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MRCP PART 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

2 options for pharmacological cardioversion of AF

A

Amiodarone
Flecianide

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2
Q

Urgent rate control for AF options

A

IV beta blocker
IV verapamil

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3
Q

Choice of longterm rate control in AF ?

A

Beta blockers (NOT SOTALOL)
Verapamil

[Can use digoxin if they are sedentary and want it]

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4
Q

How long should anticoagulate in AF that has been going on for >48hrs

A

3 weeks

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5
Q

1st line rhythm control in patients with AF? What if heart failure / or LV impairment?

A

Beta blockers

Dronaderone / amiodarone

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6
Q

Pill in the pocket drug for AF

A

Flecainide

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7
Q

AF ongoing symtoms despite rate and rhythm control or where drugs contra indicated. What management

A

Radiofrequency point by point ablation

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8
Q

How to assess stroke risk in AF

A

CHA2-DS2-VASc

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9
Q

Offer anticoagulation to whom with AF?
How to assess bleeding score?

A

Men with a score of 1 CHADSVASC
Women with a score of 2

ORBIT score

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10
Q

Should you contact DVLA if you have AF

A

Yes

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11
Q

What is virchows triad?

A

Triad of venous thromboembolism

Hypercoagulable state
endothelial damage
blood stasis

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12
Q

Pharmacological management of patient in acute HF with pulm oedema.

A

Furosemide

Importantly Vasodilators
GTN (Short half life)
Diamorphine
ACEi

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13
Q

What is HF-PEF. Breifly explain pathophsiogy

A

‘diastolic’ heart failure.
Impaired cardiac filling due to ventricular stiffness
->blood backing up in circulatory system -> Fluid overload + oedema (similar to right-sided cardiac failure)

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14
Q

BNP scores for echo

A

> 400 - For echo in 6 weeks
2000 - For echo in 2 weeks

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15
Q

Vaccines in Heart failure

A

pneumococcal + influenza

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16
Q

Which drugs improve mortality in HF

A

ACEi
BBs
ARBs - eg sprinolactone

[NOT DIRURETICS ]

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17
Q

How does ivabradine work

A

HCN channel blocker -> Selectively inhibits funny current in sinus node to slow sinus rhythm

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18
Q

4 surgical options in HF

A

Cardiac resynchronisation therapy
ICD
LV assist device
Transplant

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19
Q

Why IV furosemide in severe oedema

A

Gut wall oedema inhibits absorption

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20
Q

Most common cause of HF

A

IHD - Coronary artery disease

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21
Q

Most common bug endocardiits ?
Second most ?
Where are they usually from?

A

S aureus - most common
Often from Skin eg vascuar access / infections / IVDU / abscesses

Strep viridans
Upper Respiratory - dental treatment, chewing, brushing teeth

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22
Q

Rx Endocarditis for native valve ?
Prosthetic valve?

A

Amox + gent (unless s aureus suspected)

Prosthetic - vanc/gent/rifampicin

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23
Q

Which cause of endocaridtis always requires surgical intervention

A

Pseudomonas argenosa

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24
Q

Some causes of culture negative endocaridits

A

brucella
bartonella
coxiella
Chlamydia
leigonella
mycoplasma
Whipples disease
Fungal organisms

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25
Q

2 main causes of non-infective endocarditis

A

SLE
Metastatic

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26
Q

Most common location endocaridits

A

mitral valve

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27
Q

Common risk factors for endocarditis

A

Acquired structural disease - eg rheumatic
valve replaced
structural disease [NOT isolated ASD or repaired VSD/PDA]
HCM
Prev IE

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28
Q

Rx if staph aureus endocaridits?
Methicillin-resistant ?

Strep ?
if resistant ?

HACEK?

A

Rx if staph aureus endocaridits? Fluclox
Methicillin-resistant ? Vanc + rifampicin

Strep ? Benpen
if resistant ? add gent

HACEK? amox + gent

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29
Q

Is clorhexidine mouthwash reccomended as IE prophlyaxis for dental procedures ?

A

No (not any more)

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30
Q

How do vagal manoeuvres help identify the site of heart block

A

AV node has good vagal autonomic innervation -> responds to an increase in vagal tone

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31
Q

When might atropine worsen heart block in brady?

A

If not from AV node in origin
-Will improve AV node block
-Will worsen block from his/purkinje system

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32
Q

Which types of heart block require permenant pacing

A

Mobitz type 2
type 3

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33
Q

Types of block 1/2/3

A

1st degree: Prolonged PR

2nd: Type 1- prolonging PR until one p wave doesn’t conduct
Type 2 - Constant PR with occasional dropped p Eg 2:1/3:1 block

3rd: no association between p and qrs

[Sick sinus - signal node dysfunction]

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34
Q

Non cardiac causes of block

A

Hypothermia
Hypothyroid
HyperK
Vasovagal syncope

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35
Q

Drug induced causes of heart block

A

Digoxin
B blockers
Amiodarone
Diltiazem

Dem BAD

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36
Q

2 locations for cause of AV block

A

AV node
His-purkinje

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37
Q

Who can not get atropine

A

cardiac transplant patients
Severe asthma

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38
Q

Dose of atropine

A

0.5mg (repeated up to 3mg)

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39
Q

Who gets atropine in brady even if no adverse features

A

Mobitz type 2
type 3 Heart block
Recent asystole
Recent pause >3s

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40
Q

first shock strength for VF if biphasic defib?
Monophasic?

A

150-200J

360J

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41
Q

Which thrombolytic agent has lowest risk of haemorrhagic stroke

A

Streptokinase

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42
Q

Normal Sa02 in right side of heart? Left side ?

A

75%
>95%

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43
Q

Are primum or secundum ASDs more common?

A

90% are secundum

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44
Q

When are ostium secundum ASDs usually diagnosed? Common patient features?

A

Early adulthood.
Slim and not suffering from cyanosis

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45
Q

What do ostium primum ASDs involve? When are they diagnosed? O2 sats in these?

A

Defect involving mitral/tricuspi valves as well as a VSD..
Usually diagnosed in early childhood and have signs of congestive heart failure.
O2 sats would VARY in RV/RA

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46
Q

Ostium secundum ASD. O2 sats vary between what?

A

SVC would have lower O2 sats than RA/RV

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47
Q

O2 sats in Patent ductus arteriosus chambers? Basic physiology?

A

Oxygenated blood flows from aorta -> pulm artery.

SVC/RA/RV would have the same sats and be >75%

Left side heart sats would be NORMAL (>95%) as shunt only from Left to right

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48
Q

ASD with a triphalangeal thumb (extra joint)? Inheritance?

A

Holt-oram syndrome
Autosomal dominant (with incomplete penetration)

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49
Q

ASD with mitral stenosis syndrome name? What causes the MS

A

Lutembacher syndrome
Likely rheumatic

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50
Q

What is the syndrome ASDs can end up with in later age? Pathophysiology?

A

Eisenemenger syndrome
Chronic L->R shunt causes pulm vascular injury -> increased pulm resistance - > reversal of shunt

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51
Q

Auscultation of ASD ?

A

Fixed splitting of second heart sound
[May have left parasternal heave and ESM due to increased blood flow]

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52
Q

Fixed splitting of second heart sound found in what defect?

A

ASD

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53
Q

ECG of ASD
Secundum?
Primum?

A

Both have increased P-waves (atrial enlargement)

Secundum? Incomplete RBBB, Right axis deviation

Primum? RBBB, Left axis deviation, 1st degree heart block

[First read left to right]

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54
Q

VSD vs ASD vs PDA.
Auscultation? Risk of endocardits? Common arrythmiass? Emboli

A

VSD: Pansystolic murmur, high-risk endocarditis. None

ASD: Fixed splitting second heart sound, low-risk endocarditis, AF/Fibrillation -> Risk of emboli

PDA: Continuous murmur. High-risk endocaridits.

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55
Q

How does echo calculate the degree of AS

A

Calculating pressure gradient across valve

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56
Q

Pharmacological Rx of VSDs

A

Digoxin - positive inotropic effect

If Heart failure - diuretics. ACEi (reduce afterload)

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57
Q

Indications for surgical closure of VSD

A

Significant shunt
Elevated R heart pressures causing pulm hypertension
Endocarditis
Membranous VSD

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58
Q

Mid systolic click best heart at apex and a mid to late systolic mumur heart in?
Common patient features ?

A

Mitral valve prolapse

Young females, slim, low/normal BP
[Marfans, ehlers-danlos, pectus excavatum, autoimmune thyroid]

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59
Q

Most common SVT? Seen in who?

A

Atrioventricular nodal reentry tachycardia (AVNRT)
Young women

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60
Q

AVNRT Vs AVNT pathophysiology

A

Atrioventricular nodal re-entry tachycardia (AVNRT)
- re-entry circuit around the AV node (more than one conduction pathway) which allows a re-entry pathway -> regular tachycardia

Atrioventricular Nodal Tachycardia
An accessory pathway between atria and ventricles some DISTANCE away from the AV node
Eg WPW syndrome

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61
Q

The prominence of x and y jugular descents indicates?

A

Restrictive cardiomyopathy

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62
Q

Pathophysiology of restrictive cardopmyopathy?

A

Fibrosis / infiltrates of myo/endocardium
->Failure of ventricles to relax
->Increased ventricular end-diastolic pressures
->Atrial enlargement

Systolic function is NORMAL

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63
Q

Name a couple of causes of restrictive cardiomyopathy

A

Sarcoidosis
Amyloidosis
Haemochromatosis
endomyocardial fibrosis
Storage disorders

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64
Q

Most common thing to develop with restrictive cardiomyopathy

A

75% develop AF

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65
Q

Most common cause of restrictive cardiomyopathy?

A

Amyloidosis

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66
Q

Diagnosis of cardiac amyloidosis

A

Biopsy and staining with congo-red

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67
Q

Drug to avoid in amyloid (restrictive) cardiomyopathy?

A

Digoxin
-Binds to amyloid fibrils and can reach toxic level even in normal ranges

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68
Q

When does BNP get released by heart tissue? What does BNP do?

A

In response to raised intra-cardiac pressures.
Increased sodium excretion and decreased systemic vascular resistance

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69
Q

s3/4 gallop rhythm auscultated in ?

A

heart failure

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70
Q

ECG of LBBB 2 features

A

QRS duration > 120ms
Dominant S wave in V1
Broad monophasic R wave in lateral leads (I, aVL, V5-6)
Absence of Q waves in lateral leads
Prolonged R wave peak time > 60ms in leads V5-6

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71
Q

Contraindications to thrombolysis in MI

[Timing for head trauma? stroke? BP score?]

A

PCI available in 90 mins
Active internal bleeding, uncontrolled external bleeding
Suspected aortic dissection
Head trauma <2weeks
haemorrhagic / ischemic stroke <2months
Uncontrolled BP >200/120

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72
Q

Who should prasugrel be avoided in?

A

It works better than clopidogrel
Avoid if:
- >75
- <60kg
- history of stroke / TIA

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73
Q

Which vessle supplies the SN and AVN? Significance?

A

R coronary
[Occlusion can cause complete heart block]
Therefore, inferior MI are high risk for needing paced

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74
Q

Webbing of neck and failure of secondary sexual development? Cardiac abnormality ?

A

Turners syndrome
Bicuspid aoric valve, Coarctation of aorta, VSD, ASD….

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75
Q

Features of coarcation?
Difference between Infantile and adult type coarctation of aorta?

A

Hypertension
Intermittent claudication of legs / tiredness
LV failure
angina

Infantile - Stenosis proximal to L subclavian
-> Hypertension in right arm only

Adult - Stenosis distal to Subclavian
-> Both arm hypertensive
Upper body more developed than lower.

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76
Q

In an infant with coarcation what medication can you give and why to bridge to surgery?

A

Prostaglandin E1
-Keeps ductus arteriosus patent

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77
Q

Notching of ribs on CXR

A

Coarctation

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78
Q

Turners syndrome. Which abnormality if systolic murmur at right sternal edge? Left infrascapular?

A

Right edge - bicuspid
Left infrascapular - coarctation

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79
Q

Following diagnosis of bicuspid aortic valve, what investigation must be done?

A

Cardiac MRI / CT to assess for coarctation
[bicuspid valves are found in 50% of cases of coarctation]

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80
Q

When do you need surgery for bicuspid AV

A

When get stenosis + symptoms and a mean paravalvular gradient >40mmHg, AVA <1cm

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81
Q

Best way to capture a paroxsysmal arrythmia

A

Loop recorder - you can press it when you’re having symptoms.

With a holter - may miss the arrythmia if doesn’t occur in the 24/72hr period

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82
Q

improve outcomes with HCM who are at high risk of tachyarrhythmias ?
What drug can be used ?

A

ICD
Amiodarone

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83
Q

HCM murmur? Why? How to make murmur more?

A

Ejection systolic due to dynamic outflow tract obsturction
[This causes exersional symptoms and the risk of sudden death]

Murmur increases with Valsalva, decreases with squatting

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84
Q

HCM: finding on JVP wave?

A

Large A waves

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85
Q

Banana / spade shaped ventricle in systole during cardiac catheterization?

A

HCM

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86
Q

Swordfish narrowing of LAD seen in?

A

HCM

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87
Q

Which is the bad one? LDL or HDL

A

LDL
[Low density -> take up more space -> obstruct vessels more]

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88
Q

When do you offer atorvostatin in hyperlipidaemia

A

When QRISK2 score >10%

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89
Q

Drug for primary hypercholesterolaemia if statins inappropriate?

A

Ezetimibe
[Inhibits absorption of cholesterol from gut]

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90
Q

Inferior MI. Then develops shock: no murmurs and nothing auscultated on the chest.
What cause?

A

RV infarction

[Pooling of blood in RV -> reduces preload and therefore hypovolaemic shock.

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91
Q

Inferior infarction affecting circumflex. The develops Pulm oedema 2 hours later. What has happened? Pathophysiology? Auscultation?

A

Papillary muscle rupture (supplied by circumflex).

Papillary muscle rupture -> Severe mitral regurg -> Acute pulm oedema

Loud pansystolic murmur + bibasal creps from pulm oedema

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92
Q

Cardiac abnormality with no findings on the exam and allows an R to left shunt occasionally

A

Patent foramen ovale
[In 1 out of 4 people - very common]

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93
Q

Management of coronary artery spasm?

A

Nitrates / CCBs

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94
Q

First line treatment for angina?

A

BBs
[+GTN for symtom relief]

CCBs second line

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95
Q

Transient ST elevation, usually at rest, with to without underlying atherosclerotic lesions ?

A

Varient (Prinzmetals) angina. Due to coronary artery vasospasm

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96
Q

Angina when lying down or often when dreaming?

A

Decubitis angina
[Due to an increase in L ventricular diastolic pressure]

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97
Q

Difference in systolic BP in arms vs legs?
If Aortic regurg?

A

10-20mmHg

60-100mmHg

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98
Q

Blood pressure with exercise in HCM

A

Stays the same or falls

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99
Q

Common murmur in aortic dissection

A

Diastolic - from aortic regurg

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100
Q

Trop / d dimer in aortic dissection

A

Trop - normal or mildly raised
D dimer - very high

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101
Q

Common cardiac abnormality with ankylosing spond

A

Aortic regurg

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102
Q

AR signs

A

Collapsing radial pulse
Wide pulse pressure
Early diastolic murmur on left sternal edge

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103
Q

AR signs
Corrigans?
De Muzet
Quincke
Duroziez

A

Corrigans - Visible pulsations in neck
De Muzet - Head bobbing (due to neck pulsations)
Quincke - Subtle pulsation of capillary nail bed
Duroziez - Diastolic murmur proximal to femoral artery compression

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104
Q

Drug class to avoid in AR and why

A

B blockers - prolong diastole -> increases regurg

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105
Q

Prolong QT electrolytes

A

HYPO k/mg/ca

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106
Q

Inherited syndromes that cause prolonged QT ? If question mentions Swimming? Sensory-neural deafness? Periodic paralysis & facial abnormalities? Autism?

A

Romano ward [Swimming] dominant
Jervell and lang nielson [deaf] recessive
Anderson tawil - [Paralysis + facial/skeletal]
Timothy [autism]

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107
Q

JVP - loss of x descent, large V waves

A

Tricuspid regurg

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108
Q

JVP prominent x descent

A

contrictive pericardiits

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109
Q

sarcomere protein gene mutation seen in

A

HOCM

110
Q

Avoid CCBs for long term rx of heartfailre when?

A

presence of significant LV dysfunction

111
Q

Causes of primary PH ?
Secondary PH?

A

Primary - nil: diagnosis of exclusion

Secondary - Chronic PE, Collagen/vascular disease, LV dysfunction, COPD, cirrhosis, ASD/VSDs

112
Q

PAH on echo

A

Peak Tricuspid regurg

113
Q

Treatment of PPH

A

Anticoag
Digoxin - even if SR
PDE5 inhibitors - eg sildenafil
Diruetics

114
Q

How long does tropnin remain elevated?

A

up to 2 weeks

115
Q

First line management to prevent recurrence of NON-sustained VT

A

Sotalol

116
Q

Brugada syndrom ECG

A

ST elevation >1 of v1-v3 followed by T wave inversion

[usually with Incomplete RBBB]

117
Q

Neurological mediated postural hypotension drug?

A

Midodrine

[Fludrocortisone + adequate Na diet usuals]

118
Q

Othostatic hypotension following meals drug?

A

ocretitde

119
Q

CABG which vessels used. usual complications of the harvest of each?

A

LAD = Left internal mammary artery
-May damage phrenic (crosses at rib 1) -> diaphragm paralysis

Others usually - long saphenous vein
-Damage saphenous nerve Sensory loss over leg
[or radial artery following phallens - sensory loss over stuff box]

120
Q

Post op cabg infections commonly caused by what bugs

A

MRSA or SA
Or gram neg

121
Q

Common time for cholesterol emboli? Common blood finding? Urine microscopy?

A

Post angiogram
Eosinophilia

Eosinophilia + hyaline casts

122
Q

Which cardiac abnormality is heavily associated with GI bleeding and angiodysplasia?

A

Aortic stenosis (heydes syndrome)

-Though do do with high sheer stress around stenosed valve

123
Q

Overdose of B blockers with brady. No response to atropine. What drug could you use while getting transcut pacing set up

A

glucagon
[glyco similar effect to atropine]

124
Q

Implanted ICD for VT. driving rules

A

No driving car for 6 months post op

NEVER bus / HGV

125
Q

Occlusive disease of extremities linked heavily with smoking. Complain of claudication / ulcers / diminished pulses

A

buergers disease

126
Q

Murmur in VSD

A

pansystolic. left sternal edge

127
Q

Main thing that increases HDL levels

A

Alcohol

128
Q

WPW most common arrhythmia? Seen on ECG after cardioversion

A

AV re-entry tachycardia

Delta wave

129
Q

Loud pansystolic murmur and pulm oedema after MI = ? Which vessel?

A

acute mitral regurg from ruptured cordae tendonae
(supplied by circumflex usually)

130
Q

When and why would an angiogram worsen hyperthyroidism? How to work this out pre-procedure? Rx during and post-procedure?

A

Cardiac angiography uses iodine
-worsens toxic multinodular goitre
-Makes graves a little better

Radioisotope scan to identify the cause (TMN vs Graves)

TMN - needs antithyroid meds pre-procedure and to be continued for minimum 2 weeks

131
Q

RV failure (peripheral oedema but minimal pulm oedema)
ECG showing small complexes. Prev radiotherapy

A

= constrictive pericarditis

132
Q

Most common cause of pericarditis? In low income countries?

A

coxsackie B virus

TB

133
Q

What is pathagnomic of pericarditis

A

pericardial friction rub
-‘ high-pitched scratching sound’ on left sternal border during expiration
-may be described as walking on fresh snow OR rubbing leather on leather

134
Q

Most common drug causing pericarditis

A

hydralazine

135
Q

What position is pericarditis most sore in?

A

Laying down
Relived by sitting forward (reduces contact with pericardium )

136
Q

What does cardiac tamponade leading to compression of lingular lobe let you find on the exam?> Called?

A

Left lower lobe bronchial breathing
Ewart’s sign

137
Q

Constrictive and restrictive cardiomyopathy have some similarities…? differences?

A

Similar
-Raised JVP with prominent x and y descents
-AF
-Normal systolic function

Differences
-No LVH in constrictive
-Calcification in constrictive (CforC)

138
Q

What is common ecg in pericarditis

A

widespread ST elevation / PR depression

139
Q

Management of viral pericarditis

A

NSAIDs

colchicine if NSAIDs contra indicated

[steroids second line]

140
Q

In HCM what is most associated with risk of sudden death

A

Degree of septal hypertrophy

[even more than outflow tract gradient]

141
Q

Found on ECG WPW?

A

Slurred up stroke QRS (delta wave)
Short PR

142
Q

What is Kussmaul’s sign? Seen in?

A

Inspiratory increase in venous pressure
(pericarditis)

143
Q

Prominent S3 heard over apex

A

Aortic regurg

144
Q

SVT prophylaxis in pregnancy drug?

A

Metoprolol (TDS)

145
Q

Differentiate primium and secundum ASD on ECG.

A

Pri - often LAD
Sec - Often RAD

146
Q

Trop in peri vs myocarditis

A

Very high in myocarditis (therefore diagnostic)

147
Q

When is verapamil contraindicated

A

Accessory pathways Eg WPW
LVSD
2nd / 3rd degree block

148
Q

Kussmaul’s sign seen usually in which MI

A

proximal occlusion of the right coronary artery -> RV

149
Q

J-point depression of 1mm on ETT. Significance?

A

J point depression is normal physiological response to exercise

150
Q

PPH and pregnancy?

A

Absolute CI to pregnancy - should be advised as PPH will rapidly worsen in preg

151
Q

Systolic murmur loudest at apex most likely? Effect of isometric handgrip exercises?

A

Mitral regurg

Handgrip exercises increase afterload -> make AR/MR/VSD murmurs louder

152
Q

isometric handgrip exercises and mitral prolapse

A

Increases LV volume -> delays click and murmur

153
Q

Unstable angina due to Which lipid/cholesterol most?

A

LDL

154
Q

When is NT-proBNP unreliable

A

Renal dysfunction (95% renal cleared)

BNP is only 5% renal cleared

155
Q

AS - what concurrent issue would make murmur quieter

A

AF
LV failure (less blood)

156
Q

WPW / other pre-excitation pathway in fast AF drug?

A

Procainamide

(adeonsine may -> VT/VF)

157
Q

Class of drug CI with sildenafil

A

Nitrates
[may precipitate fatal hypotension]

158
Q

Self terminating SVT in preg

A

Reassure - don’t need to check nothing

159
Q

ECG characteristic finding in moderate hypothermia

A

J waves

160
Q

Which are the rate-limiting CCBs

A

Verapamil and Diltiazem

161
Q

Poorly controlled AF and symptomatic despite medical therapy Rx

A

Radiofrequency pulmonary vein ablation

162
Q

BP in preg physiological change?

A

Tend to get a 10mmHg diastolic drop in 2nd trimester (then normalises

163
Q

When can you use IV lidocaine?

A

Resistant haemodynamically stable VT

164
Q

New Fast AF Strucually normal heart first-line drug?
If LVH?
Significant IHD?

A

Flecianide
Amiodarone if LVH
Soltalol if IHD

165
Q

Where is the 1st heart sound on ECG? what is it?

A

R wave

mitral and tricuspid closure

166
Q

Complete heart block what is heard on auscultation

A

Variable intensity of first heart sound (mitral / tricuspid closure)

[First heart sound is related to PR interval. This varies in complete HB)

167
Q

First degree HB auscultation

A

Quiet S1 [due to long PR]

168
Q

Pulm HTN auscultation

A

Loud S2

169
Q

MR vs MS heart sound

A

MR quiet first heart sound

MS loud first heart sound

170
Q

Mitral prolapse. what happens to the murmur if the patient is standing

A

The mid-systolic click and murmur will occur earlier

171
Q

Statins post MI

A

Shown to lower risk of CV death even if normal cholesterol

172
Q

Really severe AS auscultation

A

Quiet or even loss of S2

173
Q

Handgrip in AS vs MR?

A

murmur of aortic stenosis decreases

murmur of mitral regurgitation increases.

174
Q

HR / SBP in MRCP to be classed as unstable?

A

HR >150
SBP <90

175
Q

Find a member of public in cardiac arrest. What first

A

Call 999
Then shart compression

176
Q

RCA occlusion ST elevation where? If RV completely infarcted?

A

II, III, AVF (+ depression aVL)

STe also in V1 and V4

177
Q

Aortic valve gradient to be classes as significant

A

> 70mmHg

178
Q

Right arm higher BP than the left with systolic murmur =

A

Supravalvular aortic stenosis
-> Blood preferentially sent up to R brachiocephalic

179
Q

Differentiate subclavian steal syndrome and supravalvular aortic stenosis from pt history

A

In subclavian steal, there would be significant Hx of neuro eg syncopal episodes / memory issues alongside the difference in arm BPs

180
Q

AS + anaemia =
Which clotting factor is involved?
What are they at key risk?
Rx?

A

Heyde syndrome

High stress over AV leads to the unfolding and activation of VWF
->Aquired VWF deficiency

GI bleeding from angiodysplasia

AV replacement

181
Q

Someone going for a hip replacement and can’t walk due to pain. How do you test their CV function for the operation?

A

Dobutamine stress echo - with ECG

[Need to discontinue BB 3 days in advance]

182
Q

Atrial Myxoma
Usual location?
Key symptoms / issues?
Dx?

A

L atrium attached to atrial septum 75%
Parts of tumour break off and act as clots
Can get intra cardiac obstruction

Diagnose with echo

183
Q

Bar ASD what else causes a wide fixed splitting of S2?
When in normal people is the splitting of S2 heard?

A

RBBB with heart failure
Pulm stenosis

In normal people, s2 is split during inspiration -> increased venous return to the right heart
-> delayed pulm valve closure (relative to AV)

184
Q

Reversed split of S2

A

LBBB
AS
[PDA / HCM]

185
Q

Which is the key thing auscultated in LV failure

A

S4

186
Q

Unstable angina - how to get your HGV license back

A

ETT
[Need to complete 8 mins of bruce protocol]

187
Q

New AF with no adverse features or Hx drug?

A

Felcanide

188
Q

Cranberry Fruit juice affects?

A

Warfarin mostly
[ Amitriptyline, diazepam and ARBs]

189
Q

What does graprefruit juice do

A

P450 inhibitor

190
Q

Triad of AS symptoms

A

Angina, LVF, syncope

191
Q

WPW Type A vs B on ECG

A

Both have:
Short PR, d-wave, wide QRS but normal QT

A - tall R wave in V 1
B - Deep S wave v1

192
Q

Adenosine mechanism

A

G-coupled protein receptor agonist

[Also K channel agonist and Ca channel blocker]

193
Q

Flecanide mechanism

A

Sodium channel blocker

194
Q

Amiodarone mechanism

A

Potassium channel blocker

195
Q

When does the balloon pump inflate

A

When aortic valve closes (diastole

196
Q

LBBB and history of IHD what 2 things on auscultation

A

Soft s1
Reversed splitting of S2

197
Q

Known bad asthmatic in fast AF without instability

A

Verapamil
[or diltiazem]

198
Q

Does amlodipine affect HR

A

No effect on heart rate
Only affects BP

199
Q

Why digoxin only really in AF in sedentary people

A

Dignoxin only affects heart rate at rest, not when active

200
Q

Being treated for PCP with septrin. Develops erythema multiform, then acute raised JVP, muffled heart sounds and hypotension. What has happened?

A

Allergic myocarditis from co-trimoxazole
[and probably ruptured myocardium]

201
Q

3-year vague history of Raynaud’s, PE. tricuspid stenosis murmur =

A

R atrial myxoma

202
Q

Type of echo to confirm PDA

A

Toe with bubble study

203
Q

Most common sarcomere mutation in HCM affects what?

A

beta-myosin heavy chain

204
Q

Mix of SVTs / brady arrhythmias and short sinus arrest? Usual cause? Rx?

A

Sick sinus syndrome
Fatty deposits / fibrosis of node - often due to atherosclerosis

Pacemaker + medical Rx of SVTs if needed Eg bisoprolol

205
Q

Clopidogrel mechanism

A

ADP blocker

206
Q

Aspirin mechanism for anti-platelet effects

A

Thromboxane inhibitor

207
Q

Abciximab, Tirofiban, Eptifibatine mechanism

A

Glycoprotein IIb/IIIa inhibitors

208
Q

Heparin / LMWH mechanism

A

Potentiate antithrombin III

209
Q

MI. now on ETT. What would make you refer for an angio?

A

Manage <6 mins with ECG changes

210
Q

Which antiarrhythmic class work on SA/AV node

A

Class IV - CCBs

211
Q

Flecanide class?

A

Na channel blocker (Class I)

212
Q

How do B blockers slow HR

A

Slow conduction through AV node

213
Q

Irregular cannon waves on JVP

A

Complete heart block

[Cannon waves caused by atria contracting against closed TV]

214
Q

AVR. Has ischemic stroke on warfarin (INR therapeutic Eg 3) acute Rx?

A

Nothing - continue warfarin

215
Q

Which murmur is reduced in pregnancy? Why?

Which new murmur may occur?

A

Aortic regurg - due to reduced diastolic bp
[Ie. The difference in pressure of the Aorta and LV is less]

May develop a pulm systolic murmur / 3rd heart sound
All stenosis murmurs will get louder due to increased blood flow

216
Q

Why splitting of S2 in normal inspiration

A

Increased venous return overloads RV and delays closure of pulm valve

217
Q

Which drug causes short QT

A

Digoxin

218
Q

Which antiarrhythmics cause long QT

A

Class 1, 3

219
Q

Pressure for pulm HTN

A

Pressure >25mmHg

220
Q

Normal pulm capilliary wedge pressure

A

<12

221
Q

Abx prolonging QT

A

Macrolide
Quinolones

222
Q

3 feautres of ECG for vt

A

Wide QRS
Tachycardia
AV dissociation

223
Q

Which type of pacemaker for symptomatic biventricular failure?

Brady / sick sinus syndrome?

A

Biventricular

Dual chamber for bradies
-goes in Ra / RV

224
Q

DVT -> stroke. Which abnormality is the most common?

A

Patent foromen ovale

225
Q

ST elevation of 0.5mm in V1/2 with central chest pain Rx

A

Aspirin + heparin and repeat ECG in 15 mins

226
Q

LVH due to which valvular issues?
RVH
BVH

A

LVH - AS/MR
RVH - PS/TR
BVH - VSD

227
Q

Long QT genotypes and long term Rx

A

LQT1 - B blocker first -> defib
LQT2, LQT3 - Defib

228
Q

Goes for CABG. Now has direct and indirect hyperbilirubinemia, but no other deranged LFTs. Why?

A

Haemolysis on bypass

229
Q

Inferior MI 3/7 ago. Now pan systolic murmur is worse on inspiration and hypotensive. High right atrial pressure. Diagnosis

A

Tricuspid regurg

-High right atrial pressure indicating right heart issue
-Murmur that is worse on inspiration = Right heart

230
Q

liver that pulses on systole indicates which valv issue?

A

Tricuspid regurg

231
Q

What class of antiarrhythmic worst for torsades

A

Class III eg Sotalaol / amiodarone

232
Q

What class of antiarrhythmic worst for torsades

A

Class III eg Sotalaol / amiodarone

233
Q

Which cardiac enzyme needs to be measured within the first 3 hours of an MI

A

Glycogen Phosphorylase isoenzyme BB

234
Q

AF with RVR and known reduced ejection fraction. Brittle asthma. rx?

A

Digoxin

235
Q

Does someone with lime disease complete AV block need a pacemaker?

A

No, it is usually reversible
-They do need observation until recovered though

236
Q

Tricuspid stenosis vs regurg in jugular waves

A

Stenosis = Prominent A wave
[Atrial contraction against stenosed valve]
Regurg = Prominent V waves

237
Q

Complete heart block usual rate? Auscultation?

A

25-30
Basal systolic flow murmur
[due to increased stroke volume - compensatory mechanism]

238
Q

Prothetic valve endocarditis Abx?

A

Vanc, gent and rifampicin

239
Q

2nd degree heart block where is type 1 vs type 2 issue?

A

2nd-degree type 1 - at AV node
Type 2 - bundle of his/ Purkinje

240
Q

Most common gene in long QT syndrome? chromosome? Codes for?

A

LQT1 - most common type
Gene - KCNQ1 on chromosome 11

Slow delayed rectifier potassium channel mutation

241
Q

When HTN pres existing and when pre-eclampsia

A

Before or after 20 weeks gestation

242
Q

How long sinus pause for a pacemaker?
Which types of block

A

> 3s

Mobitz 2 / complete
Trifasicular

243
Q

The most anterior valve of the heart and most likely to be injured in stabbing?

A

Pulmonary

244
Q

Develops tachy - has p waves
Rate accelerates once arrhythmia started

A

Automatic supraventricular tachyarrhythmia
[this if rate accelerates]

245
Q

Who has a CK basline 3 times normal people

A

Afro caribean

246
Q

Most common cardiac abnormality in downs

A

AVSD

[VSD>ASD]

247
Q

When in partum cycle do mothers get most VTEs

A

6 weeks postpartum

248
Q

Where on ECG are epsilon potentials seen? Indicate?

A

RV leads - Little blip after QRS in V1,2

RV dysplasia
[Due to displacement of myocytes by fat -> delays depolarisation of other myocytes]

249
Q

Old Atrial enlargement with reduced EF. In AF rate 100, has asthma and myasthenia gravis[lol]. Rx?

A

Digoxin

250
Q

Congenital myotonic dystrophy most common ECG abnormality

A

Prolonged PR

251
Q

Old. Collapse, pulseless for couple of seconds. Normal 7 day ECG = ? Dx?

A

Carotid sinus syndrome

Supine carotid sinus massage with ECG monitoring -> 3s pause / drop in BP >50mmHg
[Ovs cant do if carotid disease or stroke Hx]

252
Q

Which valve lesion would lead to increased end diasolic LV pressure

A

MR

253
Q

When might pulseless alterans be heard

A

Acute LVF - Alternating strength of pulse

[Also in low-output states Eg pericarditis ]

254
Q

PDA character of pulse

A

Collapsing
[Think similar to AR in whats happening to blood flow]

255
Q

Main agent for controlled reduction of BP in hypertensive crisis

A

IV labetalol

[If they having a phat stroke and reduced conciousness -> sodium nitroprusside ]

256
Q

Myeloma and secondary cardiac amyloid. What is the typical cardiomyopathy here

A

Restrictive

257
Q

Known ASD with progressive cyanosis, haemoptysis and episodes of syncope probably has

A

Pulm HTN

258
Q

55 years. Claudication in legs.
BP difference in arms but no radial-radial or radial-femoral delay =

A

PVD
Coarctation would expect to have RR /RF delay

259
Q

Pericarditis - 2 things found in stage one ? Then what?

A

Stage 1: Concave ST elevation, PR depression
2: ST baseline, T wave flattening
3: TWI
4: resolution

260
Q

Endocarditis rank valves in likelihood order

A

Mitral
Aortic
Tricuspid
Pulm

Obviously, any abnormality Eg MS or AR etc increases the risk

261
Q

ASD VSD endocarditis risk

A

ASD low
VSD high

262
Q

Palmar crease xanthomas are pathognomic of

A

Type III hyperlipidaemia
[broad B disease]

263
Q

Loud S1, then early diastole sound then mid-diastolic murmur

A

MS with mobile leaflets

[probably from rheumatic fever]

264
Q

HTN Rx steps

A

ACE (or ARB) or CCB
ACE + CCB
+thiazide
+Spironolactone if K+ <4.5 OR increase thiazide otherwise

265
Q

V5 V6 TWI with MI Hx features which vessle=

A

Critical stenosis of cricumflex

266
Q

Severe AS heart sound

A

Soft S2

267
Q

Prev chemoradio
Raised JVP with steep Y descent, pulsatile liver, low voltage complexes

A

Post radiation constrictive pericarditis

268
Q

Aortic dissection - going for an operation
2 drugs to give IV urgently

A

Opiates
Labetalol

269
Q

Pharyngitis, fever, polyarthritis, new murmur =?
Ix?
Rx?

A

Rheumatic fever
Echo + anti streptolysin O titre
Penicillin and supportive

270
Q

On warfarin for AF going for a dental procedure INR 2. plan?

A

Go ahead

271
Q

Acute chest pain looks unwell. Unequal BP in arms, AR on auscultation =

A

Aortic dissection

MRCP PART 1 (22 decks)

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