Cardiology Flashcards
What should you monitor when giving MgSO4?
Reflexes, respiratory rate
What mechanism causes QT prolongation?
blockage of potassium channels
What drug is best to give in a patient with WPW who is found to be in AF?
Flecainide - doesn’t block the AV node
What part of the ECG does an S4 sound coincide with
P wave
What causes an S3 sound
Diastolic filling of the ventricle (heard in LVF - e.g. dilated CM, constrictive pericarditis, MR)
What is the A wave on JVP
Contraction of right atrium
What causes the X descent (part 1) on JVP
Relaxation of right atrium
What causes the C wave on JVP
Contraction of right ventricle forcing tricuspid valve upwards into right atrium
What causes the X wave (part 2) on JVP
Final stage of ventricular contraction causing extra space in the pericardium
What causes the V wave on JVP
Relaxation of right atrium with a closed tricuspid valve
What causes the Y descent in JVP
Tricuspid valve opens
What causes U waves on ECG
Hypokalaemia
What causes J waves on ECG
Hypothermia
What is the MOA of hydralazine
increases cGMP leading to smooth muscle relaxation in the arterioles
What causes ST elevation >2 weeks post-STEMI with breathlessness but no chest pain
left ventricular aneurysm
What is the management of type A aortic dissection
IV labetolol + surgery
What is the management of type B aortic dissection
IV labetolol
What is the treatment for uraemic pericarditis
haemodialysis
What is the target INR for a mechanical aortic valve
3.0
What is the target INR for a mechanical mitral valve
3.5
Which drug is contraindicated in VT
Verapamil
What causes an S4 sound
Atrial contraction against a stiff ventricle (aortic stenosis, HOCM, hypertension)
Where is BNP produced
Mainly the LV in response to strain
What factors increase BNP levels
LVH, ischaemia, tachycardia, RV overload, hypoxaemia, eGFR <60, sepsis, COPD, diabetes, age >70, liver cirrhosis
What decreases BNP levels
Obesity, diuretics, ACEis, beta-blockers, ARB blockers, MRAs
What is initial blind therapy of IE in a native valve
Amoxicillin
What is initial blind therapy of IE in a native valve if penicillin allergic
Vancomycin + gentamicin
What is initial blind therapy of IE in a prosthetic valve
Vancomycin + rifampicin + gentamycin
What is the treatment of IE caused by fully sensitive streptococci
Benzylpenicillin
What gene is mutated in Brugada syndrome
SCN5A
What abnormality causes a bisferiens pulse
Mixed aortic valve disease
Which abnormality causes a jerky pulse
HOCM
How long should you anti-coagulate a patient following electrical cardioversion
At least 4 weeks
What drug should not be used in asthmatics presenting with SVT
Adenosine (use verapamil or flecainide instead)
What is kussmaul’s sign in constrictive pericarditis
Rise in JVP on inspiration
What are the 5 causes of restrictive cardiomyopathy
Amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Loffler’s syndrome
Which defect causes an ESM louder on inspiration
ASD
Which syndrome describes microcytic anaemia secondary to calcified AS
Heyde’s syndrome
What is the most specific finding of pericarditis on ECG
PR depression
What is the MOA of ivabradine
Reduces HR by acting on the funny current in the SA node
What is the treatment of Prinzmetal angina
Dihydropyridine CCB e.g. felodipine
What causes esoinophilia after arterial manipulation
Cholesterol embolisation
What is the most common side of atrial myxoma
Left atrium
Which deficiency leads to congenital adrenal hyperplasia and secondary hypertension
11-beta hydroxylase deficiency
What test is performed to aid management of pulmonary hypertension
Acute vasodilator testing
Where does furosemide act
Thick ascending loop of henle
What condition is associated with Aschoff bodies
Rheumatic fever
What does troponin C bind to
Calcium ions
What does troponin T bind to
Tropomyosin
What does troponin I bind to
Actin
What % of people have SA nodes supplied by the RCA
60%
Where does the coronary sinus drain into
Right atrium
Where does the circumflex artery branch from
LCA
Name 3 GPIIB/IIIa inhibitors
Eptifibatide, tirofiban, abciximab
Which condition will have a normal angiogram but ECG changes on stress testing due to microvascular angina
Cardiac syndrome X
What aortic gradient would surgery be considered at
> 40
What inhibits endothelin production
NO, prostaglandin
What promotes endothelin release
Angiotensin II, ADH, hypoxia, mechanical shearing forces
When should patients with T1DM be started on a statin
Diagnosed over 10 years ago or age >40 or established neuropathy
What is the mechanism of LQTS
defects in slow delayed rectifier potassium channel
Which drugs cause long QT syndrome
Amiodarone, sotalol, TCAs, SSRIs, methadone, chloroquine, terfenadine, erythromycin, haloperidol, ondansetron
What would indicate cardiac tamponade over constrictive pericarditis
No Y descent on JVP
What are the most common causes of viral myocarditis
Parvovirus B-19 and HHV6
What are the causes of aortic root disease that result in AR
Hypertension, Syphillis, Marfan’s, EDS, Aortic dissection, Ankylosing Spondylitis
What causes a loud S2 sound
Hypertension
What causes a reversed split S2 sound
LBBB, severe AS
What causes a widely split S2 sound
RBBB, deep inspiration
What causes a soft S2 sound
Aortic stenosis
What congenital heart defect is associated with WPW syndrome
Ebstein’s abnormality
What are the clinical features of Ebstein’s abnormality
Low insertion of TV - cyanosis, prominent ‘a’ waves, hepatomegaly, TR, RBBB
What is 1st line treatment of idiopathic pulmonary hypertension with negative response to acute vasodilator testing
Endothelin receptor antagonist, prostacyclin analogues, phosphodiesterase inhibitors
When is indomethacin given to treat PDA
Given to newborn if echo shows PDA one week after delivery
When is staphylococcus epidermidis the most common organism in IE
<2 months post valve surgery
Which organisms cause IE associated with poor dental hygiene
Strep viridans (mitis and sanguinis)
Which organism causes IE associated with colorectal cancer
Strep bovis (gallolyticus)
What are the culture negative causes of IE
prior ABx therapy, coxiella, bartonella, brucella, HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
Which drugs are direct thrombin inhibitors
Bivalirudin, dabigatran
What is the MOA of fondaparinux
Activates antithrombin III
What is the treatment of prosthetic valve IE caused by staph aureus
Flucloxacillin + rifampicin + low-dose gentamycin
What ECG changes are seen in hypokalaemia
U waves, small/absent T waves, prolonged PR interval, ST depression, long QT
What happens to BP in normal pregnancy
Falls in the first trimester until 20-24 weeks, then increases back to pre-pregnancy levels by term
What drugs are centrally acting antihypertensives
Methyldopa, monoxidine, clonidine
What is the MOA of sodium nitroprusside
Potent short acting vasodilator that increases cGMP
What is maternal lithium use during pregnancy associated with
Ebstein’s abnormality
Which drugs affect the effect of adenosine
Dipyramidole - enhances effect, aminophylline - reduces effect
What are the indications for urgent valvular replacement in IE
Severe heart failure, overwhelming sepsis despite ABx, recurrent embolic episodes, pregnancy
What are the RFs for myopathy in statin treatment
Age, female, low BMI, multisystem disease
What causes irregular cannon ‘a’ waves
Ventricular tachycardia, AVNRT
What is the mechanism of VSD causing aortic regurgitation
Poorly supported right coronary cusp leading to cusp prolapse
Which congenital cause of Long QT syndrome also causes deafness
Jervell-Lange-Nielsen Syndrome
What condition is associated with pulsus alternans
Severe LVF
Which valvular abnormality is most associated with takayasu’s arteritis
Aortic regurgitation
Which anti-arrhythmic is safest for treating SVT in pregnancy
Metoprolol
Which structural cardiac abnormality is most associated with duchenne muscular dystrophy
Dilated cardiomyopathy
What is the investigation of choice for aortic dissection
CT angiography TAP, TOE if unstable
What ECG changes are characteristically seen in ARVC
TWI in V1-V3, epsilon wave
What is Naxos disease
Autosomal recessive variant of ARVC - associated with palmoplantar keratosis and woolly hair
Which electrolyte abnormalities cause long QT syndrome
Hypokalaemia, hypomagnesaemia, hypocalcaemia
Which statins are most associated with myopathy
Lipophilic statins (simvastatin, atorvastatin)
What is the MOA of nicorandil
Potassium-channel activator - increases cGMP
What causes cannon ‘a’ waves
Atrial contractions against a closed tricuspid valve (CHB, VT, nodal rhythm, single chamber ventricular pacing)
What can cause acute mitral regurgitation, hypotension and pulmonary oedema suddenly after an MI
Rupture of papillary muscle
How long after an MI does Dressler’s syndrome tend to appear
2-6 weeks
What is the treatment of a left ventricular aneurysm after MI
Anticoagulation (thrombus can form within aneurysm)
What can occur 1-2 weeks after MI with raised JVP and pulsus paradoxus
Left ventricular free wall rupture
What can cause an overestimation of BP when measuring incorrectly
Cuff too small, arm below heart level, unsupported arm (raises diastolic BP)
What is transposition of the great arteries due to
Failure of the aorticopulmonary septum to spiral
What is the MOA of adenosine
Agonist of the A1 receptor, causing transient heart block in the AV node
Which drug reduces the action of adenosine
Aminophylline reduces
DEAR
Which drug enhances the action of adenosine
Dipyridamole enhances
DEAR
What is the initial treatment of hypertension caused by phaeochromocytoma
Blockage of alpha adrenoreceptors with phenoxybenzamine
What is the risk of maternal ASD in pregnancy
No increased risk compared to general population
What is p mitrale associated with
Left atrial enlargement (MS, MR, hypertension)
What is p pulmonale associated with
Right atrial enlargement (PS, increased PASP)
Palmar xanthomas are pathognomic of which condition
Remnant hyperlipidaemia (mixed hyperlipidaemia aka dysbetalipoproteinaemia, type III hyperlipidaemia)
What is lutembacher syndrome
Mitral stenosis + ASD
Which muscular dystrophy typically presents with heart failure secondary to DCM at 5-15 years
Becker’s muscular dystrophy
What are the typical cardiac manifestations of myotonic dystrophy
Conduction disorders (AF, heart block, ventricular arrhythmias)
What is the LDL goal for a patient at very high CV risk
<1.8, or 50% reduction if baseline is between 1.8 - 3.5
