Symptoms of large VSD

A

Poor feeding
Reduced exercise tolerance

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59
Q

Complications of VSD

A

PHTN
Eisenmengers

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60
Q

Syndromes assosiated with VSD

A

Edwards
Pataus
Downs
Turners
Holt Oram
Foetal alcohol syndrome

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61
Q

Why are membranous VSDs more complicated?

A

AVN
Proximity to the aortic apparatus

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62
Q

What do large VSDs result in?

A

Left to right shunt
Causes elevated heart pressures and consequently PHTN

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63
Q

Murmur of VSD

A

Ejection systolic on LSE
Also parasternal heave

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64
Q

Differentials of VSD

A

PDA
Pulmonary stenosis

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65
Q

Findings of VSD on an ECG

A

LVH
Biventricular hypertrophy
PHTN

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66
Q

Management of VSD

A

Spontaneous closure
Digoxin (positive inotropic effect)
Heart failure
- diuretics
- ACEIs (reduce afterload)

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67
Q

In which VSDs are spontaneous closures most common?

A

Muscular defects`

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68
Q

Indications for surgical closure of VSD

A

Significant L > R shunt
Assosiated with other defect requiring cardiotomy
Elevated right heart pressure causing PHTN
Endocarditis
Membranous VSD causing

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69
Q

Murmur heard in LBBB

A

Soft first heart sound
Reversed splitting of the second heart sound

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70
Q

Which drug used to treat angina has no survival benefit post MI?

A

ISMN

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71
Q

What is a common complication following an anterior MI?

A

LBBB

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72
Q

Treatment of acute mitral regurg following MI

A

Emergency surgery

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73
Q

What does sudden death in family members and a long QT indicate

A

congenital long QT syndrome

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74
Q

WHat is congnital long QT syndrome assosiated with

A

torsades dde points VT

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75
Q

Examples of drugs that can prolong QT interval

A

erythromycin
ketoconazole
antihistamines
antiarrythmics

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76
Q

Feautres of aortic dissection

A

HTN
Tearing chest pain radiating to back
Audible diastolic murmur (from aortic regurg)
Unequal blood pressure readings
Widened mediastinum on CXR
Backward tear is capable of causing dissection to the right coronary artery, giving rise to inferior lead changes on ECG
Significantly raised D dimer
Possibly a raised troponin

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77
Q

How does the body during exercise deliver blood around the body

A

Dilation of the blood vessels - causes a fall in total peripheral resistance, resulting in a decrease of diastolic BP
Decrease in venous complicance (dilatation) caused by sympathetic stimulation, helping to maintain ventricualr filling during diastole
Pulmonary vessels undergo passive dilatation, as more blood flows into the pulmonary circulation, leading to decreased pulmonary vascular resistance
Increased venous return to the heart means an increased stroke volume
Systemic arterial pressure increases secondary to an increase in HR

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78
Q

S/es amiodarone

A

Corneal microdeposits
Pulmonary fibrosis
Hepatotoxicity
Hyper / hypo thyroidism
Lengthening of QT interval
Pancreatitis

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79
Q

WHat drugs have evidence that they prevent and allow the reversal of myocardial hypertrophy?

A

ACEIs and ARBs

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80
Q

WHat type of pacemaker is appropriate for someone with AF and pauses/periods of complete heart block

A

DDDR

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81
Q

first letter of pacemaker means what

A

Related to the chamber that needs to be paced
A = atrium
V = ventricle
D = both

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82
Q

Second letter of pacemaker means what

A

the chamber that is sensed
A, V or D

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83
Q

Third letter of pacemaker means what

A

the response to the sensed beat by the pacemaker
I = inhibits
T = triggers
D = both (inhibits and triggers)

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84
Q

What is a VOO pacemaker

A

Fixed output setting
The O as second and third symbol implies that the chamber is not sensed and therefore is no response to a sensed beat
e.g. pacing at 60bpm irrespective of intrinsic activity

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85
Q

What is the fourth letter of a pacemaker mean

A

Wether or not the pacemaker has rate adaptive properties

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86
Q

What are the main carriers of cholesrerol

A

LDL

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87
Q

there is a strong assosiation between LDL-C concentration and what

A

risk of coronary artery disease

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88
Q

What is seen in left ventricular hypertrophy and pressure overload

A

4th heart sound

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89
Q

What murmur is known to improve in pregnancy

A

AORTIC REGURG

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90
Q

Inheritance of HOCM

A

AD
(note has a high degree of penetrance)

91
Q

Pathology of nitrate tolerance

A

Generation of reactive oxygen species

92
Q

Causes of a reversed splitting of the 2nd heart sound

A

Aortic stenosis
HCM
Ischaemic heart disease with LBBB

93
Q

S/Es amiodarone

A

Skin deposits
- photodermatitis
- greyish-blue discolouration
Tingling and numbness in hands and feet
Lethargy
SOB
Weight gain
Fatigue
Slowing of peripheral reflexes
Pulmonary toxicity
Hypo or hyper thyroidism

94
Q

Pathology in gene for HOCM

A

Beta myosin heavy chain mutation

95
Q

Defects in which ion channels are present in congenital long QT syndrome

A

Potassium

96
Q

Commonoest cause of restrictive cardiomyopathy in the UK

A

Amyloidosis

97
Q

Most common drugs used for cardioversion in AF

A

Flecanide
Amiodarone

98
Q

Which drug should you use for cardioversion in a structurally normal heart?

A

Flecanide

99
Q

Who should flecanide be avoided in ?

A

Previous ischaemic cardiac history

100
Q

Cardiac assosiations of turners syndrome

A

Bicuspid aortic valve
Coarctation of the aorta
VSD
ASD

101
Q

ECG diagnosis of VT

A

Rapid ventricular rhythm
Broad QRS
AV dissociation may result in visible P waves
Capture and fusion beats seen
Each QRS is identical (apart from capture / fusion beats)

102
Q

Ventricular tachycardia is more likely than SVT with BBB when there is

A

Very broad QRS (>0.14)
AV dissociation
Bifid upright QRS with a taller first peak in V1
Deep S wave in V6
Concordant (same polarity) QRS direction in all chest leads

103
Q

Most likely common causative organism of prosthetic valve IE

A

Staph epidermidis

104
Q

AntiHTN of choice in <55s

A

ACEIs

105
Q

AntiHTN of choice in > 55s / african or carribean descent

A

CCBs

106
Q

What artery and ECG changes are affected in an anterior MI?

A

LAD occlusion
ST elevation V1-V4

107
Q

What artery and ECG changes are affected in a lateral MI?

A

LAD occlusion
ST elevation in V5,6 and AVL

108
Q

What artery and ECG changes are affected in an inferior MI

A

Right coronary artery
ST elevation in II, III, avF and reciprocal depression in aVL

109
Q

What artery and ECG changes are affected in a posterior MI

A

RCA or LC occlusion
ST depression V1-V2
ST elevation in posterior leads if placed

110
Q

What is the first heart sound in reference to on an ECG

A

R waves

111
Q

What is kauslmauls sign and where is it seen?

A

Inspiratory increase in venous pressure
Steep y descent in the jugular pulse

Seen in constrictive pericarditis

112
Q

causes of constrictive pericarditis

A

TB
incomplete drainage of purulent pericarditis
fungal and parasitic infections
chronic pericarditis
post viral pericarditis
post-op
post-MI
Assosiation with pulmonary asbestosis

113
Q

Causes of reversible PEA

A

Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Hypoxia
Tension pneumothorax
Thrombus
Toxins
Tamponade

114
Q

ECG change of mod - severe hypothermia

A

J waves
Slow AF
Death from ventricular arrythmias

115
Q

Most common cardiac abnormality seen in downs syndrome

A

AVSDs

116
Q

What blood test is elevated in 80% of patients with a cholesterol embolism?

A

Eosinophils

117
Q

Murmur of HOCM

A

Ejection systolic murmur

118
Q

Who usually has Mitral valve prolapse

A

Young females
Narrow AP chest diameter
Low body weight
Low/Normal BP

119
Q

Increased incidence of MVP in

A

Autoimmune thyroid disease
Ehlers Danlos syndrome
Marfans syndrome
Pseudoxanthoma elasticum
Pectus excavum

120
Q

MUrmur of MVP

A

Mid to late systolic click
Best heard at apex
Late systolic murmur

121
Q

Values of PHTN

A

MAP > 25 at rest or > 30 with exercise

122
Q

What is cardioinhibitory carotid sinus hypersensitivtiy

A

cardiac asystole > 3 seconds

123
Q

What is usually required in carotid sinus hypersensitivity and why

A

Some form of ventricular pacing, with or without atrial pacing
As AV block can occur during the periods of hypersensitive carotid reflex

124
Q

Absaloute contraindications to carotid sinus massage

A

MI
TIA last 3 months
CVA last 3 months
Carotid artery occlusion
Previous ventricular arrythmia

125
Q

Definition of pure vasodepressor type of carotid sinus hypersensivity

A

systolic BP drop > 50 in the abscence of significant bradycardia

126
Q

INR and routine DC cardioversion

A

Needs to be 2 or above on day of and 4 weeks prior to procedure

127
Q

Causes of the reversed splitting of the second heart sound

A

AS
LBBB
HOCM

128
Q

Physical signs of coarctation of the aorta

A

Radio-femoral pulse delay
Development of collateral vessels (may be heard as systolic murmur over precordium)
LVF
ESM

129
Q

Cyanotic heart diseases

A

Teratology of fallot
Total anomalous pulmonary venous congestion
Hypoplastic left heart syndrome
Transposition of great arteries
Truncus arteriosus
Tricuspid atresia
Interrupted aortic arch
Pulmonary artresia
Critical pulmonary stenosis

130
Q

When do you see tuberoeruptive xanthomas

A

Type III Hyperproteinlipidaemia

131
Q

Murmurs seen in marfans

A

AR
MVP

132
Q

What should patients with SVT be cardioverted with if they are asthmatic

A

Verapamil rather than adenosine

133
Q

Why can you get constrictive pericarditis post heart surgery?

A

Fibrosis seen around surgery site / site of graft

134
Q

Causes of constrictive pericarditis

A

Post heart surgery
Infective pericarditis
TB
Kidney disease

135
Q

Physical signs of constrictive pericarditis and what is this called

A

Asucultation of heart sounds with inspiration is assosiated with a drop in BP > 10
Pulsus paradoxus

136
Q

Classic feature of a automatic supraventircular tachycarrythmia

A

Show a warm up phenomenon
Rate accelerates after inititation

137
Q

What should you avoid drinking if you are on warfarin

A

Cranberry juice

138
Q

Interactions of cranberry juice

A

Warfarin
Amitriptyline
Diazepam
NSAIDs
Fluvastatin
Losaratan
Irbestran

139
Q

What is used to prevent episodes of VT in patients with long QT syndrome

A

Beta blockers (atenolol)

140
Q

Signs of HOCM

A

Double apex beat
Jerky pulse
Mid systolic murmur

141
Q

What do recurrent palpitations with a short PR interval indicate

A

Prescence of an accessory pathway
- AVRT
- WPW
- LGL

142
Q

What is the findings on an ECG classic for WPW

A

Delta wave (slurred upstroke)
Broadening of QRS

143
Q

What sound on auscultation indicates more severe AS

A

Quiet S2

144
Q

Examples of secondary harm of HTN

A

LVH
Raised creatinine

145
Q

Who is pulsus alternans found in

A

Patients with acute left ventricular failure

146
Q

Assosiatio nof pulsus alternans

A

Third heart sound
Only occurs in low output states

147
Q

There are more chance of complete heart block in occlusion of which artery

A

Prioximal right coronary

148
Q

Who does torsades de points occur in

A

Patients with a prolonged QT interval

149
Q

1st line therapy of torsades de points

A

IV magnesium (even if its normal)

150
Q

The epsilon potential is seen on ECG in what condition

A

Right ventricular dysplasia

151
Q

Murmur of an atrial myoxoma

A

Patient in sinus rhythm
No opening snap on auscultation
Murmur changes character with posture

152
Q

Which side are atrial myoxomas most common

A

left atrium

153
Q

What are atrial myoxomas

A

Gelatinous friable tumours
Lead to transient signs of MS that occur only if the tumour approahes the valve orifice

154
Q

Complications of atrial myoxomas

A

Since they are friable, small fragments can break off during movement and cause tia/stroke

155
Q

What would be an indication for surgery in IE

A

Increase of PR interval (suggests extension of endocardiac infection into the myocardium and also raises the posibility of an infection)
MR or AR with heart failure
Septal perforation
Valvular obstruction
Large vegetations (>15mm) can be refered for surgical assessment however not immediate intervention

156
Q

Mechanism of action of flecanide

A

Sodium channel blocker

157
Q

Mechanism of action of amiodarone

A

Potassium channel blocker

158
Q

Commonest cardiac abnormality seen in patients with marfans syndrome

A

Aortic root dilatation

159
Q

What is strep bovis assosiated with

A

Colonic carcinoma
Infection of the biliary tree

160
Q

What is systolic click murmur sydnrome

A

Features of MVP and recurrent non cardiac chest pains

161
Q

What murmur do you get in systolic click murmur syndrome and what happens to it on standing

A

MIdsystolic click and late systolic murmur
During standing or the valvalva manouvre the ventricular volume gets smaller
the click and the murmur move earlier into systle

162
Q

What is recognised as a cause of sudden death in patients on methadone

A

Long Qt sydnrome

163
Q

Eye findings in malignant HTN

A

Bilateral retinal haemorrhages
Exduates
Cotton wool spots

164
Q

Physical findings suggestive of rheumatic fever

A

History of previous pharyngitis
Fever
Polyarthritis
Carditis (including MR murmur)
Prescence of S/c extensor surface nodules

165
Q

Blood findings of rheumatic fever

A

Positive anti-streptolysin O titre
Raised ESR
CRP
Leucocytosis

166
Q

How to calculate the EF

A

(EDV - ESV) / EDV

167
Q

What is the preferred drug in patients with a multifocal atrial tachycardia in patients with pulmonary artieral HTN

A

Verapramil

168
Q

How does adenosine work

A

G protein coupled receptor agonist

169
Q

What causes a wide fixed split of S2

A

ASD
RBBB with HF

170
Q

ECGs in HOCM

A

LVH
Appearances of ischaemia despite normal coronary arteries
- deep T wave inversion
- anterir Q waves

171
Q

Murmur in HOCM

A

Sytolic murmur
- worse on standing
- quieter on sqautting
Displaced and foreful apex
Loud S4

172
Q

Treatment of early prosthetic valve IE

A

IV vanc, gent and oral rifampicin

173
Q

What is J point depression on an ECG

A

Physiological response to an increase in HR

174
Q

ECG findigns WPW

A

Short PR interval (<0,12s)
Slurring of QRS - delta wave
Paroxysms of tachycardia

175
Q

What conditions shoud beta blockers not be used

A

asthma
myasthenia gravis

176
Q

Mechanism of action of clopidogrel

A

Blocks ADP receptors
P2Y12 inhibitor

177
Q

Indications for permanent pacing

A

Persistent symptomatic bradycardia
Trifascicular block
Mobitz type 2 AV block
Sinus pauses >3s
Selected patients with tachyarythmias
Symptomatic heart failure on max medical therapy that fulfil guideliens fr cardiac resynchronisatin therapy

178
Q

What does the dicrotic notch refer to

A

Aortic valve closing

179
Q

digoxin and QT interval

A

shortens it

180
Q

Whcih murmur is heard loudest in the left lateral position

A

mitral stenosis

181
Q

Infarction of which artery can cause complete heart block and why

A

Right cornary
- supplies the AV node

182
Q

systolic function in restrictive cardiomyopathy

A

normal

183
Q

Where is the commenst site for radiofrequency ablation in AF

A

Pulmonary veins

184
Q

WHat can haemodynamically ASDs lead to over time?

A

Pulmonary HTN

185
Q

Differential diagnosis of acute pulmonary oedema

A

Severe LVSD
Paroxysmal arrythmias
3 vessel or left mainsteam coronary artery disease
In context of HTN
- renal artery stenosis
- phaechromocytoma

186
Q

WHat is the anti HTN of choice for a patient on lithium

A

Amlodipine

187
Q

Triad of aortic stenosis

A

Angina
LVF
Syncope

188
Q

Features of teratology of fallot

A

Large VSD
Overriding aorta
Right ventricular outflow obstruction
Right ventricular hypertrophy

189
Q

What drugs should be used in caution with patients with AS

A

Beta blockers

190
Q

JVP signs in a patient with increased atrial contraction pressure (i.e. secondary to e.g. TS or PS)

A

Dominant A waves

191
Q

Murmur heard in severe pulmonary HTN

A

Narrow splitting of the second heart sound

192
Q

What is the intervention of choice in patients with HOCM who have significant left ventricular outflow obstruction

A

Beta blockers

193
Q

Where does the coronary sinus drain into

A

Right atrium

194
Q

Triad of heyde syndrome

A

AS
Angiodysplasia
Acquired von willebrand disease

195
Q

ECG findings of hypokalaemia

A

U waves
Small or absent T waves (occassionaly inversion)
Prolong PR interval
ST depression
Long QT

196
Q

Two clinical findings of hypocalcaemia

A

Trousseaus sign
Chvosteks sign

197
Q

Trosseaus sign

A

Carpal spasm if the brachial artery is occluded by inflating the BP cuff and maintaining the pressure above systolic
Wrist flexion and fingers drawn together

198
Q

Chvosteks sign

A

Tapping over the parotid causes facial muscles to twitch

199
Q

What does significant pulmonary HTN lead to (murmur wise)

A

Tricuspid regurg (due to significant back pressure)

200
Q

What is the treatment of ventricular tachycardia secondary to tricyclic antidpressaant overdose where there is acidosis

A

Sodium bicarcbonate

201
Q

Triad of cardiac tamponade

A

SOB
Tachycardia
Elevated JVP

202
Q

Features of cardiac tamponade

A

SOB
Tachycardia
Elevated JVP
Pulsus paradoxus
Kussmauls sign (rise in JVP on inspiration)
Area of dullness to percussion with bronchial breathing below the angle of the left scapula (ewarts sign)

203
Q

JVP findings of complete heart block

A

Cannon a waves

204
Q

Features of ASD (never identified in infancy)

A

Large shunt later teenage years leading to hypoxia, pulmonary HTN and tricuspid regurg
Decreased exercise tolerance
Palpitations assosiated with AF

205
Q

Pericarditis ECG assosiations

A

Widespread conCAVE or saddle shaped ST elevation

206
Q

1st line interventions for pericarditis

A

NSAIDs
Colchicine

207
Q

Pathology of long QT syndrome

A

Potassium channel alpha subunit

208
Q

Treatment of HTN in marfan patient

A

ARBS (e.g. valsartan) or beta blockers

209
Q

What is the glucose content in 1 litre of 5% glucose

A

50g

210
Q

What would a patient with recurrent viral pericarditis iwth new signs of cardiac failure indicate

A

Development to constrictive pericarditis

211
Q

Treatment of constrictive pericarditis

A

Anakira

212
Q

Mechanism of action of ticagrelor

A

P2Y12 receptor inhibitor

213
Q

Treatment of native valve endocarditis

A

Amoxicillin and gentamicin

214
Q

Treatment of prosthetic valve endocarditis

A

Fluclox, gentamicin and rifampicin

215
Q

Drug treatment of choice for medical cardioversion of VT post MI

A

aMIODARONE

216
Q

ASD murmur

A

Fixed split second heart sound

217
Q

Treatment of paroxysmal SVT where patients refuse an ablation procedure

A

Beta blockers e.g. metoprolol
Verampramil / diltiazem

218
Q

Gene mutation in HOCM

A

MYH7

219
Q

How does pregabalin work

A

Voltage gated calcium channel inhibitor

220
Q

WHat is streptococcus gallolyticus assosiated with with IE

A

Underlying colon cancer
Cholangiocarcinoma

221
Q

Most common cardiac defect in patients with noonsans syndrome

A

Pulmonary stenosis

222
Q

What can reduce the level of clopidogrel

A

Omeprazole

223
Q
A

MRCP - Part 1 (20 decks)

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