Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCP2 > Cardio > Flashcards

Cardio Flashcards

1
Q

What is an accelerated idioventricular rhythm? Management?

A

Benign ectopic rhythm of ventricular origin

Occurs following reperfusion of ischaemic tissue, electrolyte abnormalities or drug toxins –> increased rate of ventricular depolarisation

Management: Self limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the acceptable rise in eGFR/creatinine when starting ACEi?

A

Creatinine - up to 30%
eGFR - up to 25%
K - up to 5.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is achondroplasia?

A

Autosomal dominant

Short stature
Large heart with frontal bossing
Trident hands
Lumbar lordosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of STEMI?

A

Aim saturations >94%
GTN, IV morphine, metoclopramide

Aspirin 300mg
+Clopidogrel/Ticagrelor/Prasurgel

NOTE: Ticagrelor is now preferred over clopidogrel if medically managed. Aspirin and Prasugrel if PCI

PCI within 120 minutes

If not, fibrinolysis. If failure of resolution at 90 minutes on ECG, then transfer for PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of acute pericarditis? Most specific ECG finding? What should all patients have?

A

NSAID + Colchicine

ECG: PR depression most specific. Widespread saddle shaped ST elevation

All should have TTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of pericarditis? (8)

A 
viral infections (Coxsackie)
tuberculosis
uraemia (causes 'fibrinous' pericarditis)
trauma
post-myocardial infarction, Dressler's syndrome
connective tissue disease
hypothyroidism
malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What potentiate the effects of adenosine?

A

Dipyridamole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What reduces the effects of adenosine?

A

Theophyllines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What condition is a contraindication for adenosine?

A

Asthma

Can enhance conduction down accessory pathways i.e. WPW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Examples of ADP (adenosine diphosphate) receptor inhibitors?

A

Clopidogrel
Prasugrel
Ticagrelo
Ticlopidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

New recommendations for dual antiplatelet treatment for 12 months as secondary prevention?

A

Aspirin (75mg OD)

Ticagrelor (90mg BD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the interaction between clopidogrel and PPIs?

A

Reduced antiplatelet effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the four Hs and four Ts in ALS?

A

Hypoxoia
Hypovolaemia
Hyperkalaemia/Hypokalaemia/Hypoglycaemia/Hypocalcaemia
Hypothermia

Thrombosis
Tension Pneumothorax
Tamponade
Toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is adrenaline given in VT/VF arrest?

A

After the third shock. The every 3-5 minutes (alternate cycles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is adrenaline given in asystole/PEA?

A

Immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would amyloidosis look like on an ECG?

What might you see on echo?

A

Low voltage complexes
Poor R wave progression

Global speckled pattern on echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is drug management of angina?

A
  1. Beta-blocker or Calcium Channel blocker (verapamil or diltiazem if monotherapy. Nifedipine, amlodipine, felodipine if dual)
  2. Poor response - titrate up
  3. 1: Add second agent
  4. 2: If no response and second agent not tolerated, add long acting nitrate, ivabradine, nicorandil, ranolazine
  5. Assess for PCI or CABG

All patients:
Aspirin
Statin
GTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should you do i nitrate tolerance develops in angina?

A

Second dose after 8 hours (for IR only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Antiplatelet management (first and second line):

Medically treated ACS

A

Aspirin (life)
Ticagrelor (12 mo)

OR
Clopidogrel (life)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Antiplatelet management (first and second line):

PCI

A

Aspirin (life)
Ticagrelor/Prasurgrel (12 mo)

OR
Clopidogrel (life)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Antiplatelet management (first and second line):

TIA

A

Clopidogrel (life)

OR
Aspirin (lifelong) & dipyridamole (lifelong)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Antiplatelet management (first and second line):

Ischaemic Stroke

A

Clopidogrel (life)

OR
Aspirin (lifelong) & dipyridamole (lifelong)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Antiplatelet management (first and second line):

Peripheral Arterial Disease

A

Clopidogrel (life)

OR
Aspirin (life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs of aortic regurgitation?

A 
Early diastolic murmur
Collapsing Pulse
Wide pulse pressure
Quinke's sign
De Musset's sign
Mid-diastolic Austin Flint murmur if severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Aortic dissection management.

Type A vs Type B

A

Type A:
Surgical
BP aim 100-120

Type B:
Conservative
IV Labetalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Features of aortic stenosis?

A

Chest pain
SOB
Syncope

Ejection systolic murmur
Narrow pulse pressure
Slow rising pulse Delayed ESM
Soft/absent S2
S4
Thrill
LVH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of aortic stenosis?

What other investigation should be done whilst investigating and why?

A

Symptomatic - replace

Asmyptomatic with gradient >40mmHg - consider surgery

Often do angiogram at same time - so can have CABG if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is arrhythmogenic right venticular cardiomyopathy?

Typical ECG findings?

Management?

A

Autosomal dominant
Fatty and fibrofatty tissue replaced

Palpitations
Syncope
Sudden cardiac death

V1-3 T Wave Inversion
Epsilon Wave (terminal notch in QRS)

Management:
Sotalol
ICD
Catheter Ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How to rate control AF?

A

Beta-blocker
OR
Rate-limiting calcium channel blocker (Diltiazem)

If this fails, can combine with any 2 of the following:

Beta-blocker
Diltiazem
Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Who can be electively cardioverted in AF?

What extra precaution of high risk of failure?

A

Only if new onset for 48 hours –> heparinise

Onset >48hrs
Anticoagulated for 3 weeks and then continue for 4 weeks after (or can exclude with TOE and then heparinise and cardiovert immediately)

If high risk of failure (previous failure, AF recurrence) - at least 4 weeks amiodarone or sotalol prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is CHA2DS2VASc score?

A 
CCF (1)
HTN (1)
Age 75 (2)
Age 64-75 (1)
Diabetes (1)
Stroke/TIA (2)
Vascular Disease (1)
Sex - Female (1)

If 0 - no treatment
If 1 - male consider, female no treatment
If 2 - offer anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Where should atrial flutter be ablated?

A

Radiofrequency ablation of the tricuspid valve isthmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is an atrial myxoma?

Features?

A

Primary cardiac tumour

75% in left atrium

SOB
Fatigue
Pyrexia
Clubbing
Emboli
AF
Mid diastolic murmur
Tumour plop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Features of ASD?

A

ESM

Fixed split S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the features of the two common ASDs?

A

Ostium Secundum
70%
Higher in location
ECG: RBBB with RAD

Ostium Primum
Abnormal AV valve
Lower in location
ECG: RBBB with LAD, prolonged PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is Mobitz 1?

A

Progressive prolongation of PR interval until dropped beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is Mobitz 2?

A

PR interval constant

P wave often not followed by a QRS complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What drug must beta blockers never be used with? Why?

A

Verapamil

Can cause severe bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is Brugada syndrome? How is it managed?

A

Autosomal dominant

Mutation in SCN5A gene –> sodium ion channel (20-40%)

Can cause sudden death

Management:
ICD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are characteristic ECG findings of Brugada?

A

Convex ST elevation >2mm in V1-3 followed by negative T wave

Partial RBBB

May be more apparent with flecainide or ajmaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which returns lower oxygenation levels. The IVC or SVC?

A

SVC returns lower oxygenation levels due to the higher consumption of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What non-invasive imaging modalities can you use for investigating the heart (i.e. following NSTEMI)

A

Nucelar Imaging
- assess myocardial perfusion and myocardial viability

Cardiac CT

  • calcium score
  • contrast CT - visualise coronary artery lumen

Cardiac MRI

  • gold standard for structural abnormalities
  • perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Beck’s triad in cardiac tamponade?

A

Hypotension
Raised JVP
Muffled Heart sounds

Also:
SOB
Tachycardia
Absent Y descent
Pulsus paradoxus
Kussmauls
Electrical alternans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

JVP in cardiac tamponade vs constrictive pericarditis?

A

Cardiac Tamponade
- Absent Y descent

Constrictive pericarditis
X + Y present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Common echo findings suggestive of HOCM?

A

MR
Systolic anterior motion of anterior mitral valve
Asymmetric septal hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Causes of dilated cardiomyopathy?

A

Alcohol
Coxsackie B
Wet Beri Beri
Doxorubicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Causes of restrictive cardiomyopathy?

A

Amyloidosis
Post-radiotherapy
Loeffler’s edocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the three features of typical angina?

A
  1. Constricting discomfort in front of chest, neck, shoulders, jaw or arms
  2. Precipitated by physical exertion
  3. Relieved by rest or GTN in 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Investigation of stable angina?

How is this order changed according to likely hood of coronary artery disease?
>90%
61-90%
30-60%
10-29%
A
  1. CT coronary angiography
  2. Non-invasive functional imaging (ie. MPS with SPECT, Stress Echo, MRI)
  3. Invasive Coronary Angiography

> 90% - no tests
61-90% - Invasive coronary angiography
30-60% - functional imaging
10-29% - CT calcium scoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Features of cholesterol embolisation?

A

Eosinophilia
Purpura
Renal Failure
Livedo reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Features of complete heart block?

A 
Syncope
Heart Failure
Regular bradycardia
Wide pulse pressure
JVP - cannon waves
Variable intensity of S1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Features of constrictive pericarditis?

A 
SOB
Right heart failure (elevated JVP< ascites, oedema, hepatomegaly)
Prominant X and Y descent
Pericardial knock
Kussmaul's sign
Pericardial calcification on CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How does dabigatran work?

What is it used for?

A

Direct thrombin inhibitor

Used for prevention of stroke in patients with non-valvular AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Management of HTN in diabetes:

What is the target BP?

Target BP with end organ damage?

What should first agent be?

A

Aim <140/80

Aim <130/80 if end organ damage

Begin with ACEi regardless of age or race.

If African, begin with ACEi + Thiazide/CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are common cardiac defects found in patients with Down’s syndrome?

A 
Endocardial cushion defect (40%))
VSD (30%)
2. ASD (10%)
ToF (5%)
PDA (5)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

DVLA Rules for:

Elective Angioplasty
CABG
ACS +/- PCI
Angina
PPM
ICD (for arrhythmia, for prophylaxis)
AAA >6.5cm
Catheter ablation for arrhythmia
A

Elective Angioplasty
- 1 week

CABG
- 4 weeks

ACS +/- PCI

  • 4 weeks
  • 1 week if PCI

Angina
- stop if sx at rest

PPM
- 1 week

ICD

  • 6 months (arrhythmia)
  • 1 month (prophylaxis)

AAA >6.5cm
- Banned

Catheter ablation for arrhythmia
- 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

ECG Criteria for electrical hypertrophy?

A

> 40mm the sum of V1 S and V5 or V6 R

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Bifid P wave?

A

Left atrial enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

ECG Bifasicular block?

A

RBBB + left anterior or posterior hemiblock

i.e. RBBB with LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

ECG Trifasicular block?

A

RBBB + left anterior or posterior hemiblock

+

1st degree block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

ECG Territories and Coronary Arteries

Anterior Septal

Inferior

Anterolateral

Lateral

Posterior

A

Anterior Septal

  • V1-V4
  • LAD

Inferior

  • II, III, aVF
  • Right Coronary

Anterolateral

  • V4-6, I, aVL
  • LAD or Left circumflex

Lateral

  • I, aVL +/- V5-6
  • Left circumflex

Posterior

  • Tall R wave V1-2
  • eft circumflex, also right
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

ECG Digoxin signs (4)

A

Downward sloping ST depression

Flattened/Inverted T wave

Short QT

Arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

ECG Hypokalaemia

A 
U waves
Small or absent T waves
Prolong PR
ST depression
Long QT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

ECG Hypothermia

A 
Bradycardia
J wave (small hump at end of QRS)
1st degree block
Long QT
Atrial and ventricular arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

ECG P Pulmonale?

A

Cor Pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the significance of prolonged PR infective endocarditis?

A

Abscess secondary to endocarditis –> refer to cardiac surgeons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is Eisenmenger’s Syndrome?

A

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

ASD
VSD
PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How should acute heart failure patients be classified?

A

Four groups

With or without hypoperfusion

With or without fluid congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Management of heart failure? What cardiac drug class is contraindicated?

A

ACEi
B-Blocker (bisoprolol, carvedilol, nebivolol)

Spironolactone/Hydralazine with nitrates/ARB

Consider CRT (If NHYA Class III, Wide QRS)/Digoxin (digoxin indicated if co-existant AF)

Consider Ivabradine if HR >75, EF <35% and on maximal medical

Annual influenza Vaccine

One off pneumococcal vaccine

Contraindicated: Rate-limiting CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is S3 heart sound?

A

Rapid diastolic filling of ventricle

Heard in LVH, constrictive pericarditis, mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is S4 heart sound?

A

Atrial contraction against a stiff ventricle

Heard in aortic stenosis, HOCM, HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Cause of widely split S2?

A

RBBB
Deep inspiration
Pulmonary stenosis
Severe MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Cause of loud S2?

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Cause of reversed split S2?

A 
LBBB
Severe aortic stenosis
WPW Type B
PDA
RV pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Cause of fixed split S2?

A

ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Features of HELLP?

A

N&V
RUQ pain
Lethargy

Haemolysis
Elevated Liver Enzymes
Low Platelet

Management:
Deliver baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is homocystinuria?

A

Autosomal recessive

Defieicny in cystathionine beta synthase

Severe elevations in plasma and urine homocysteine

Fine fine hair
Marfan's like
Learning difficulty
Dislocation of lens
Malar flush

Positive cyanide-nitroprusside test
Positive cystinuria

Treat: Vitamin B6 (pyridoxine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

ECG changes from hypercalcaemia?

A

Short QT interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Diagnosis of HTN?

A

Clinic Reading >140/90

Offer ABPM

<135/85 - Nil
>135/85 - Stage 1 HTN
>150/95 - Stage 2 HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Treatment of Stage 1 HTN

A

Only if < 80 years and any of the following:

  • Target organ damage
  • CVS disease
  • Renal disease
  • Diabetes
  • 10 yr score >10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

When should immediate HTN be arranged in clinic?

A

If BP > 180/110

Signs of papilloedema or retinal haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Management of HTN?

A

Lifestyle (low salt <6g, low caffeine, stop smoking, less alcohol, Mediterranean diet, exercise, lose weight)

< 55 or T2DM

1) ACEi
2) ACEi + CCB or Thiazide-like

> 55 or Afro-caribbean

1) ACEi
2) ACEi + CCB

Common Pathy

3) ACEi + CCB + Thiazide-like
4) If K <4.5 - Spiro. If K >4.5 alpha or beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is resistant HTN?

A

HTN requiring step four of treatment algorithm.

You should seek specialist advice if this fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

BP Target (in clinic and home)

< 80 years

> 80 years

A

<80
140/90
135/85

> 80
150/90
145/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Causes of secondary HTN?

A

Renal:

  • Glomerulonephritis
  • Pyelonephritis
  • APKD
  • Renal Artery Stenosis

Endo:

  • Conn’s
  • Phaeo
  • Cushing
  • Liddle’s
  • CAH
  • Acromegaly

Drug:

  • Steroids
  • MAOi
  • COC
  • NSAIDs
  • Leflunomide

Other

  • Pregnancy
  • Coarctation of aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Management of Hypertrophic obstructive cardiomyopathy?

A 
(ABCDE)
Amiodarone
Beta-blocker/verapamil
Cardioverter Defibrillator
Dual Chamber PPM
Endocarditis Prophylaxis

AVOID:
Nitrates
ACEi
Inotropes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Infective endocarditis:

Most common organism in Developing world

A

Streptococcus Viridans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Infective endocarditis:

Most common organism in Developed world

A

Staphylococcus Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Infective endocarditis:

Most common organism in indwelling lines (thus first 2 months following prosthetic surgery)

A

Staphylococcus epidermidis

90
Q

Infective endocarditis:

Most common organism in poor dental hygeine?

A

Streptococcus viridans (mitis or sanguinis)

91
Q

Infective endocarditis management:

Blind

A

Native Valve - Amox

Pen Allergy - Vanc, Gent

Prosthetic - Vanc, Rifampicin, Gent

92
Q

Infective endocarditis management:

Native (Staphylococci)

A

Flucloxacillin

Pen Allergy - Vanc, Rifampicin

93
Q

Infective endocarditis management:

Prosthetic (Staphylococci)

A

Flucloxacillin, rifampicin, gent

Pen allergy - vanc, rifampicin, gent

94
Q

Infective endocarditis management:

Streptococci (full sensitive)

A

Benzylpenicillin

Pen Allergy - vanc + gent

95
Q

Infective endocarditis management:

Streptococci (partial sensitive)

A

Benzylpenicillin + gent

Pen Allergy - vanc + gent

96
Q

Indications for surgery in infective endocarditis?

A

Severe valve incompetence

Aortic abscess

Resistant to Abx

Cardiac failure refractory to medical managent

Recurrent emboli after Abx

97
Q

Adverse effects of ivabradine? (3)

A

Visual effect (luminous phenomena)
Headache
Bradycardia/Heart block

98
Q

JVP - list the order of waves

A

A –> C –> X –> V –> Y

99
Q

JVP: What does the A wave represent?

What do cannon A waves represent?

A

A = atrial contraction

If large –> Tricuspid stenosis, pulmonary stenosis, pulmonary HTN

Cannon A = atrial contraction against a close tricuspid valve

Seen in complete HB, VT, Ectopics, Nodal Rhythm

100
Q

JVP: What does the c wave represent?

A

Closure of tricuspid valve

Not normally visible

101
Q

JVP: What does the V wave represent?

What do giant V waves represent?

A

Passive filling of blood into atrium against closed tricuspid valve

Giant V waves in tricuspid regurgitation

102
Q

JVP: What does the X descent represent?

A

Fall in atrial pressure during ventricular systole

103
Q

JVP: What does the Y descent represent?

A

Opening of tricuspid valve

104
Q

Management of Kawasaki disease?

A

High dose aspirin
IVIG
ECHO

105
Q

What complicaiton of kawasaki disease are you most concerned about?

A

Coronary artery aneurysm

106
Q

What are the features of kawasaki disease?

A 
High grade fever >5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of hands and soles of feet which later peel
107
Q

How do LQT 1 patients present?

A

Exertional syncope

108
Q

How do LQT 2 patients present?

A

Emotional syncope

109
Q

How do LQT 3 patients present?

A

Die in sleep or event at night

110
Q

Congenita LQT and Deafness

A

Jervell-Lange-Nielsen Syndrome

111
Q

Congenital LQT

No deafness

A

Romano-Ward Syndrome

112
Q

What is Lown-Ganong-Levine Syndrome?

A

Pre-excitation disorder of heart

Abnormal connection between atria and ventricles which bypassess AV node straight to Bundle of His

Bundle of James

Short PR interval

113
Q

Features of McCune-Albright syndrome?

A

precocious puberty
cafe-au-lait spots
polyostotic fibrous dysplasia
short stature

114
Q

Causes of mitral stenosis?

A

Rheumatic Fever - often presents late in pregnancy

(also:

Mucopolysaccharidoses
Carcinoid
Endocardial Fibroelastosis)

115
Q

Features of Mitral stenosis?

A 
Mid-late diastolic murmur
Loud S1 (opening snap)
Low volume pulse
Malar flush
AF

Left Atrial Enlargement on CXR

116
Q

Continuous machine like murmur

A

PDA

117
Q

Mid-late diastolic murmur (2)

A

Mitral stenosis (rumbling)

Austin-Flint (severe AR)

118
Q

Early diastolic murmur (2)

A

Aortic Regurgitation (blowing, high pitch)

Graham-Steel Murmur (Pulmonary regurgitation)

119
Q

Late Systolic (2)

A

Mitral Valve prolapse

Coarctation of aorta

120
Q

Holosystolic (2)

A

Mitral/tricuspid regurgitation (high pitch, blowing)

VSD (harsh)

121
Q

Ejection Systolic (5)

A 
Aortic stenosis
Pulmonary Stenosis
HOCM
ASD
ToF
122
Q

Complications of MI (10)

A
  1. Cardiac Arrest (VF –> ALS)
  2. Cardiogenic Shock (inotropic support/intra-aortic balloon pump)
  3. CHF
  4. Tachyarrhythmia
  5. Bradyarrhythmia
  6. Pericarditis (acute, dressler’s)
  7. LV Aneurysm (persistent ST elevation, LV failure. Anticoagulate)
  8. LV Free Wall Rupture (leads to tamponade, pericardiocentesis)
  9. VSD (acute HF and pansystolic murmur)
  10. Acute MR (infero-osterior infarction. Acute hypotension and pulmonary oedema)
123
Q

Secondary prevention of MI?

A 
Dual antiplatelet
ACEi
B-Blocker
Statin
Mediterranean diet
Exercise

If signs of HF after acute MI, treat with eplerenone within days 3-14.

124
Q

Glycaemic control in MI patients with diabetes?

A

Dose adjusted insulin infusion

Aim < 11mmol/l

125
Q

Causes of myocarditis?

A 
Viral: Coxsackie B, HIV
Bacteria: Diphtheria, clostridia
Lyme disease
Chagas
Toxoplasmosis
Autoimmune
Doxorubicin
126
Q

Treatment of orthostatic hypotension?

How is it defined?

A

Drop >20/10 mgHg within 3 minutes of standing

Midodrine
Fludrocortisone

Beware other causes i.e. alpha-blockers

127
Q

What is a patent ductus arteriosus?

Management?

A

Connection between pulmonary trunk and descending aorta

Indomethacin - closes connection

128
Q

Features of PDA?

A 
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
129
Q

What are the signs for urgent treatment of a bradyarrhythmia/tachyarrhythmia?

A

BP < 90, pallor, sweating, cold, confused

Syncope

MI

HF

130
Q

What is the management of symptomatic bradyarrhythmia?

A
  1. Atropine (500mcg) IV up to 3x

2. Trascutaneous Pacing OR Isoprenaline/Adrenaline

131
Q

What is the management of symptomatic tachyarrhythmia?

A

DC Shock!

132
Q

What is Phenylketonuria?

A

Autosomal recessive

Disorder of phenylalanine metabolism

Presents as:
Seizures
Developmental delay
Fair hair, blue eyes
Eczema
Musty odour

Management:
Strict diet

133
Q

Features of pre-eclampsia?

A

After 20 weeks gestation
HTN
Proteinuria

Headache
Visual distrubance
Papilloedema
RUQ pain
Hyperreflexia
134
Q

Risk factors for pre-eclampsia?

A 
High risk:
Previous HTN pregnancy
CKD
Autoimmune disease
Diabetes
Chronic HTN
Moderate Risk:
First pregnancy
Age 40+
BMI >35
Family history
Multiple pregnancy
135
Q

Management of pre-eclampsia?

A

Target BP <160/110

Labetaolol
Nifedipine
Hydralazine

Deliver baby

136
Q

Investigation of DVT/PE in pregnancy?

Why is CTPA bad?

A

If suspect DVT:
1. Compression duplex USS

If suspect PE:

  1. ECG, CXR
  2. Compression duplex USS
  3. V/Q or CTPA

CTPA carries increased risk of maternal breast cancer

137
Q

What is pulmonary arterial hypertension?

Presentation?

A

> 25mmHg

Progressive SOB on exertion
Exertional syncope
Exertional CP
Perioheral oedema
Cyanosis
RV heave
Loud P2
Raised JVP
TR
138
Q

Management of pulmonary arterial HTN?

A

First vasodilator testing

If positive:
- Oral calcium channel blocker

If negative:
prostacyclin analogues: treprostinil, iloprost
endothelin receptor antagonists: bosentan, ambrisentan
phosphodiesterase inhibitors: sildenafil

139
Q

Using the 2-level wells score for PE, what is the cut off point for PE likely ?

A

More than 4 points

4 or less means PE unlikely

140
Q

Investigation and management of PE with score of 4 on Wells score?

A

Urgent CTPA

If not possible, treat with LMWH whilst waiting

V/Q if renal impairment

141
Q

What is a pulsus paradoxus?

A

Fall of 10mmHg systolic BP during inspiration

Severe asthma
Cardiac tamponade

142
Q

What is a slow rising pulse?

A

Aortic stenosis

143
Q

What is a collapsing pulse?

A

Aortic regurgitation
PDA
Hyperkinetic state (anaemia, thyrotoxic, fever, exercise)

144
Q

What is a Pulsus alternans?

A

Regular alternation of force of arterial pulse

Severe LVF

145
Q

What is a Bisferiens pulse?

A

Double pulse (two systolic peaks)

Mixed aortic valve disease

146
Q

What is a Jerky pulse?

A

HOCM

147
Q

What is Rheumatic fever?

A

Develops following umunologicalr eaction to recent (2-6weeks) streptococcus pyogenes infection

148
Q

Diagnosis of Rheumatic fever?

A

Diagnosis is based on evidence of recent streptococcal infection accompanied by:
2 major criteria
1 major with 2 minor criteria

Evidence of recent streptococcal infection
raised or rising streptococci antibodies,
positive throat swab
positive rapid group A streptococcal antigen test

Major criteria
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)*
subcutaneous nodules

Minor criteria
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval
149
Q

What is superficial thrombophlebitis? How should it be investigated and managed?

A

Inflammation and throbosis of one of the superficial veins

20% have underlying DVT

Investigaiton:
USS to exclude DVT

Management:
Compression Stockings
LMWH for 30 days (fondaparinux for 45 days) OR NSAIDs for 8-12 days

If near the sapheno-femoral junctoin - anticoagulate for 6-12 weeks

150
Q

Management of SVT in asthmatics if vagal manoeuvre fails?

A

Verapamil

151
Q

Management of Takayasu’s arteritis?

A

Steroids

Associated with renal artery stenosis

152
Q

Features of Takotsubo cardiomyopathy?

A

Stress induced
Apical ballooning and severe hypokinesis of mid and apical segments of heart

Chest pain
HF features
ST elevation
Normal Coronary angiogram

Supportive management

153
Q

What are the four features of tetraolgy of fallot

A

VSD
RV Hypertrophy
RV outflow tract obstruction
Overriding aorta

Presents around 1-2 months

154
Q

Features of Tricuspid regurgitation

A

Pan systolic murmur
Prominent/giant V waves
Pulsatile hepatomegaly
Left parasternal heave

155
Q

Management of haemodynamically stable VT?

A

Amiodarone
Lidocaine
Procainamide

DO NOT USE VERAPAMIL!

156
Q

INR target for warfarinised VTE:

Initial event

Recurrent

A

Initial - 2.5

Recurrent - 3.5

157
Q

AF INR target:

A

2.5

158
Q

Management of Warfarin with high INR:

Major Bleed

A

Stop warfarin

Give IV Vit K and Prothrombin complex concentrate

159
Q

Management of Warfarin with high INR:

INR >8, minor bleed

A

Stop warfarin

IV Vit K

Repeat dose if still high at 24 hrs

Restart when INR <5

160
Q

Management of Warfarin with high INR:

INR >8, no bleed

A

Stop warfarin

Oral vit K

Repeat dose if still high at 24 hrs

Restart when INR <5

161
Q

Management of Warfarin with high INR:

INR 5-8, minor bleed

A

Stop warfarin

IV vit K

Re-start when <5

162
Q

Management of Warfarin with high INR:

INR 5-8, no bleed

A

Withhold 1 or 2 doses

163
Q

WPW positive R wave in V1. Which type and where is the accessory pathway?

A

Type A

Between left atria and ventricle

Causes RAD

164
Q

Which patients benefit from CABG over PCI in uncontrolled angina?

A

No more than 2 antianginals prior to consideration of reperfusion therapy

When stable coronary artery disease and ischaemia >10% in left ventricle

Patients with:

Complex Anatomy
Triple Vessel disease
Proximal left main stem disease
Age 65+
Diabetes
165
Q

Side effects/contraindications of the additional anti-anginal drugs:

Long-acting nitrates
Nicorandil
Ivabradine
Ranolazine

A

Long-acting nitrates

  • Hypotension
  • Contraindicated with sildenafil

Nicorandil

  • Hypotension
  • Severe headaches
  • Contraindicated with sildenafil

Ivabradine

  • Only works in sinus rhythm (thus not used in sick sinus)
  • Reduces heart rate (don’t use in bradycardia)
  • Do not use in moderate to severe angina
  • Does not cause hypotension

Ranolazine

  • Negative inotrope
  • Liver dysfunction
  • Severe renal disease
166
Q

What is Wellen’s syndrome?

A

ECG manifestation of critical proximal left anterior descending coronary artery stenosis

Unstable angina

Symmetrical deep >2mm T wave inversion in anterior precordial leads

Treat with urgent angiography and revascularisation

167
Q

When should patients with angina have a third agent?

A

Only if not candidate for PCI or CABG

168
Q

What is Prinzmetal’s angina?

A

Due to vasospasm

Pain at rest

ECG - ST elevation. This disappears when pain goes

Avoid smoking

Rx:
CCB, Nitrates, Nicorandil

169
Q

When investigating angina, if calcium score is:

0
1-400
>400

A

0 - Ix for other causes of pain

1-400 - 64 slice CT angiogram

> 400 - invasive angiogram

170
Q

When should ivabradine be used for heart failure patients?

A 
Ejection fraction 35%
Heart rate >75/min
Sinus rhythm
NYHA class 2-4
Maximally titrated beta blocker therapy.
171
Q

Management of resistant hypertension?

A

Resistant Hypertension

HTN that has not responded to 3 appropriately dosed anti-HTN medications

K+ > 4.5 - alpha or beta-blocker

K+ <4.5 - spironolactone

172
Q

What should not be done / given to patients with WPW in AF?

How should they be managed?

A

Do not:
Valsalva
AV Blocking Drugs (adenosine, beta-blocker, calcium channel blocker, digoxin [ABCD])

Risk VT or VF

Unstable - urgent syncrhonised DC cardioversion

Stable - procainamide, DC cardioversion, flecainide, amiodarone

Definitive - ablation

173
Q

Differentiate WPW Type A from Type B

A

Type A

  • Left AV connection
  • Positive R wave in V1

Type B

  • Right AV connection
  • Negative delta wave in V1
174
Q

Differentiating spinal stenosis from vascular claudication?

A

Neurogenic Claudication:
- Sx on exertion that improve with leaning forward, sitting down

Vascular Claudication:
- Sx on exertion that improve with rest

175
Q

Criteria for diagnosis of Takayasu?

A

3 of 6 below = 90% sensitivity and specificity

  1. Age onset <=40 years
  2. Claudication of the extremities
  3. Decreased pulsation of one or both brachial arteries
  4. Difference of at least 10 mm Hg in systolic blood pressure between the arms
  5. Bruit over one or both subclavian arteries or the abdominal aorta
  6. Arteriographic narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities, not due to arteriosclerosis, fibromuscular dysplasia, or other causes
176
Q

What is the pulmonary wedge pressure a surrogate marker for?

A

Left atrial pressure

177
Q

What commonly occurs with right ventricle infarction? What happens to JVP?

A

Tricuspid regurgitation

Prominent V Wave

178
Q

What are the HACEK group and what is their significance in infective endocarditis?

A

Can causes gram negative endocarditis

Haemophilus species
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella
179
Q

What clue can help distinguish VT from SVT and BBB?

A

If RBBB and RAD –> more likely to be SVT with BBB

180
Q

Who is Cardiac resyhchronisation therapy offered to?

A

NYHA III or IV heart failure
Ejection fraction of <35%
The heart is beating regularly with evidence of electrical conduction disease (wide QRS)
They are medication that is most effective for them

181
Q

What do patients with sick sinus syndrome often have before beginning medication therapy? Why?

A

AAIR pacemaker

Can present with mixture of brady and tachy arrhyhthmias

182
Q

When is starting a beta-blocker in heart failure contra-indicated?

A

When in acute decompensated heart failure

183
Q

What is cyclizine induced heart failure?

A

Causes systemic HTN and tachycardia

Not recommended in ACS or severe hF

184
Q

Side effect of ivabradine?

A

Visual disturbances (phosphenes and green luminescence)

185
Q

Afro-Carribean on optimal first line heart failure medication. What is the next step?

A

Hydralazine and Nitrate

186
Q

When would Sacubitril-Valsartan be indicated?

What is the washout period?

A

Heart failure not optimally managed despite medical therapy AND:

  • Bradycardic
  • Hypotensive
  • Slightly raised K+

Washout 36 hours from last ACEi

187
Q

Medical treatment of HOCM? What should not be given?

A

Betablocker (propranolol)
Or
Rate-limiting CCB (Verapamil)

If not managed:
Disopyramide

Not controlled with two agents:

  • Surgical Myectomy
  • DDR pacemakers
  • Alcohol ablation

DO NOT give ACEi, Nitrates

188
Q

Mainstay in additional treatment of anterior wall MI?

A

Diuretics to reduce pulmonary congestion

Inotropic support to enhance cardiac output and perfusion

189
Q

In initial phase after PCI for ACS in patients with AF, what should be given to thin the blood?

A

2 antiplatelets

1 anticoagulant

190
Q

What is Bornholm disease?

A

Viral infection causing pain in lower chest

191
Q

What is pacemaker syndrome?

A

VVI Pacemaker
Simultaneous atria and ventricle contraction

Causes fatigue, dizziness, hypotension

192
Q

Causes of AKI following angiography?

A

Contrast induced nephropathy

Cholesterol emboli

  • raised eosinophils
  • livedo reticularis
193
Q

Management of Pulmonary embolism?

A

Sub-massive (RV dysfunction, myocardial injury):
- LMWH

Massive (shock or hypotension):
- Thrombolysis

194
Q

Drug management of HTN?

A

Step 1; Age <55 - ACE inhibitor. Age >55 or of black African or Caribbean origin - calcium channel blocker

Step 2; ACE inhibitor + calcium channel blocker

Step 3; ACE inhibitor + calcium channel blocker + thiazide-like diuretic (Indapamide in preference)

Step 4; consider further diuretic or beta-blockade or alpha blocker and seeking expert advice

195
Q

Complete heart block following MI in:
Anterior MI
Inferior MI

What are the different outlooks?

A

Anterior MI - significant damage. Will need pacing

Inferior MI - Likely transient (resolves after PCI)

196
Q

Management of P wave systole?

A

External pacing

197
Q

What can be used for rapid reversal of dabigatran?

A

Idarucizumab

198
Q

When is Ezetimibe used?

A

Primary Hypercholesterolaemia

199
Q

Elderly male with syncope on alpha blocker or BPH. What should you do?

A

Lying standing BP

Stop the alpha blocker!

200
Q

List causes of secondary hypertension:

Endocrine (4)
Adrenal (3)
Renal (4)
Cardiovascular (1)
Drugs (5)
A

Endocrine:

  • Cushing
  • Acromegaly
  • Thyroid
  • Hyperparathyroid

Adrenal

  • Conns
  • Adrenal hyperplasia
  • Phaeo

Renal

  • Diabetic nephropathy
  • Chronic GN/TIN
  • Adult polycystic kidney disease
  • Renovascular disease

Cardiac
- Aortic dissection

Drugs:

  • NSAIDs
  • Oral Contraception
  • Steroids
  • Symphathomimetics
  • MAOi
201
Q

What is a MIBG scan used for?

A

Investigating Phaeo

202
Q

Drugs causing Long QT?

A 
TCAs
Quinidine
Erythromycin
Digoxin
Amiodarone
Lithium
203
Q

Mobitz 2 or Complete heart block. What type of pacemaker?

A

DDD or DDDR

as functioning atria

204
Q

Relevance of cardiac amyloidosis and digoxin?

A

Digoxin should not be given due to higher risk of digoxin toxicity

205
Q

What should happen to anticoagulation in AF after elective DC cardioversion?

A

Continue for 1 month

High risk of recurrent AF

206
Q

What is the valve disease associated with ADPKD?

A

Mitral valve prolapse

207
Q

What is Twiddling?

A

Refers to pacemaker dysfuntion due to patients interfering with wires

208
Q

What imaging would you use to diagnose myocarditis?

A

Cardiac MRI

209
Q

What is the risk if start AF patients on flecainide alone?

A

May turn to Atrial Flutter

Slows AF and then nay increase conduction due to 1:1 conduction and thus HR increases

210
Q

What is peripartum cardiomyopathy?

A

LV ejection fraction reduced in last month or within 5 months of giving birth

Avoid ACEi if breast feeding/pregnant

211
Q

What imaging would you use to investigate cardiomyopathy?

A

Cardiac MRI

212
Q

Who is eligible for a pill in the pocket?

A

Paroxysmal AF (infrequent) with few symptoms

No history of IHD, valve or LV dysfunction
Infrequent episodes
BP >100
HR > 70
Understand when to take
213
Q

How do you assess risk of LV tract obstruction in cardiomyopathy?

A

Exercise stress echo

214
Q

Xanthelasma cause?

A

Hypercholesterolaemia

215
Q

Management of Mitral valve stenosis?

A

Symptomatic (mitral valve area 1.5cm) and favourable valve morphology in absence of LA thrombus or moderate-to-severe MR
- Mitral valve balloon valvotomy

Severely symptomatic (NYHA 3,  mitral valve area 1.5cm) who are not high risk for surgery and not candidates or failed previous balloon valvotomy
- Mitral valve surgery
216
Q

When should TAVI be offered?

A

TAVI (transfemoral) for patients with low or intermediate risk surgical aortic valve insertion

For older patients that would usually have bioprosthetic valve

NOTE: Transapical TAVI inferior to surgical

217
Q

Management of patient with severe aortic stenosis and sign of heart failure?

A

Consider aortic valve replacement

218
Q

BP target?

HTN without comorbidity

Patient with Diabetes

Patient with diabetes and organ damage

A

HTN without comorbidity
140/90

Patient with Diabetes
140/80

Patient with diabetes and organ damage
130/80

219
Q

Indication for mitral valve replacement?

A

New AF with MR

symptoms, left ventricular dysfunction, pulmonary hypertension, new atrial fibrillation and dilated left ventricle.

220
Q

Indication for aortic valve replacement in AR?

A

significant enlargement of the ascending aorta, severe regurgitation with symptoms or if severe with an ejection fraction of less than 50%.

MRCP2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions