Cardiology

Question 1

Additional percentage of AF found with 30 day monitor post CVA

Answer 1

10-15%

Question 2

Strongest RF for stroke in non-valvular AF

Answer 2

Age (>75 = 5x risk)

Question 3

Most common cause of sudden cardiac death in > 40 years old

Answer 3

IHD 90% in those >35-40years, second is HCM

Question 4

Mutation leading to Brugada syndrome

Answer 4

SCN5A

Question 5

ECG findings in Brudaga

Answer 5

Coved STe V1-3

Question 6

What are the triggers for cardiac arrest in the different LQTS subtypes?

Answer 6

LQTS1 = Exercise
LQTS2 = Emotion
LQTS3 = Sleep (sudden waking)

Question 7

When is intervention warranted for HCM?

Answer 7

Class III-IV heart failure OR syncope and LVOT gradient > 50mmHg

Question 8

What is Bernoulli’s equation?

Answer 8

p=4v^2

Question 9

What classifies as severe mitral stenosis?

Answer 9

Valve area < 1cm^2
MG > 10mmHg
PASP > 50mmHg

Question 10

Indication for valve intervention in mitral stenosis? What is the preferred intervention?

Answer 10

Symptoms and mod-severe
Asymptomatic and mod-severe and high risk (new AF, PASP > 50, ?before pregnancy). Percutaneous balloon valvuloplasty preferred if suitable valve, otherwise surgical.

Question 11

When to intervene for primary MR?

Answer 11

Severe MR with symptoms and EF > 30%

Asymptomatic and EF < 60% or LVESD > 40/45mm

Question 12

What are criteria for severe AS?

Answer 12

Valve area < 1cm^2
MG > 40mmHg
Peak velocity > 4m/s

Question 13

Indications for valve repair in AS?

Answer 13

Symptoms and severe

Asymptomatic and LVEF < 50%

Question 14

What are indications for valve repair in aortic regurgitation?

Answer 14

Symptoms and severe

Asymptomatic and LVEF < 50% or LVESD > 50mm or LVEDD > 65mm

Question 15

What is pulsus paradoxus?

Answer 15

Fall in BP > 10mmHg with inspiration

Question 16

What are causes of pulsus paradoxus?

Answer 16

Cardiac tamponade, constrictive pericarditis, severe COPD, asthma, tension PTX, PE, large bilateral pleural effusions

Question 17

What medication has the biggest mortality benefit in HFrEF?

Answer 17

Beta blockers

Question 18

What is the best beta blocker for HFrEF

Answer 18

Carvedilol

Question 19

How do PCSK9 inhibitors work?

Answer 19

Inhibit PCSK9, which normally degrades LDL receptors once bound by LDL. So allows LDL receptors to be recycled and mop up more LDL.

Question 20

How does ezetimibe work?

Answer 20

Inhibits small intestine cholesterol absorption (Niemann Pick C1 Like protein NPC1L1)

Question 21

What is inclisiran?

Answer 21

siRNA to PCSK9

Question 22

What is FFR cut-off for intervention?

Answer 22

FFR < 0.75
FFR 0.75-0.8 debatable
FFR > 0.8 not bad

Question 23

When is CABG preferred?

Answer 23

Any proximal LAD/LM disease

Triple vessel disease

Question 24

How do you grade coronary blood flow?

Answer 24

TIMI: Grade 0 = no perfusion, 1 = penetration without perfusion, 2 = partial perfusion, 3 = complete perfusion

Question 25

What is different between BMS and DES?

Answer 25

DES have improved efficacy with reduced in stent restenosis. No difference in stent thrombosis.

Question 26

What is the best second antiplatelet agent in ACS?

Answer 26

Prasugrel and ticagrelor superior to clopidogrel in ACS but with increased risk of bleeding (so avoid in age > 75, weight < 60kg, renal dysfunction, CVA)

Question 27

beta blocker MOA for stable angina

Answer 27

Reduce myocardial O2 demand NOT increase coronary blood flow

Question 28

Most common origin of idiopathic VT in absence of structural heart disease?

Answer 28

RVOT

Question 29

commonest viral cause of myocarditis in developed world

Answer 29

enterovirus

Question 30

Non-selective beta blocker with alpha blocker activity

Answer 30

carvedilol

Question 31

What is the best test for establishing a diagnosis of Strep pharyngitis in Aboriginal patients?

Answer 31

Streptococcal Ab titres- ASOT, Anti-DNase B

Question 32

In what time frame must you start rx to prevent acute rheumatic fever in strep pharyngitis?

Answer 32

within 9 days of sx onset

Question 33

What can BNP levels predict?

Answer 33

all cause mortality, inc. sudden death

Question 34

What cohort of pts with a non-ischaemic/dilated CM would benefit from ICD for secondary prevention?

Answer 34

Age <60

Question 35

By what % do PCSK9-I reduce LDL levels in those already on statin therapy?

Answer 35

50-60%

Question 36

What outcome do PCSK9-Is have on recurrence of MI in patients post ACS

Answer 36

reduce recurrence of MI

Question 37

Where is BNP released from?

Answer 37

Ventricles

Question 38

Where is ANP released from?

Answer 38

Atria