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MRCP 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

HOCM: what is it?

A

AD disorder causing diastolic dysfunction

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2
Q

HOCM: features

A

Exertional dyspnoea, angina, syncope, sudden death

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3
Q

HOCM: JVP

A

large a waves

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4
Q

HOCM: murmur

A

ejection systolic murmur

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5
Q

HOCM: associations

A

Friedreich’s ataxia, WPW

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6
Q

HOCM: echo

A

MR SAM ASH
Mitral regurgitation
Systolic anterior motion of anterior MV leaflet
Asymmetrical hypertrophy

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7
Q

HOCM: ECG

A

LVH, non-specific ST segment and T wave changes, deep Q waves

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8
Q

HOCM: Mx

A

ABCDE

Amiodarone, beta blockers, cardioverter defib, dual chamber pacemaker, endocarditis prophylaxis

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9
Q

HOCM: avoid

A

Nitrate, ACE-i, inotropes

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10
Q

Ebstein’s anomaly: what?

A

Low insertion of tricuspid valve resulting in large atrium and small ventricle

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11
Q

Ebstein’s anomaly: associations

A

Patent foramen ovale or ASD

WPW

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12
Q

Ebstein’s anomaly: features

A

Cyanosis, a wave, HSM, TR and RBBB

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13
Q

LAD: causes

A 
Left anterior hemi block
LBBB
Inferior MI
WPW
Hyperkalaemia
Congenital (ASD, tricuspid atresia)
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14
Q

RAD: causes

A 
RVH
Left posterior hemiblock 
Lateral MI
Cor pulmonale 
PE
ASD
Normal in infants
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15
Q

S1 represents…

A

Closure of mitral and tricuspid valves

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16
Q

S2 represents…

A

Closure of aortic and pulmonary valves

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17
Q

S3 represents…

A

Diastolic filling of ventricle

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18
Q

S4 associations…

A

AS, HOCM, HTN

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19
Q

S4: ECG

A

p waves

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20
Q

S3: causes

A

LVF, constrictive pericarditis and MR

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21
Q

Loud S1 causes

A

MS, left to right shunts, short PR, hyperdynamic states

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22
Q

Quiet S1 causes

A

MR

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23
Q

Loud S2

A

Hypertension, hyperdynamic states, ASD

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24
Q

Soft S2

A

AS

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25
Q

Fixed split S2

A

ASD

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26
Q

Widely split S2

A

Deep inspiration, RBBB, pulmonary stenosis, severe MR

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27
Q

Pulmonary HTN: positive vasodilator testing

A

Oral CCB

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28
Q

Pulmonary HTN: negative vasodilator testing

A

Prostacyclin analogues - treprostinil, iloprost
Endothelin receptor antagonists - bosentan
Sildenafil

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29
Q

PR prolongation

A 
MID RASH
Myotonic dystrophia
IHD/idiopathic
Digoxin
Rheumatic fever
Aortic abscess
Sarcoidosis
Hypo K/Ca
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30
Q

DVLA: angioplasty

A

1 week off driving

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31
Q

DVLA: CABG

A

4 weeks off driving

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32
Q

DVLA: pacemaker insertion

A

1 week off driving

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33
Q

DVLA: ICD: ventricular arrhythmia

A

6 months no driving

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34
Q

DVLA: ICD: prophylactic

A

1 month off driving

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35
Q

DVLA: ICD

A

Permanent bar for group 2

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36
Q

Malignant HTN: Mx

A

IV sodium nitroprusside / labetolol

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37
Q

Aortic dissection: causes

A 
MEN TSH
Marfans
Ehler Danlos
Noonan's
Trauma / Turners
Syphilis
HTN
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38
Q

Aortic dissection: Type A

A

Ascending aorta

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39
Q

Aortic dissection: type B

A

Descending aorta

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40
Q

Central acting antihypertensives (3)

A

Methyldopa
Moxonidine
Clonidine

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41
Q

TR; signs

A

Pan-systolic murmur
Giant v waves
Pulsatile hepatomegaly
L parasternal heave

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42
Q

TR; causes

A 
RV infarction
Pulmonary HTN
Rheumatic HD
IE
Ebstein's
Carcinoid's
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43
Q

Warfarin; major bleeding

A

Stop warfarin
IV vitamine K 5mg
PT complex

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44
Q

Warfarin; INR >8 and minor bleeding

A

Stop warfarin
IV vitamin K 1-3mg
Restart when INR <5

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45
Q

Warfarin; INR >8 and no bleeding

A

Stop warfarin
PO vitamin K 1-5mg
Restart when INR <5

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46
Q

Warfarin; INR 5-8, minor bleeding

A

Stop warfarin
IV vitamin K 1-3 mg
Restart when INR <5

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47
Q

Warfarin; INR 5-8, no bleeding

A

Withhold 1-2 doses

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48
Q

ECG: V1-4

A

Anteroseptal MI

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49
Q

ECG: Anteroseptal MI

A

LAD

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50
Q

ECG: II, III, aVF

A

Inferior MI

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51
Q

ECG: Inferior MI

A

Right coronary

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52
Q

ECG: V4-6, I, aVL

A

Anterolateral MI

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53
Q

ECG: Anterolateral MI

A

LAD or left circumflex

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54
Q

ECG: I, aVL, V5-6

A

Lateral MI

55
Q

ECG: Lateral MI

A

Left circumflex

56
Q

ECG: Tall R wave V1-2

A

Posterior MI

57
Q

ECG: Posterior MI

A

Left circumflex

58
Q

Ejection systolic murmur, louder on expiration

59
Q

Ejection systolic murmur, louder on inspiration

60
Q

Ejection systolic murmur

61
Q

Pansystolic murmur

A

MR, TR

VSD (harsh)

62
Q

Late systolic murmur

A

Mitral prolapse

Coarctation

63
Q

Early diastolic murmur

A

AR

Graham-Steel murmur (PR)

64
Q

Mid-late diastolic murmur

A

MS

Austin-Flint murmur (AR)

65
Q

Continuous machine like murmur

66
Q

Takaysau’s arteritis: features

A 
Features of vasculitis
Unequal BP
Carotid bruit
Intermittent claudication
AR
67
Q

IE: poor prognostic factors

A

Staph
Prosthetic valve
Culture negative
Low complement levels

68
Q

Decreased BNP

A 
Obesity
Diuretics
ACEi
BB
ARBs
Aldosterone antagonists
69
Q

JVP: a wave

A

atrial contraction

70
Q

JVP: x descent

A

ventricular systole

71
Q

JVP: c wave

A

closure of tricuspid valve

72
Q

JVP: v wave

A

passive filling of atria

73
Q

JVP: y descent

A

opening of tricuspid valve

74
Q

JVP: large a wave

A

TS, PS, pulmonary HTN

75
Q

JVP: absent a wave

76
Q

JVP: cannon a waves

A

complete heart block, VT

77
Q

JVP: giant v waves

78
Q

CHADSVASC

A 
CHA2 DSV2 ASC
CHF (1)
HTN (1)
Age >75 (2)
Diabetes (1)
Vascular - stroke/TIA (2)
Age 65-74 (1)
Sex (female) (1)
79
Q

AR: features

A

Early Diastolic murmur
Collapsing pulse
WIde pulse pressure

80
Q

AS: features

A

chest pain
dyspnoea
syncope
ESM

81
Q

AS: severe features

A 
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft S2
S4
LVH
82
Q

AS: Mx asymptomatic

83
Q

AS: Mx symptomatic

A

valve replacement

84
Q

AS: valvular gradient

A

> 40mmHg and with LVH then surgery

85
Q

Arrythmogenic right ventricular cardiomyopathy: pathophysiology

A

AD

RV is replaced by fatty and fibrofatty tissue

86
Q

Arrythmogenic right ventricular cardiomyopathy: ECG

A

Abnormalities in V1-3

Typically T wave inversion

87
Q

Features suggestive of VT rather than SVT

A 
AV dissociation
Capture beats
Positive QRS in chest leads
LAD
IHD
Lack of response to adenosine or valsalva
QRS >160ms
88
Q

Brugada Sx: gene

A

Mutation in SCN5A gene

Encode myocardial sodium ion channel

89
Q

Angina: Mx

A

1) BB or CBB
2) BB AND CBB
3) Long acting nitrate, ivabradine, nicorandil or ranlazine

90
Q

Type A dissection: Mx

A

Surgical management

Target SBP 100-120

91
Q

Typa B dissection: Mx

A

Conservative
Bed rest
BP control

92
Q

BNP: effects

A

Vasodilator
Diuretic and natriuretic
Suppress sympathetic tone and RAAS

93
Q

First cardiac enzyme to rise

94
Q

Cardiac enzyme for re-infarctions

95
Q

Hypokalaemia: ECG

A 
U waves
Small T waves
Prolonged PR
ST depression 
Long QT
96
Q

NYHA Class 1

A

No Symptoms

No limitation

97
Q

NYHA Class 2

A

Mild symptoms

Slight limitation of physical activity

98
Q

NYHA Class 3

A

Moderate symptoms

Marked limitation of physicial activity

99
Q

NYHA Class 4

A

Severe symptoms

Unable to carry out any physical activity

100
Q

IE: Staph aureus

A

Most common cause

101
Q

IE: Staph epidermis

A

Indwelling lines

Post 2 months valve replacement

102
Q

IE: Strep viridans / sanguinis

A

Poor dentition

103
Q

IE: Strep bovis

104
Q

IE: Strep galloyticus

105
Q

IE: Blind therapy

A

Native valve: amoxicillin/vanc +/- gent

Prosthetic valve: vanc, rifampicin + gent

106
Q

Long QT: drugs

A 
Amiodarone, sotalol
TCA, SSRIs
Methadone
Chloroquine
Erythromycin
Haloperidol 
Ondansetron
107
Q

MS: features

A

Mid late diastolic murmur
Loud S1
Low volume pulse
Malar flush

108
Q

Direct thrombin inhibitors

A

Bivalirudin

Dabigatran

109
Q

Treprostinil, iloprost MoA

A

Prostacyclin analogues

110
Q

Bosentan, abrisentan

A

Endothelin receptor antagonists

111
Q

Ticragelor SE

112
Q

Right ventricular MI avoid..

A

Nitrates as reduces preload

113
Q

COX inhibitors e.g.

114
Q

P2Y12 Receptor blockers

A

Clopidogrel

115
Q

GPIIb IIIa Inhibitors

A

Abciximab, tirofiban

116
Q

Phosphodiesterase inhibitors

A

Dipyridamole

117
Q

Drugs to maintain rhythm in AF

A

Sotalol, amiodarone and flecanide

118
Q

AF: Factors favouring rate control

A

65+

History of IHD

119
Q

AF: factors favouring rhythm control

A 
Younger than 65
Symptomatic
First presentation 
Lone AF 
Congestive HF
120
Q

Atrial myxoma: location

A

Left atrium

Attached to fossa ovalis

121
Q

Features suggestive of VT rather than SVT

A 
AV dissocation 
Fusion / capture beats 
Positive QRS in chest leads
Marked LAD
History of IHD
Lack of response to adenosine or valsala
QRS >160
122
Q

Acyanotic congenital heart disease

A 
VSD
ASD
PDA
Coarctation of aorta
Aortic valve stenosis
123
Q

Cyanotic heart disease

A

ToF
TGA
Tricuspid atresia

124
Q

HOCM: poor prognosis

A 
Syncope
FH sudden death
Young age 
Non sustained VT 
Abnormal BP changes on exercise
125
Q

VSD: complications

A 
AR
IE
Eisenmenger's 
RH failure
Pulmonary HTN
126
Q

Atrial Myxoma: location

A

Left atrium

Attached to fossa ovalis

127
Q

Atrial Myxoma: features

A

Dyspnoea, fatigue, weight loss, pyrexia unknown origin, clubbing
Emboli
AF
Mid-diastolic murmur

128
Q

Cholesterol Embolus: features

A

Eosinophilia
Purpura
Renal failure
Livedo reticularis

129
Q

PDA: Mx

A

Indomethacin or ibuprofen

130
Q

Pulsus paradoxus

A

Severe asthma, cardiac tamponade

131
Q

Slow rising pulse

132
Q

Collapsing pulse

A

AR, PDA, hyperkinetic states

133
Q

Pulsus alternans

A

Severe LVF

134
Q

Syndrome X: what?

A

Angina like pain on exertion
ST depression of exercise stress test
Normal coronary angiogram

MRCP 1 (16 decks)

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