Brainscape's Knowledge GenomeTM

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


See full index

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
Q

Heart sounds:
S4
Causes

A

S4 – blood is push into stiffened vent

  • Severe aortic stenosis,
  • HOCM,
  • hypertension

Atrial contraction- the P wave on ECG

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

Heart sounds: Wide splitting of S2

A

Anything that delay RV emptying
pHTN
Pulmonary stenosis ,
PE
RBBB

(S2= A2+ P2 closing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Heart sounds: Fixed splitting of S2

A

L to right shunts
ASD
(S2= A2+ P2 closing)

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

Heart sounds: Paradoxical splitting of S2

A

Delayed aortic valve closure

AS,
HTN,
Coartation
LBBB

(S2= A2+ P2 closing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Heart sounds: Absent S2

A

Severe AS

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

Soft S1

A

MR, severe HF, LBBB, and 1st-degree heart block.

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

S4 is a marker of severity of which valvular disorder?

A

AS

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

variable intensity of S1

A

Complete hrt blk

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

What hrt sound occur w/ closure of mitral and tricuspid valves?

A

S1

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

Name the Vent systolic mummers

A

AS & PS
TR & MR

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

What hrt sound occur w/ closure of aortic and pulmonary valves?

A

S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name the Vent Diastolic mummers

A

AR& PR
TS & MS

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

Ejection systolic louder on expiration

A

o aortic stenosis
o HOCUM
Left side mummers

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

Ejection systolic louder on inspiration

A

o pulmonary stenosis
o atrial septal defect
* also: tetralogy of Fallot
(RIGHT sided mummers)

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

Standing increases mummers

A

MVP & HCM

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

Squatting will increases mummers

A

(decreases afterload )
VSD, AR, PR, MR & AS

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

RX mitral stenosis

A

Percutaneous balloon valvularplasty

40
Q

2ond most common valve disease after aortic stenosis?

A

MR

41
Q

What causes
Pansystolic murmur described as “blowing”

which radiats to axilla.

May cause quiet S1

In severe cases = widely split S2

A

MR (blows though systole)
Radiates to axilla

42
Q

Late systolic murmur (longer if patient standing)

A

MVP (MPVs come late!)

43
Q

Mitral valve prolapse
Associations

A
  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
Q

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre

A

AR

45
Q

Mummer ass. w/
-collapsing pulse
-wide pulse pressure

A

AR

46
Q

Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing) Is caused by

A

AR

47
Q

Causes of AR

A

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
Q

Indications for Surgery in AR

A
  1. Symptomatic patients with severe AR
  2. Asymptomatic patients with severe AR who have LV systolic dysfunction
49
Q

Features of severe aortic stenosis
Pulse 2
Sound 3

A

narrow pulse pressure
slow rising pulse

delayed ESM
soft/absent S2
S4

thrill

LVH/LVF

Narrow and slow soft 2 added 4

50
Q

Indications for Management of Aortic stenosis

A

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
Q

aortic valve replacement (AVR)
which intervention is best for
low/medium operative risk patients

Pt w/ high operative risk

balloon valvuloplasty

A

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
Q

most common valves which need replacing are

A

the aortic and mitral valve.

53
Q

Biological (bioprosthetic) valves disadvantages
Who normally gets these

A

deterioration and calcification over time.

pts > 65 years for aortic valves
Pts > 70 years for mitral valves receive a bioprosthetic valve

54
Q

Long-term anticoagulation for Biological (bioprosthetic) valves

A

not usually needed in the long term

  • Warfarin may be given for the first 3 months
  • Low-dose aspirin is given long-term.
55
Q

Major disadvantage of Mechanical valves

A

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
Q

Mechanical valves warfarin targets
Aortic
Mitral

A

Target INR
aortic: 3.0
mitral: 3.5

57
Q

Causes Pulsus paradoxus
(2)

A

(>10 mmHg) fall in sBP during inspiration → faint or absent pulse in inspiration

severe asthma,
cardiac tamponade

58
Q

Pulsus alternans

A

regular alternation of the force of the arterial pulse
* severe LVF

59
Q

Slow-rising/plateau pulse

A
  • aortic stenosis
60
Q

Collapsing Pulse

A
  • Aortic Regurgitation
  • PDA
  • hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy
61
Q

Pulsus alternans

A

regular alternation of the force of the arterial pulse
* severe LVF

62
Q

‘Jerky’ pulse

A
  • hypertrophic obstructive cardiomyopathy*
63
Q

Endocarditis: Initial blind therapy- Native valve
- In pen allergy

A

amoxicillin +/-gentamicin

If penicillin allergic, MRSA or severe sepsis
vancomycin +/-gentamicin

64
Q

Endocarditis rx: prosthetic valve Initial blind therapy-

A

vancomycin + rifampicin + gentamicin

65
Q

Native valve endocarditis caused by staphylococci rx
& in pen allergy

A

Most common cause
Flucloxacillin

If penicillin allergic or MRSA
vancomycin + rifampicin

66
Q

prosthetic valve endocarditis caused by staphylococci rx
& in pen allergy

A

Flucloxacillin + rifampicin + low-dose gentamicin

If penicillin allergic or MRSA
vancomycin + rifampicin + low-dose gentamicin

67
Q

Endocarditis after prosthetic valve surgery most common cause

A
  • Staphylococcus epidermidis commonly colonise indwelling lines & most common cause following prosthetic valve surgery
68
Q

Streptococci Endocarditis caused by

A

Streptococcus bovis is ass. w/colorectal cancer.
Subtype Streptococcus gallolyticus

Streptococcus viridans - subtype Streptococcus mitis /oralis - linked w/ poor dental hygiene

69
Q

Rx Streptococci Endocarditis fully-sensitive

A

Benzylpenicillin

If penicillin allergic
vancomycin + low-dose gentamicin

70
Q

Endocarditis caused by less sensitive streptococci

A

Benzylpenicillin + low-dose gentamicin

If penicillin allergic
vancomycin + low-dose gentamicin

71
Q

Endocarditis Indications for surgery (5)

A
  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
Q

What does the RCA supply

A

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
Q

What does the LCx typically supply

A

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
Q

The Left anterior descending supplies?

What does this correspond to on ECG ?

A

Anteroseptal V1-V4
Anterior v1 v2
Septal V3 & V4

74
Q

What vessel supplying is responsible for v1 v2
V3 & V4

A

LAD

75
Q

What vessel supplies the
AV Bundle of HIS, RBB & anterior fascicle of the left bundle

A

LAD

75
Q

The RCA supplies?
As represented on ECG

A

Inferior wall
II,III&AVF

76
Q

The Left circumflex supplies ?
As represented on ECG

A

Lateral wall
V5, V6,
I
AVL

77
Q

V1-V3 ST depression

Tall, broad R waves (>30ms)

Upright T waves
Dominant R wave (R/S ratio > 1) in V2
Represents

A

inferior or lateral infarction
Posterior MI

78
Q

List the 3 components of Anginal pain
How is typical and Atypical angina defined

A
  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
Q

IX Stable PT with angina

A

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
Q

Explain Drug rx for Angina
3 drugs all pts get
Monotherapy
then duel therapy

A

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
Q

Why don’t you prescribe β-blocker & rate-limiting CCB (verapamil or diltiazem)

A

Can cause complete heart block

82
Q

If starting duel therapy for angina but cant have the addition of CCB/ β-blocker
What other drug should be considered (4)

A

Consider one of the following drugs: a
 long-acting nitrate,
 ivabradine,
 nicorandil or ranolazine

83
Q

Contra indications to β-blocker

A

Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent verapamil use: may precipitate severe bradycardia

84
Q

β-blocker adverse effect

A

Adverse
* Bronchospasm
* Cold peripheries
* Fatigue
* Sleep disturbances, including nightmares
* Erectile dysfunction

85
Q

SE Verapamil

A

Heart failure, constipation, hypotension, bradycardia, flushing

86
Q

If a further drug is needed after duel tx in angina
what should they be lined up for?

A

is awaiting assessment for PCI or CABG

87
Q

MAO Ivabradine

A

reducing HR.
It acts on the If (‘funny’) ion current which is highly expressed in the sinoatrial node, reducing cardiac pacemaker activity.

88
Q

SE Ivabradine

A
  • visual effects, particular luminous phenomena, are common
  • headache
  • bradycardia, heart block
89
Q

4 Main indications for statin

A
  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
Q

Should statin be monitored and when should they be discontinued ?

A

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
Q

Contra indications to statins

A

Contra indications
Pregnancy and macrolides

92
Q

DVLA LOC 2ndry to cardiovascular origin

A

6 Months

93
Q

DVLA Cardiac catheter procedure (incl PCI)

A

1 week

94
Q

DVLA MI

A

1 Month

95
Q

DVLA prophylactic ICD

A

1 month

96
Q

After ICD or 2ndary prevention

A

6 months

MRCP Master (47 decks)

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