Cardiology Flashcards
Additional percentage of AF found with 30 day monitor post CVA
10-15%
Strongest RF for stroke in non-valvular AF
Age (>75 = 5x risk)
Most common cause of sudden cardiac death in > 40 years old
IHD 90% in those >35-40years, second is HCM
Mutation leading to Brugada syndrome
SCN5A
ECG findings in Brudaga
Coved STe V1-3
What are the triggers for cardiac arrest in the different LQTS subtypes?
LQTS1 = Exercise LQTS2 = Emotion LQTS3 = Sleep (sudden waking)
When is intervention warranted for HCM?
Class III-IV heart failure OR syncope and LVOT gradient > 50mmHg
What is Bernoulli’s equation?
p=4v^2
What classifies as severe mitral stenosis?
Valve area < 1cm^2
MG > 10mmHg
PASP > 50mmHg
Indication for valve intervention in mitral stenosis? What is the preferred intervention?
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.
When to intervene for primary MR?
Severe MR with symptoms and EF > 30%
Asymptomatic and EF < 60% or LVESD > 40/45mm
What are criteria for severe AS?
Valve area < 1cm^2
MG > 40mmHg
Peak velocity > 4m/s
Indications for valve repair in AS?
Symptoms and severe
Asymptomatic and LVEF < 50%
What are indications for valve repair in aortic regurgitation?
Symptoms and severe
Asymptomatic and LVEF < 50% or LVESD > 50mm or LVEDD > 65mm
What is pulsus paradoxus?
Fall in BP > 10mmHg with inspiration
What are causes of pulsus paradoxus?
Cardiac tamponade, constrictive pericarditis, severe COPD, asthma, tension PTX, PE, large bilateral pleural effusions
What medication has the biggest mortality benefit in HFrEF?
Beta blockers
What is the best beta blocker for HFrEF
Carvedilol
How do PCSK9 inhibitors work?
Inhibit PCSK9, which normally degrades LDL receptors once bound by LDL. So allows LDL receptors to be recycled and mop up more LDL.
How does ezetimibe work?
Inhibits small intestine cholesterol absorption (Niemann Pick C1 Like protein NPC1L1)
What is inclisiran?
siRNA to PCSK9
What is FFR cut-off for intervention?
FFR < 0.75
FFR 0.75-0.8 debatable
FFR > 0.8 not bad
When is CABG preferred?
Any proximal LAD/LM disease
Triple vessel disease
How do you grade coronary blood flow?
TIMI: Grade 0 = no perfusion, 1 = penetration without perfusion, 2 = partial perfusion, 3 = complete perfusion
What is different between BMS and DES?
DES have improved efficacy with reduced in stent restenosis. No difference in stent thrombosis.
What is the best second antiplatelet agent in ACS?
Prasugrel and ticagrelor superior to clopidogrel in ACS but with increased risk of bleeding (so avoid in age > 75, weight < 60kg, renal dysfunction, CVA)
beta blocker MOA for stable angina
Reduce myocardial O2 demand NOT increase coronary blood flow
Most common origin of idiopathic VT in absence of structural heart disease?
RVOT
commonest viral cause of myocarditis in developed world
enterovirus
Non-selective beta blocker with alpha blocker activity
carvedilol
What is the best test for establishing a diagnosis of Strep pharyngitis in Aboriginal patients?
Streptococcal Ab titres- ASOT, Anti-DNase B
In what time frame must you start rx to prevent acute rheumatic fever in strep pharyngitis?
within 9 days of sx onset
What can BNP levels predict?
all cause mortality, inc. sudden death
What cohort of pts with a non-ischaemic/dilated CM would benefit from ICD for secondary prevention?
Age <60
By what % do PCSK9-I reduce LDL levels in those already on statin therapy?
50-60%
What outcome do PCSK9-Is have on recurrence of MI in patients post ACS
reduce recurrence of MI
Where is BNP released from?
Ventricles
Where is ANP released from?
Atria
