Cardiology Flashcards

Question

Management HCM

Answer 1

- Beta blockade - Non-dihydropuridine CCB - Avoid Nitrates and EtOH - Septal reduction therapy - Disopyramide - Na channel blocker (Class 1a) - Septal ablation - Myectomy

Answer 2

Kussmauls - Elevation of JVP on inspiration due to poor RV filling. eg. constrictive pericarditis, cardiac tamponade Pulsus paradoxes; BP decreases > 10mmHg with inspiration eg. Cardiac tamponade, constrictive pericarditis, severe COPD, asthma, tension PTX, PE, large bilateral pleural effusions

Answer 3

- Concordance in precordial leads - Absence of RS complex in all precordial leads - R to S interval > 100s in any precordial lead - AV disassociation - Morphology of VT

Answer 4

Aortic stenosis

Answer 5

Sex - Exercise - Type 1 - increased amplitude (KCNQ1); Beta blockers most protective Orgasm - Excitement, alarmed - Type 2 - low amplitude (KCNQ2/HERG) Sleep - Resting, shortens with exercise - Type 3 - normal T wave but long isoelectric ST segment (gain of function SCN5a (Brugada is loss of function))

Answer 6

Gain of function gene in Type 3 Long QT syndrome Loss of function gene in Brugada

Answer 7

- LV > 15mm - Septum 1.3 x thickness posterior free wall

Answer 8

Atrial Flutter - Tricuspid annulus Idiopathic VT - RVOT Atrial fibrillation - Pulmonary veins AVNRT - Kochs triangle WPW - Bundle of Kent

Answer 9

PRIMARY MV > 0.7 Symptomatic LVEF < 60% SECONDARY Severe symptoms despite GDMT

Answer 10

Severe < 1cm (< 0.6cm if corrected fro BSA) Mean gradient > 40 Aortic Velocity > 4 If symptomatic and severe - for AVR/TAVI Mod 1.0 - 1.5cm Mean gradient 20 - 40 Velocity 3-4 Mild > 1.5 Mean gradient < 20 Velocity 2.6 - 2.9 Aortic sclerosis - velocity < 2.5

Answer 11

Low-flow low gradient (AS severity is overestimated due to incomplete opening of the valve secondary to loss of LV systolic function) Valve < 1.0 cm Gradient < 40 LVEF < 40 Paradoxical low flow low gradient Valve < 1.0 Gradient < 40 LVEF > 50 but with reduced stroke volume < 35ml/min Pseudo severe AS Valve >1.0 Gradient < 40 Can be tested with Dobutamine Stress Test which will increase valve opening

Answer 12

Severe AR with valve > 0.6cm and holodiastolic flow reversal > 60ml Surgery if; If symptomatic If asymptomatic - LVEF < 55%

Answer 13

PCSK9 is a protein that targets LDL receptors for degradation and its inhibition thereby means there are more LDL receptors on the livers surface to bind LDL and remove it from our system. liver's ability to remove LDL-C Evolocumab Alirocumab - Reduces LDL by 50-60% even if already on statin therapy - Reduce reoccurrence of MI

Answer 14

Inhibits cholesterol absorption from gut by blocking via NPC1L1

Answer 15

Inhibits hepatic synthesis of PCSK9 to reduce cholesterol (rather than blocking action in PCSK9 inhibitors)

Answer 16

FFR < 0.8 indicates haemodynamic significant obstruction

Answer 17

0 - no perfusion 1 - penetration without perfusion 2 - partial reperfusion 3 - normal flow

Answer 18

B's! Breathlessness Bleeding Block (can precipitate ventricular pauses so do not use in first or second degree heart block) Bradycardia BD dosing

Answer 19

ICD - Sustained VT with or without arrest - EF < 35% on GDMT - Must be > 40 days after MI CRT-D - NYHF III - EF < 35% on GDMT - LBBB - QRS > 100 - Must be in sinus rhythm

Answer 20

Decreased myocardial demand (rather than increased coronary flow)

Answer 21

Beta 1 selective - Metoprolol, Atenolol, Nebivolol (has nitric oxide vasodilatory effects) Beta 1 + Alpha 1- Carvedilol (evidence of improvement in HF) Non-selective - Propanolol, Sotalol

Answer 22

Treatment must be started within 9 days of strep throat Stat IM benpen Oral BD dosing Penicillin V for strep pharyngitis Treatment should be started within 9 days of symptom onset for patients with Strep pharyngitis to avoid rheumatic heart disease Aspirin for arthritis

Answer 23

Major Polymigratory arthritis Carditis Nodules (subcutaneous) Erythema marginatum Syndenham criteria Minor - Arthralgia - prolonged PR interval - Fever - Elevated CRP/ESR

Answer 24

Anti-streptolysin antibody (sensitivity improved when combined with Anti-DNAse B) Anti-DNAse - B Poor diagnostic yield from throat swabs NO screening for asymptomatic family members Chorea is self limiting

Answer 25

LM disease 3-vessel disease 2-vessel disease with LAD involvement or LVEF < 50%

Answer 26

- Proximal LAD/LM disease - FFR < 80 - Stenosis > 90% - EF < 35% secondary to IHD - > 10% ischaemia LV

Answer 27

- ST elevation 1mm in 2 x concordant leads with positive QRS - ST depression 1mm in leads V1-3 - ST elevation > 25% S wave in leads with negative QRS complex

Answer 28

- BP > 180/100 - Anticoagulation use - GI/GU bleeding in 4 weeks - Stroke or TIA within 12 months - AV malformation - Recent surgery - Bleeding diathesis - Head trauma in 3 months

Answer 29

Occlusion first diagonal branch LAD South African Flag sign; - STE I, AvF, V2 - STD III Relies on preload and require fluid resuscitation and avoidance of nitrates!

Answer 30

PCI within 24hrs if high risk PCI within 72 hrs if medium risk AMERICA Age > 65 Markers elevated ECG changes Risk factors (HTN, FHx, High cholesterol, DM, Smoking) Ischaemia (2 or more episodes of angina in 24hrs) CAD with known lesions > 50% Aspirin within 7 days

Answer 31

Fibromuscular dysplasia

Answer 32

Cardiac Tamponade - Distended Neck Veins - Muffled Heart Sounds - Hypotension Electrical Alternans; 2: 1 ratio of alternating QRS Pulses Paradoxus; drop in BP > 10mmHg with inspiration

Answer 33

Atrial Gallop caused by left atria contracting against a stiff LV which forces blood through the mitral valve - S4 is produced by the blood striking the non-compliant left ventricle.

Answer 34

For primary MR Valve > 0.7cm Symptomatic LVEF < 60% For secondary MR (i.e. RHD) Must try GDMT -> then can consider MVR

Answer 35

For LVH S wave in V1 or V2 > 35mm PLUS R wave in V5 or 6 > 35mm (7 large boxes)

Answer 36

Acquired monoclonal immunoglobulin light chain - AL - associated with MM and peri orbital purpura. Rapidly progressive. Heriditary Transthyretin-related form, mutant type - ATTRm - mutation of transthyretin protein synthesised in liver. Rx Liver transplant. Common in African americas Non-mutant, wild-type transthyretin-related (senile amyloid)- ATTRwt - wild-type mutation in elderly males with cardiac deposition. Associated with carpal tunnel syndrome.

Answer 37

Paroxysmal AF - 48 hours to 7 days Persistent - > 7 days, or requires cardio version to terminate Permanent - when no further attempts made to achieve sinus rhythm

Answer 38

- Absorbed as a pro-drug - Direct Thrombin inhibitor - Reversed by Idarucizumab (Praxbind) - Absorbed and re-absorbed in gut by p-glycoprotein -> drugs that inhibit P-glycoprotein will increase plasma concentrations - 85% renally excreted (contraindicated in renal impairment) - High rate dyspepsia Inhibitors of the P-glycoprotein transporter can increase plasma concentrations “Azoles” Protease inhibitors Macrolides Calcineurin inhibitiors Amiodarone Verapamil Potentiators of P-glycoprotein will decrease plasma concentrations Rifampicin Carbemazepine Phenytoin

Answer 39

- Type 3 AV Block - Mobitz 1 or 2 with symptoms - Mobitz type 2 with wide QRS - Exercise induced second or third degree AV block

Answer 40

Two Major or One Major and two minor Major criteria - RV dysfunction - Fibrofatty infiltrate of tissue - Epsilon waves Minor criteria - Mild RV dysfunction - TWI V2-3 without RBBB - Frequent PVCs - VT with LBBB

Answer 41

Class 1, work at phase 0 1a - Na+ and K+ channel inhibitors - prolongs action potential and refractory periodn- Moderate Na blocker 1b - Inactive Na+ channel inhibitors - shortens action potential and refractory period - weak Na blocker (lidocaine for VT) 1c - Active Na+ channel inhibitors - No effect on length of action potential - strong Na blocker Class 2 Beta blockers - work at phase 4 action potential Class 3 K+ blockers - prolong action potential and refractory period, work at phase 3 Class 4 Non-dihydropyridine - Verapamil and Diltizem, negative inotropic effect, work at stage 2

Answer 42

Statins - inhibit HMG-CoA to reducer endogenous production of cholesterol Ezetimibe - inhibit NPC1L1 to decrease intestinal reabsorption of cholesterol Fenofibrates - Activates PPAR-alpha - to increase synthesis of HDL and induce lipolysis of TAGS Evolocumab/Alirocumab - PCSK9 inhibitors - inhibit resorption of LDL receptor on liver surface to increase LDL uptake

Answer 43

- ASD with epsteins anomaly - large RA with displaced tricuspid valve and small RV leading to arrhythmias and commonly WPW. Most common ASD is Secondum - can be treated percutaneous. Others require surgery (Ovale, Venosus, Coronary sinus) - VSD - Patent Ductus arteriosus - leads to LVH and infantile heart failure - Pulmonary stenosis - Williams syndrome - growth retardation, star pattern in eyes, widely spaced teeth. Noonans syndrome - short stature, distinctive facial features, postpartum oedematous limbs, Rash, developmemental delay - Aortic stenosis/coarctation aorta - requires Ross procedure

Answer 44

- Tetrology of Fallot; RV hypertrophy, VSD, Overarching Aorta, Pulmonary stenosis - Translocation of Great Arteries; TGA-D, Aorta from RV - not compatible with life unless coexisting PDA or PFO, TGA-L - complete translocation of ventricles with VSD - requires Fontan procedure - bypass right side of heart and SVC drains into pulmonary artery