Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCP Master > Cardio: General > Flashcards

Cardio: General Flashcards

1
Q

JVP A wave

A

right Atrial contraction [presystolic]

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

JVP X descent:

A

right atrial relaxation; fall in atrial pressure during ventricular systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • JVP C wave (not seen Clinically):
A

bulging of the triCuspid valve closer into the right atrium [beginning of systole]

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

JVP V wave:

A

max Venous return [late systole]; due to passive filling of blood into the atrium against a closed tricuspid valve

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

JVP Y descent:

A

Right ventricular filling [diastole]; opening of tricuspid valve
EmptYing of RA

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

Cardiac cycle what happens during:
Atrial contraction
-Valves/ sounds
-ECG
-JVP

A

Last 10% of blood is pushed into vent
Atrial contraction = SA node firing

ECG = P wave

JVP = A wave

(S4 – blood is push into stiffened vent )
Ends with MV closing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cardiac cycle what happens during:
Isovolumetric Ventricular Contraction
(ventricular systole)

-Valves/ sounds
-ECG
-JVP

A

Ventricular depolarization (just before vent cont) = Start of QRS; AV (T&M) valves close = S1

Ventricles start to contract all valves are closed

C wave Jvp= Buldge of AV into atria=

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

Cardiac cycle what happens during:
Rapid ventricular ejection
(ventricular systole)
-Valves/ sounds
-ECG
-JVP

A

Aortic and pulmonary valves open- large amount of blood out of the vent;

ECG ST segment

JVP X wave = AV relax and

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

Cardiac cycle what happens during:
reduced ventricular ejection (diastasis)
(ventricular systole)
-Valves/ sounds
-ECG
-JVP

A

Ventricular Repolarization = t wave

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

Cardiac cycle what happens during:
Isovolumetric ventricular relaxation
(ventricular diastole)
-Valves/ sounds
-ECG
-JVP

A

End of T wave Start ventricular diastole,
Aortic and then pul valves close =ST2
= V wave JVP- passive filling of blood into the atrium against a closed tricuspid valve

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

Cardiac cycle what happens during:

** Rapid Ventricular Filling
(ventricular diastole)**
-Valves/ sounds
-ECG
-JVP

A

AV (M&T) valves open
= Y on JVP = 3rd hrt sound (Vent dilation/ overload )

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

Cardiac cycle what happens during:

reduced ventricular filling
(ventricular diastole)
-Valves/ sounds
-ECG
-JVP

A

Reduced ventricular filling, also called diastasis; Passive fill= 90% filling of the vent.

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

Name the 7 phases of the cardiac cycle

A
  1. Atrial contraction
  2. Isovolumetric ventricular contraction
    (ventricular systole)
  3. rapid ventricular ejection
    (ventricular systole)
  4. reduced ventricular ejection (diastasis) (ventricular systole)
  5. isovolumetric ventricular relaxation(ventricular diastole)
  6. rapid ventricular filling (ventricular diastole)
  7. reduced ventricular filling
    (ventricular diastole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

JVP: Abnormally large A waves (3)

A

indicate increased resistance to right atrial emptying from
Pulmonary hypertension
Tricuspid stenosis
Pulmonary stenosis

nb. a wave = atrial contraction blood thru the open tricuspid

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

JVP: Absent A wave

A

AF
nb. a’ wave = atrial contraction blood thru the open tricuspid

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

JVP: Cannon A wave

A

Cannon a waves occur when the atria and ventricle contract simultaneously, producing a greatly elevated a wave.

Causes:

Complete heart block- Irregular waves
Ventricular tachycardias- regular waves

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

JVP in Constrictive pericarditis

A

Sharp x and y descent
Large v wave

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

Tamponade
JVP features:

A

Sharp x descent only
Large v wave

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

Elevated JVP with no waves present

A

Cause: Superior vena cava obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

JVP: Kussmaul’s sign what is it and what does it signify (3)

A

JVP should go down with inspiration as a result of the drop in intrathoracic pressure. Kussmaul’s sign is an abnormal finding that refers to the JVP paradoxically rising with inspiration.
Causes:

Tamponade
Constrictive pericarditis
Right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

JVP giant v waves

A

in tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Heart sounds:
S1

A

Mitral & tricuspid closures

Isovolumetric ventricular contraction
(ventricular systole)

Start of QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Heart sounds:
S2

A

Aortic and then pul valves close =ST2

isovolumetric ventricular relaxation(ventricular diastole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Heart sounds:
S3 (3)

A

3rd hrt sound Vent

  1. Dilation/ overload
  • normal if < 30 years old (may persist in women up to 50 years old)
  • heard in: LVF(e.g. dilated cardiomyopathy),
  • constrictive pericarditis (called a pericardial knock) and mitral regurgitation

rapid ventricular filling (ventricular diastole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Heart sounds: S4 Causes
S4 – blood is push into stiffened vent * Severe aortic stenosis, * HOCM, * hypertension Atrial contraction- the P wave on ECG
24
Heart sounds: Wide splitting of S2
Anything that delay RV emptying pHTN Pulmonary stenosis , PE RBBB (S2= A2+ P2 closing)
25
Heart sounds: Fixed splitting of S2
L to right shunts ASD (S2= A2+ P2 closing)
26
Heart sounds: Paradoxical splitting of S2
Delayed aortic valve closure AS, HTN, Coartation LBBB (S2= A2+ P2 closing)
27
Heart sounds: Absent S2
Severe AS
28
Soft S1
MR, severe HF, LBBB, and 1st-degree heart block.
29
S4 is a marker of severity of which valvular disorder?
AS
30
variable intensity of S1
Complete hrt blk
31
What hrt sound occur w/ closure of mitral and tricuspid valves?
S1
32
Name the Vent systolic mummers
AS & PS TR & MR
33
What hrt sound occur w/ closure of aortic and pulmonary valves?
S2
34
Name the Vent Diastolic mummers
AR& PR TS & MS
35
Ejection systolic louder on expiration
o aortic stenosis o HOCUM Left side mummers
36
Ejection systolic louder on inspiration
o pulmonary stenosis o atrial septal defect * also: tetralogy of Fallot (RIGHT sided mummers)
37
Standing increases mummers
MVP & HCM
38
Squatting will increases mummers
(decreases afterload ) VSD, AR, PR, MR & AS
39
RX mitral stenosis
Percutaneous balloon valvularplasty
40
2ond most common valve disease after aortic stenosis?
MR
41
What causes Pansystolic murmur described as “blowing” which radiats to axilla. May cause quiet S1 In severe cases = widely split S2
MR (blows though systole) Radiates to axilla
42
Late systolic murmur (longer if patient standing)
MVP (MPVs come late!)
43
Mitral valve prolapse Associations
1. **Congenital heart disease**: PDA, ASD 2. **Collagen disorders** : Marfan's syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, Ehlers-Danlos Syndrome 3.**Gentic d's:** Turner's syndrome, Fragile X, polycystic kidney disease cardiomyopathy, WPW, long-QT syndrome
44
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
AR
45
Mummer ass. w/ -collapsing pulse -wide pulse pressure
AR
46
Quincke's sign (nailbed pulsation) De Musset's sign (head bobbing) Is caused by
AR
47
Causes of AR
Rheumatic fever: most common cause calcific valve disease bicuspid aortic valve connective tissue diseases: RA / SLE spondylarthropathies (e.g. ankylosing spondylitis) hypertension syphilis Marfan's, Ehler-Danlos syndrome
48
Indications for Surgery in AR
1. Symptomatic patients with severe AR 2. Asymptomatic patients with severe AR who have LV systolic dysfunction
49
Features of severe aortic stenosis Pulse 2 Sound 3
narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill LVH/LVF Narrow and slow soft 2 added 4
50
Indications for Management of Aortic stenosis
if symptomatic then valve replacement if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
51
aortic valve replacement (AVR) which intervention is best for low/medium operative risk patients Pt w/ high operative risk balloon valvuloplasty
low/medium operative risk patients: **surgical AVR** **pts with a high operative risk:** transcatheter AVR (TAVR) is used for balloon valvuloplasty may be used in children with no aortic valve calcification in adults limited to patients with critical aortic stenosis who are not fit for valve replacement
52
most common valves which need replacing are
the aortic and mitral valve.
53
Biological (bioprosthetic) valves disadvantages Who normally gets these
deterioration and calcification over time. pts > 65 years for aortic valves Pts > 70 years for mitral valves receive a bioprosthetic valve
54
Long-term anticoagulation for Biological (bioprosthetic) valves
not usually needed in the long term - Warfarin may be given for the first 3 months - Low-dose aspirin is given long-term.
55
Major disadvantage of Mechanical valves
Increased risk of thrombosis = long-term anticoagulation is needed. Warfarin is preferred aspirin is only normally given in addition if there is an additional indication,
56
Mechanical valves warfarin targets Aortic Mitral
Target INR aortic: 3.0 mitral: 3.5
57
Causes **Pulsus paradoxus** (2)
(>10 mmHg) fall in sBP during inspiration → faint or absent pulse in inspiration severe asthma, cardiac tamponade
58
**Pulsus alternans**
regular alternation of the force of the arterial pulse * severe LVF
59
Slow-rising/plateau pulse
* aortic stenosis
60
Collapsing Pulse
* Aortic Regurgitation * PDA * hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy
61
Pulsus alternans
regular alternation of the force of the arterial pulse * severe LVF
62
'Jerky' pulse
* hypertrophic obstructive cardiomyopathy*
63
Endocarditis: Initial blind therapy- Native valve - In pen allergy
amoxicillin +/-gentamicin If penicillin allergic, MRSA or severe sepsis vancomycin +/-gentamicin
64
Endocarditis rx: prosthetic valve Initial blind therapy-
vancomycin + rifampicin + gentamicin
65
Native valve endocarditis caused by staphylococci rx & in pen allergy
Most common cause Flucloxacillin If penicillin allergic or MRSA vancomycin + rifampicin
66
prosthetic valve endocarditis caused by staphylococci rx & in pen allergy
Flucloxacillin + rifampicin + low-dose gentamicin If penicillin allergic or MRSA vancomycin + rifampicin + low-dose gentamicin
67
Endocarditis after prosthetic valve surgery most common cause
- **Staphylococcus epidermidis** commonly colonise indwelling lines & most common cause following prosthetic valve surgery
68
Streptococci Endocarditis caused by
Streptococcus bovis is ass. w/colorectal cancer. Subtype Streptococcus gallolyticus Streptococcus viridans - subtype Streptococcus mitis /oralis - linked w/ poor dental hygiene
69
Rx Streptococci Endocarditis fully-sensitive
Benzylpenicillin If penicillin allergic vancomycin + low-dose gentamicin
70
Endocarditis caused by less sensitive streptococci
Benzylpenicillin + low-dose gentamicin If penicillin allergic vancomycin + low-dose gentamicin
71
Endocarditis Indications for surgery (5)
1. severe valvular incompetence 2. aortic abscess (often indicated by a lengthening PR interval) 3. Infections resistant to antibiotics/fungal infections 4. cardiac failure refractory to standard medical treatment 5. recurrent emboli after antibiotic therapy
71
What does the RCA supply
RA , most of RV, Diaphragmatic part of the LV, supplies the posterior 1/3 of the interventricular septum, sinoatrial node & AV node. Leads II, III, AVF
72
What does the LCx typically supply
LA most LV, part of the RV, the anterior 2/3 of the IVS, including the AV bundle, through perforating IV septal branches and the sinu-atrial node in some people. I, v5, v6 avl; lbb
73
The Left anterior descending supplies? What does this correspond to on ECG ?
Anteroseptal V1-V4 Anterior v1 v2 Septal V3 & V4
74
What vessel supplying is responsible for v1 v2 V3 & V4
LAD
75
What vessel supplies the AV Bundle of HIS, RBB & anterior fascicle of the left bundle
LAD
75
The RCA supplies? As represented on ECG
Inferior wall II,III&AVF
76
The Left circumflex supplies ? As represented on ECG
Lateral wall V5, V6, I AVL
77
V1-V3 ST depression Tall, broad R waves (>30ms) Upright T waves Dominant R wave (R/S ratio > 1) in V2 Represents
inferior or lateral infarction Posterior MI
78
List the 3 components of Anginal pain How is typical and Atypical angina defined
1. **Constricting discomfort** in the front of the chest, or in the neck, shoulders, jaw or arms 2. **Precipitated by physical exertion** 3. **Relieved by rest or GTN** in about 5 minutes Interpretation: Pts with all 3 features = **typical angina** pts w/ 2 of the above features = atypical angina Pts with 1 or none=non-anginal chest pain
79
IX Stable PT with angina
1st line: CT coronary angiography 2nd line: Non-invasive functional imaging (looking for reversible myocardial ischaemia) (SPEC, Stress echo, MR perfusion) 3rd line: Invasive coronary angiography
80
Explain Drug rx for Angina 3 drugs all pts get Monotherapy then duel therapy
1.All pts receive aspirin + statin + sublingual glyceryl trinitrate Monotherapy with β -blocker or a CCB -rate-limiting CCB (verapamil or diltiazem) Dual: β-blocker + long-acting dihydropyridine CCB (e.g. modified-release nifedipine)
81
Why don't you prescribe β-blocker & rate-limiting CCB (verapamil or diltiazem)
Can cause complete heart block
82
If starting duel therapy for angina but cant have the addition of CCB/ β-blocker What other drug should be considered (4)
Consider one of the following drugs: a  long-acting nitrate,  ivabradine,  nicorandil or ranolazine
83
Contra indications to β-blocker
Uncontrolled heart failure Asthma Sick sinus syndrome Concurrent verapamil use: may precipitate severe bradycardia
84
β-blocker adverse effect
Adverse * Bronchospasm * Cold peripheries * Fatigue * Sleep disturbances, including nightmares * Erectile dysfunction
85
SE Verapamil
Heart failure, constipation, hypotension, bradycardia, flushing
86
If a further drug is needed after duel tx in angina what should they be lined up for?
is awaiting assessment for PCI or CABG
87
MAO Ivabradine
reducing HR. It acts on the If ('funny') ion current which is highly expressed in the sinoatrial node, reducing cardiac pacemaker activity.
88
SE Ivabradine
* visual effects, particular luminous phenomena, are common * headache * bradycardia, heart block
89
4 Main indications for statin
1. ALL pt w/ cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease) 2. Anyone with a 10-year cardiovascular risk >= 10% 3. DM2 should be assessed QRISK2 like other patients are 4. DM 1 who were diagnosed >10 years ago OR >40 OR have established nephropathy
90
Should statin be monitored and when should they be discontinued ?
LFTs @ baseline, 3 months and 12 months. Discontinued if serum transaminase **conc x persist at 3 times the upper limit** of the reference range
91
Contra indications to statins
Contra indications Pregnancy and macrolides
92
DVLA LOC 2ndry to cardiovascular origin
6 Months
93
DVLA Cardiac catheter procedure (incl PCI)
1 week
94
DVLA MI
1 Month
95
DVLA prophylactic ICD
1 month
96
After ICD or 2ndary prevention
6 months

MRCP Master (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions