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MRCP 2 > Cardio > Flashcards

Cardio Flashcards

1
Q

Young Patient presents with palpitations and dizziness. What ECG changes would indicate arrythmogenic right ventricular cardiomyopathy

A

T wave inversion in V1-3. And an epsilon wave - terminal notch in QRS complex

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2
Q

T wave inversion in V1-3. And an epsilon wave - terminal notch in QRS complex

A

arrythmogenic right ventricular cardiomyopathy

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3
Q

Epsilon wave - describe and what condition is it going in?

A

Terminal notch in QRS…

Found in 50% of Arrythmogenic right ventricular cardiomyopathy

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4
Q

Criteria for giving patient pill for PRN rate control for AF

A

pill in pocket consider if :

No history of LVD, valvular/ischaemic HD
Infrequent episodes
Systolic>100 and HR >70

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5
Q

When is Cardiac Resynchronisation Therapy indicated with heart failure

A

CRT can be used in patients with a QRS duration of >130 msec and LBBB to improve symp

RBBB has a worse disease state so CRT not helpful

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6
Q

mechanism for Aortic dissection causing MI

A

The origin for the right coronary artery is the right coronary sinus which is at the bases of the aorta
So can cause inf MI
(ST elevation in leads II, III and aVF)

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7
Q

SVC obstruction management

A

Oral dex

steroids can affect histology, but waiting is only an option in mildly symp pt

small cell: chemo + radiotherapy
non-small cell: radiotherapy

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8
Q

Signs of ASD

A

Often present with AF
Fixed splitting of S2, mid systolic murmur in pulmonary area
RBBB
Significant ASD should be fixed below 10 or asap as adult

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9
Q

Indications for ICD with VT

A

Spontaneous sustained VT
Cardiac arrest due to VT (non-reversible causes)
Unexplained syncope with VT inducible at EPS
non-sustained VT with prior MI

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10
Q

Is non sustained VT an indication for AICD?

A

Only if prior MI

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11
Q

Brady Arrhythmia management

A

Atropine 3mg max, if that fails then can do external pacing

..but if recent MI then temporary pacing wire

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12
Q

Small deflection immediately after T wave

A

U wave

Hypokal

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13
Q

Management of acute pericarditis

A

Aspirin and colchicine

Colchicine reduces rate of recurrence from 37% to 17%

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14
Q

Features of patient with atrial myxoma

A

May have finger clubbing, normocytic anaemia, positional heart murmur, intracardiac calcification on CXR

May have syncope from LV inflow obstruction

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15
Q

Patient with finger clubbing, normocytic anaemia, positional heart murmur, intracardiac calcification on CXR

A

Atrial myxoma

Could have syncope from transient LV inflow obstruction

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16
Q

ECG changes in WPW

A

PR <120
slurring up to the QRS - Delta waves
Wide QRS
left axis deviation if right-sided accessory pathway
right axis deviation if left-sided accessory pathway

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17
Q

tachyarrhythmia management

A

synchronised DC shock - if systolic <90, sweating, pallor, syncope, MI, HF

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18
Q

Wellens’ syndrome

A

deeply inverted or biphasic T waves in V2-3

highly specific for critical stenosis of LAD

Treated as a STEMI with urgent angiography and revascularisation

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19
Q

When is PCI indicated

A

Presentation is within 12h of symptoms AND PCI can be delivered within 120min of when fibrinolysis could have been given

Consider after 12 with ongoing ischaemic

Radial access

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20
Q

upper limit of normal for cQT interval

A

Men 450 ms
Women 460 ms

Each 10 ms increase in QT interval increases the risk of TdP by around 5-7 %

cQT > 500 ms, the risk is markedly increased

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21
Q

drug-induced prolonged QT interval and risk of torsades de points

A

Each 10 ms increase in QT interval increases the risk of TdP by around 5-7 %

cQT > 500 ms, the risk is markedly increased

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22
Q

Management for takotsubo cardiomyopathy

A

Supportive
Majority have good prognosis

(Apical ballooning due to severe hypokinesis of basal segments)

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23
Q

Description of torsades de pointes

A

Polymorphic Broad complex ventricular tachycardia

24
Q

Clicking sound synchronous with sounds of heart is sign of….

A

Small left Apical pneumothorax

25
Q

Investigations for PFO

A

Contrast enhanced echo

45% of young patients with a stroke! (20% of normal pop)

26
Q

Pt with ckd post angio develops:
dusky limbs w painful ulceration on his shins,
peripheral purpuric rash,
and worsened kidney function

A

Cholesterol embolism
Also has oesonophilia raised ESR and low complement

No treatment

27
Q

Patient has MI which causes Bradycardia, which vessel?

A

Interior

RCA

28
Q

ecg changes in Brugada

A

convex ST elevation > 2mm in > 1 of V1-V3, followed by negative T
partial RBBB

More apparent after flecainide challenge

29
Q

definition of paroxysmal AF

A

recurrent episodes (>=2),
>30 seconds
terminates spontaneously

<30s is not an indication for oral anticoagulation

30
Q

sudden severe breathlessness, short-lived left-sided chest pain, collapse, normal ECG
BG mitral valve prolapse

A

acute mitral regurgitation

Caused by: chordal rupture, flail leaflet, and papillary muscle rupture (usually secondary to myocardial infarction)

31
Q

25yr old with chest pain, acute heart failure and a continuous murmur accentuated in diastole

A

rupture of sinus of Valsalva

32
Q

What additional drug after ACEi and beta-bl is most likely to improve the prognosis in HF?

A

spironolactone

no long-term reduction in mortality has been demonstrated for loop diuretics such as furosemide

33
Q

PR interval is constant but the P wave is often not followed by a QRS complex

A

Second-degree heart block type 2 (Mobitz II):

34
Q

progressive prolongation of the PR interval until a dropped beat occurs

A

Second-degree heart block type 1 (Mobitz I, Wenckebach)

35
Q

which is most common ASD?

A

ostium secondum

36
Q

Definition of pulmonary artery hypertension

A

resting mean pressure >= 25 mmHg

Severe>40

—-measured by cardiac catheterisation

37
Q

Most common cardiac issue with down’s

A

endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)

Followed by VSD

38
Q

cholesterol embolism features

A

painful ulceration
livedo reticularis
Eosinophilia

39
Q

giant A waves JVP

A

‘a’ wave = atrial contraction
large if atrial pressure e.g. tricuspid stenosis, pulmonary stenosis, pulmonary hypertension

large in Hypertrophic obstructive cardiomyopathy

40
Q

echo findings in Hypertrophic obstructive cardiomyopathy HOCM

A

MR SAM ASH
mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)

41
Q

BP is 135/85, who do you treat?

A

If under 80 yr AND organ damage, cardiovascular disease, renal disease, diabetes, or 10-yr risk greater than 10%

42
Q

Which vessel supplies AV node

A

Posterior interventricular artery, branch of Right coronary

43
Q

specific ECG changes for Acute pericarditis

A

PR depression is most specific

Also ST saddle-shaped elevation

44
Q

What is the time window for primary PCI

A

Presents with STEMI within 12hr and PCI can be reached within 120 minutes, if not then thrombolysis

45
Q

Young patient with AF for more than 48hr, stable rate, what’s the plan

A

2, 3, 4
If more than 2 days, then 3 weeks of anticoagulant before electrical cardioversion, then 4 weeks of anticoagulant after. Obv carry on if risk factors

If high risk of failure (i.e. previous failed cardioversion) then 4 weeks amiodarone or sotalol

46
Q

What type of valve would someone who’s 75 probably get Vs 55yr

A

Bioprosthetic biologic valve for older, as they don’t need long-term anticoag (except aspirin)

Mechanical for younger, because they last longer.. need warfarin though (aortic: 3.0, mitral: 3.5)

47
Q

Drugs to avoid in HOCM

A

DANI has HOCM

Diuretics and digoxin
ACEi
Nitrates
Inotropes

48
Q

Management of HOCM

A 
Amiodarone
Beta blocker
Cardioverter defib (could be first line!)
Dual chamber pacemaker
Endocarditis prophylaxis
49
Q

PR depression on ECG…diagnosis?

A

most specific marker for pericarditis

50
Q

how successful is catheter ablation for AF?

A

Doesn’t seem to reduce stroke rate
55% of patient w single procedure remain in sinus rhythm at 3yr
80% of patient with multiple procedures

51
Q

important thing to warn woman with pulmonary hypertension…………..

A

pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality

52
Q

patient post NSTEMI with normal Echo gets started on aspirin, ticagrelor and fondaparinux.
He develops dyspnoea a few days later, what is the likely cause of this?

A

ticagrelor can cause dyspnoea, due to the impaired clearance of adenosine

Heart failure unlikely due to normal Echo

53
Q

Afro Caribbean patient on amlodopine 10mg with persistent hypertension, what do you add?

A

an angiotensin receptor blocker in preference to an ACE inhibitor

54
Q

Which occurs sooner post PCI stent - stent thrombosis or restenosis?

A

Stent thrombosis = first month

Restenosis = 3 to 6 months (risk factors: Diabetes, renal impairment)

55
Q

AF pharmacological cardioversion… No structural heart disease Vs structural heart disease

A

Flecainide if nil

Amiodarone if structural HD

56
Q

treatment to slow progression of aortic root dilatation. e.g. in Marfan’s

A

Beta blocker

MRCP 2 (13 decks)

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