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MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What should you monitor when giving MgSO4?

A

Reflexes, respiratory rate

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2
Q

What mechanism causes QT prolongation?

A

blockage of potassium channels

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3
Q

What drug is best to give in a patient with WPW who is found to be in AF?

A

Flecainide - doesn’t block the AV node

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4
Q

What part of the ECG does an S4 sound coincide with

A

P wave

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5
Q

What causes an S3 sound

A

Diastolic filling of the ventricle (heard in LVF - e.g. dilated CM, constrictive pericarditis, MR)

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6
Q

What is the A wave on JVP

A

Contraction of right atrium

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7
Q

What causes the X descent (part 1) on JVP

A

Relaxation of right atrium

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8
Q

What causes the C wave on JVP

A

Contraction of right ventricle forcing tricuspid valve upwards into right atrium

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9
Q

What causes the X wave (part 2) on JVP

A

Final stage of ventricular contraction causing extra space in the pericardium

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10
Q

What causes the V wave on JVP

A

Relaxation of right atrium with a closed tricuspid valve

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11
Q

What causes the Y descent in JVP

A

Tricuspid valve opens

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12
Q

What causes U waves on ECG

A

Hypokalaemia

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13
Q

What causes J waves on ECG

A

Hypothermia

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14
Q

What is the MOA of hydralazine

A

increases cGMP leading to smooth muscle relaxation in the arterioles

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15
Q

What causes ST elevation >2 weeks post-STEMI with breathlessness but no chest pain

A

left ventricular aneurysm

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16
Q

What is the management of type A aortic dissection

A

IV labetolol + surgery

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17
Q

What is the management of type B aortic dissection

A

IV labetolol

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18
Q

What is the treatment for uraemic pericarditis

A

haemodialysis

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19
Q

What is the target INR for a mechanical aortic valve

A

3.0

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20
Q

What is the target INR for a mechanical mitral valve

A

3.5

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21
Q

Which drug is contraindicated in VT

A

Verapamil

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22
Q

What causes an S4 sound

A

Atrial contraction against a stiff ventricle (aortic stenosis, HOCM, hypertension)

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23
Q

Where is BNP produced

A

Mainly the LV in response to strain

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24
Q

What factors increase BNP levels

A

LVH, ischaemia, tachycardia, RV overload, hypoxaemia, eGFR <60, sepsis, COPD, diabetes, age >70, liver cirrhosis

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25
Q

What decreases BNP levels

A

Obesity, diuretics, ACEis, beta-blockers, ARB blockers, MRAs

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26
Q

What is initial blind therapy of IE in a native valve

A

Amoxicillin

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27
Q

What is initial blind therapy of IE in a native valve if penicillin allergic

A

Vancomycin + gentamicin

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28
Q

What is initial blind therapy of IE in a prosthetic valve

A

Vancomycin + rifampicin + gentamycin

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29
Q

What is the treatment of IE caused by fully sensitive streptococci

A

Benzylpenicillin

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30
Q

What gene is mutated in Brugada syndrome

A

SCN5A

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31
Q

What abnormality causes a bisferiens pulse

A

Mixed aortic valve disease

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32
Q

Which abnormality causes a jerky pulse

A

HOCM

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33
Q

How long should you anti-coagulate a patient following electrical cardioversion

A

At least 4 weeks

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34
Q

What drug should not be used in asthmatics presenting with SVT

A

Adenosine (use verapamil or flecainide instead)

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35
Q

What is kussmaul’s sign in constrictive pericarditis

A

Rise in JVP on inspiration

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36
Q

What are the 5 causes of restrictive cardiomyopathy

A

Amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Loffler’s syndrome

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37
Q

Which defect causes an ESM louder on inspiration

A

ASD

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38
Q

Which syndrome describes microcytic anaemia secondary to calcified AS

A

Heyde’s syndrome

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39
Q

What is the most specific finding of pericarditis on ECG

A

PR depression

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40
Q

What is the MOA of ivabradine

A

Reduces HR by acting on the funny current in the SA node

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41
Q

What is the treatment of Prinzmetal angina

A

Dihydropyridine CCB e.g. felodipine

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42
Q

What causes esoinophilia after arterial manipulation

A

Cholesterol embolisation

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43
Q

What is the most common side of atrial myxoma

A

Left atrium

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44
Q

Which deficiency leads to congenital adrenal hyperplasia and secondary hypertension

A

11-beta hydroxylase deficiency

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45
Q

What test is performed to aid management of pulmonary hypertension

A

Acute vasodilator testing

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46
Q

Where does furosemide act

A

Thick ascending loop of henle

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47
Q

What condition is associated with Aschoff bodies

A

Rheumatic fever

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48
Q

What does troponin C bind to

A

Calcium ions

49
Q

What does troponin T bind to

A

Tropomyosin

50
Q

What does troponin I bind to

A

Actin

51
Q

What % of people have SA nodes supplied by the RCA

A

60%

52
Q

Where does the coronary sinus drain into

A

Right atrium

53
Q

Where does the circumflex artery branch from

A

LCA

54
Q

Name 3 GPIIB/IIIa inhibitors

A

Eptifibatide, tirofiban, abciximab

55
Q

Which condition will have a normal angiogram but ECG changes on stress testing due to microvascular angina

A

Cardiac syndrome X

56
Q

What aortic gradient would surgery be considered at

A

> 40

57
Q

What inhibits endothelin production

A

NO, prostaglandin

58
Q

What promotes endothelin release

A

Angiotensin II, ADH, hypoxia, mechanical shearing forces

59
Q

When should patients with T1DM be started on a statin

A

Diagnosed over 10 years ago or age >40 or established neuropathy

60
Q

What is the mechanism of LQTS

A

defects in slow delayed rectifier potassium channel

61
Q

Which drugs cause long QT syndrome

A

Amiodarone, sotalol, TCAs, SSRIs, methadone, chloroquine, terfenadine, erythromycin, haloperidol, ondansetron

62
Q

What would indicate cardiac tamponade over constrictive pericarditis

A

No Y descent on JVP

63
Q

What are the most common causes of viral myocarditis

A

Parvovirus B-19 and HHV6

64
Q

What are the causes of aortic root disease that result in AR

A

Hypertension, Syphillis, Marfan’s, EDS, Aortic dissection, Ankylosing Spondylitis

65
Q

What causes a loud S2 sound

A

Hypertension

66
Q

What causes a reversed split S2 sound

A

LBBB, severe AS

67
Q

What causes a widely split S2 sound

A

RBBB, deep inspiration

68
Q

What causes a soft S2 sound

A

Aortic stenosis

69
Q

What congenital heart defect is associated with WPW syndrome

A

Ebstein’s abnormality

70
Q

What are the clinical features of Ebstein’s abnormality

A

Low insertion of TV - cyanosis, prominent ‘a’ waves, hepatomegaly, TR, RBBB

71
Q

What is 1st line treatment of idiopathic pulmonary hypertension with negative response to acute vasodilator testing

A

Endothelin receptor antagonist, prostacyclin analogues, phosphodiesterase inhibitors

72
Q

When is indomethacin given to treat PDA

A

Given to newborn if echo shows PDA one week after delivery

73
Q

When is staphylococcus epidermidis the most common organism in IE

A

<2 months post valve surgery

74
Q

Which organisms cause IE associated with poor dental hygiene

A

Strep viridans (mitis and sanguinis)

75
Q

Which organism causes IE associated with colorectal cancer

A

Strep bovis (gallolyticus)

76
Q

What are the culture negative causes of IE

A

prior ABx therapy, coxiella, bartonella, brucella, HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

77
Q

Which drugs are direct thrombin inhibitors

A

Bivalirudin, dabigatran

78
Q

What is the MOA of fondaparinux

A

Activates antithrombin III

79
Q

What is the treatment of prosthetic valve IE caused by staph aureus

A

Flucloxacillin + rifampicin + low-dose gentamycin

80
Q

What ECG changes are seen in hypokalaemia

A

U waves, small/absent T waves, prolonged PR interval, ST depression, long QT

81
Q

What happens to BP in normal pregnancy

A

Falls in the first trimester until 20-24 weeks, then increases back to pre-pregnancy levels by term

82
Q

What drugs are centrally acting antihypertensives

A

Methyldopa, monoxidine, clonidine

83
Q

What is the MOA of sodium nitroprusside

A

Potent short acting vasodilator that increases cGMP

84
Q

What is maternal lithium use during pregnancy associated with

A

Ebstein’s abnormality

85
Q

Which drugs affect the effect of adenosine

A

Dipyramidole - enhances effect, aminophylline - reduces effect

86
Q

What are the indications for urgent valvular replacement in IE

A

Severe heart failure, overwhelming sepsis despite ABx, recurrent embolic episodes, pregnancy

87
Q

What are the RFs for myopathy in statin treatment

A

Age, female, low BMI, multisystem disease

88
Q

What causes irregular cannon ‘a’ waves

A

Ventricular tachycardia, AVNRT

89
Q

What is the mechanism of VSD causing aortic regurgitation

A

Poorly supported right coronary cusp leading to cusp prolapse

90
Q

Which congenital cause of Long QT syndrome also causes deafness

A

Jervell-Lange-Nielsen Syndrome

91
Q

What condition is associated with pulsus alternans

A

Severe LVF

92
Q

Which valvular abnormality is most associated with takayasu’s arteritis

A

Aortic regurgitation

93
Q

Which anti-arrhythmic is safest for treating SVT in pregnancy

A

Metoprolol

94
Q

Which structural cardiac abnormality is most associated with duchenne muscular dystrophy

A

Dilated cardiomyopathy

95
Q

What is the investigation of choice for aortic dissection

A

CT angiography TAP, TOE if unstable

96
Q

What ECG changes are characteristically seen in ARVC

A

TWI in V1-V3, epsilon wave

97
Q

What is Naxos disease

A

Autosomal recessive variant of ARVC - associated with palmoplantar keratosis and woolly hair

98
Q

Which electrolyte abnormalities cause long QT syndrome

A

Hypokalaemia, hypomagnesaemia, hypocalcaemia

99
Q

Which statins are most associated with myopathy

A

Lipophilic statins (simvastatin, atorvastatin)

100
Q

What is the MOA of nicorandil

A

Potassium-channel activator - increases cGMP

101
Q

What causes cannon ‘a’ waves

A

Atrial contractions against a closed tricuspid valve (CHB, VT, nodal rhythm, single chamber ventricular pacing)

102
Q

What can cause acute mitral regurgitation, hypotension and pulmonary oedema suddenly after an MI

A

Rupture of papillary muscle

103
Q

How long after an MI does Dressler’s syndrome tend to appear

A

2-6 weeks

104
Q

What is the treatment of a left ventricular aneurysm after MI

A

Anticoagulation (thrombus can form within aneurysm)

105
Q

What can occur 1-2 weeks after MI with raised JVP and pulsus paradoxus

A

Left ventricular free wall rupture

106
Q

What can cause an overestimation of BP when measuring incorrectly

A

Cuff too small, arm below heart level, unsupported arm (raises diastolic BP)

107
Q

What is transposition of the great arteries due to

A

Failure of the aorticopulmonary septum to spiral

108
Q

What is the MOA of adenosine

A

Agonist of the A1 receptor, causing transient heart block in the AV node

109
Q

Which drug reduces the action of adenosine

A

Aminophylline reduces

DEAR

110
Q

Which drug enhances the action of adenosine

A

Dipyridamole enhances

DEAR

111
Q

What is the initial treatment of hypertension caused by phaeochromocytoma

A

Blockage of alpha adrenoreceptors with phenoxybenzamine

112
Q

What is the risk of maternal ASD in pregnancy

A

No increased risk compared to general population

113
Q

What is p mitrale associated with

A

Left atrial enlargement (MS, MR, hypertension)

114
Q

What is p pulmonale associated with

A

Right atrial enlargement (PS, increased PASP)

115
Q

Palmar xanthomas are pathognomic of which condition

A

Remnant hyperlipidaemia (mixed hyperlipidaemia aka dysbetalipoproteinaemia, type III hyperlipidaemia)

116
Q

What is lutembacher syndrome

A

Mitral stenosis + ASD

117
Q

Which muscular dystrophy typically presents with heart failure secondary to DCM at 5-15 years

A

Becker’s muscular dystrophy

118
Q

What are the typical cardiac manifestations of myotonic dystrophy

A

Conduction disorders (AF, heart block, ventricular arrhythmias)

119
Q

What is the LDL goal for a patient at very high CV risk

A

<1.8, or 50% reduction if baseline is between 1.8 - 3.5

MRCP (16 decks)

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