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cardiology Flashcards

1
Q

Dressler’s syndrome

A

post MI pericarditis

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2
Q

ECG changes in pericarditis

A

global/widespread,
‘saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis

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3
Q

Mx pericarditis

A

acute pericarditis should have transthoracic echocardiography
treat the underlying cause
a combination of NSAIDs and colchicine

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4
Q

ECG leads and territories

A

see screenshot

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5
Q

when is adenosine used

A

terminate SVTs

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6
Q

when is amiodarone used

A

Amiodarone is a class III antiarrhythmic agent used in the treatment of atrial, nodal and ventricular tachycardias

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7
Q

eg rate limiting ca channel blockers

A

verapamil, diltiazem

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8
Q

which 2 cardio meds can cause complete heart block if taken together

A

beta-blockers and verapamil

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9
Q

ARB examples

A

candesartan
losartan
irbesartan

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10
Q

causes of aortic dissection

A

hypertension: the most important risk factor
trauma
bicuspid aortic valve
collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
Turner’s and Noonan’s syndrome
pregnancy
syphilis

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11
Q

Aortic dissection symptoms

A

chest/back pain
pulse deficit
aortic regurgitation
hypertension
the majority of patients have no or non-specific ECG changes. In a minority of patients, ST-segment elevation may be seen in the inferior leads

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12
Q

types aortic dissection

A

Stanford classification
type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases

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13
Q

gold standard aortic dissection Ix

A
  • CT angiography of the chest, abdomen and pelvis is the investigation of choice
    suitable for stable patients and for planning surgery
    a false lumen is a key finding in diagnosing aortic dissection
  • Transoesophageal echocardiography (TOE)
    more suitable for unstable patients who are too risky to take to CT scanner
  • CXR can be also done- shows widened mediastinum (or loss of aortic knob)
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14
Q

atrial flutter ecg findings

A

saw tooth

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15
Q

management atrial flutter

A

Management
is similar to that of atrial fibrillation although medication may be less effective
atrial flutter is more sensitive to cardioversion however so lower energy levels may be used
radiofrequency ablation of the tricuspid valve isthmus is curative for most patients

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16
Q

Atrial myxoma most common chamber

A

LA

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17
Q

Atrial septal defects symptoms
which type more common?

A

Features
ejection systolic murmur, fixed splitting of S2
embolism may pass from venous system to left side of heart causing a stroke
ostium secundem more common

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18
Q

types of heart block and symptoms and ecg

A
  1. first degree heart block: Prolonged PR >0.2secs, asymptomatic usually and o tx needed
  2. mobitz1 wenkebach: increasing pr interval until missed beat
    mobitz 2: constant PR interval but P often not followed by QRS
  3. complete heart block there is no association between the P waves and QRS complexes
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19
Q

atropine use

A

bradycardia

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20
Q

Bivalirudin

A

Bivalirudin is a reversible direct thrombin inhibitor used as an anticoagulant in the management of acute coronary syndrome.

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21
Q

Brugada syndrome

CFs
Tx

A

inherited cardiovascular disease with may present with sudden cardiac death.

autosomal dominant fashion
mutation in the SCN5A gene

ECG shows convex ST elevation in V1-V3 with a partial right bundle branch block

Mx= ICD

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22
Q

becks triad

A

cardiac tampondade:
- hypotension
- muffled heart sounds
- raised JVP

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23
Q

other symptoms of cardiac tamponade (inc becks traid)

A

pulsus paradoxus - an extra large drop in BP during inspiration
Kussmaul’s sign - much debate about this
ECG: electrical alternans

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24
Q

management cardiac tamponade

A

Management
urgent pericardiocentes

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25
Q

Leading cause of sudden cardiac death in young athletes

A

Hypertrophic obstructive cardiomyopathy

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26
Q

Right ventricular myocardium is replaced by fatty and fibrofatty tissue

A

Arrhythmogenic right ventricular dysplasia
Tx= ICD and sotalol , catheter ablation

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27
Q

Catecholaminergic polymorphic ventricular tachycardia

A

inherited cardiac disease associated with sudden cardiac death.

autosomal dominant fashion and has a prevalence of around 1:10,000.
- defect in the ryanodine receptor (RYR2)
Mx Management
beta-blockers
implantable cardioverter-defibrillator

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28
Q

Coarctation of the aorta

A

Coarctation of the aorta describes a congenital narrowing of the descending aorta.

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29
Q

Complete heart block symptoms

A

syncope
heart failure
regular bradycardia (30-50 bpm)
wide pulse pressure
JVP: cannon waves in neck
variable intensity of S1

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30
Q

systole or diastole when coronary arteries fill?

A

The coronary arteries fill during diastole.

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31
Q

prolonged QT interval on ECG?

A

hypocalcemia

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32
Q

causes L axis deviation

A

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

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33
Q

causes RAD

A

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people

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34
Q

digoxin ecg changes

A

ECG features
down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia

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35
Q

ECG: hypokalaemia

A

ECG features of hypokalaemia
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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36
Q

ECG: hypothermia

A

The following ECG changes may be seen in hypothermia
bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

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37
Q

LBBB AND RBBB ECG

A

in LBBB there is a ‘W’ in V1 and a ‘M’ in V6
in RBBB there is a ‘M’ in V1 and a ‘W’ in V6

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38
Q

WHICH TYPe of BBB is always pathological

A

new LBBB always pathological

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39
Q

S1Q3T3’)

A

PE

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40
Q

Inverted T waves CAUSES

A

myocardial ischaemia
digoxin toxicity
subarachnoid haemorrhage
arrhythmogenic right ventricular cardiomyopathy
pulmonary embolism (‘S1Q3T3’)
Brugada syndrome

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41
Q

Eisenmenger’s syndrome
- which conditions cause it

A

reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.
- ventricular septal defect
atrial septal defect
patent ductus arteriosus

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42
Q

symptoms eisenmengers syndrome

Tx

A

original murmur may disappear
cyanosis
clubbing
right ventricular failure
haemoptysis, embolism

Tx= heart and lung transplant

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43
Q

when are exercise tolerance tests used

A
  1. suspected angina
  2. risk stratifying patients post MI
  3. risk stratifying pts with hypertrophic cardiomyopathy
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44
Q

Causes of a loud S1

A

mitral stenosis
left-to-right shunts
short PR interval, atrial premature beats
hyperdynamic states

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45
Q

Causes of a quiet S1

A

mitral regurgitation

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46
Q

Hypercalcaemia: features

A

‘bones, stones, groans and psychic moans’
corneal calcification
shortened QT interval on ECG
hypertension

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47
Q

Hypertension in pregnancy in usually defined as:

A

systolic > 140 mmHg or diastolic > 90 mmHg
OR

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48
Q

Blood pressure classification

A

Stage 1 Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

Stage 2 Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

Severe hypertension Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg

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49
Q

Infective endocarditis causes and organisms- which org most common?

A

Staphylococcus aureus
-most common cause
- IVDUs

Streptococcus viridans
-dental procedures
- streptococcus sanguinis and streptococcus mitis

coagulase-negative Staph such as Staphy epidermidis
- valve surgery

Strep bovis
- colorectal ca

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50
Q

Infective endocarditis- duke criteria - MAJOR criteria

A
  • Positive blood cultures
  • Echo signs (veg, abscess etc)
  • new regurg murmur
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51
Q

Infective endocarditis treatment- initial blind therapy

A

Initial blind therapy
- NATIVE VALVE: amox
PEN allergic- vanc and gent

If prosthetic valve
vancomycin + rifampicin + low-dose gentamicin

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52
Q

JVP wave order

A

ACXVY

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53
Q

Kawasaki disease

A

Features
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

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54
Q

Mx kawasaki disease

A
  • high-dose aspirin
  • IV immunoglobulin
  • echocardiogram -is used as the initial screening test for coronary artery aneurysms
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55
Q

What type of murmurs are benign

A

systolic

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56
Q

AORTIC STENOSIS

A
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57
Q

is the aortic valve usually tri or bileaflet

A

tricuspid

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58
Q

Aortic stenosis
causes
symptoms
signs
treatment

A

causes: age related calficication, congential bicuspid valve, post rheumatic
SYMPTOMS: SOBOE, syncope, LV dysfunction,
SIGNS:
ejection systolic murmur, slow rising pulse, narrow pulse pressure, S4, split A2.
Tx: if symptomatic- surgery

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59
Q

Aortic regurgitation
causes
symptoms
signs
treatment

A

causes: post rheumatic fever, HTN, syphylis, Ank spon, infective endocarditis, AORTIC DISSECTIOn

symptoms
SOB, LV failure, infective endocarditis not responsive to treatment, enlarged heart

signs,
lengthening diastolic murmur, pistol shot femorals, de quinckes, de musset, collapsing radial pulse
tx= prompt surgery

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60
Q

eponymous signs assosciated with AR

A

see album on phone

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61
Q

cyanotic or acyanotic?
ASD

A

acyanotic

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62
Q

cyanotic or acyanotic?
ToF

A

cyanotic

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63
Q

cyanotic or acyanotic
VSD

A

acyanotic

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64
Q

cyanotic or acyanotic
CoA

A

acyanotic

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65
Q

cyanotic or acyanotic
PDA

A

acyanotic

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66
Q

cyanotic or acyanotic
ebstiens anomaly
- what type of murmur does ebsteins anomaly cause

A

causes TR
cyanotic

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67
Q

cyanotic or acyanotic
transposition of great vessels

A

cyanotic

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68
Q

cyanotic or acyanotic
hypoplastic left heart

A

cyanotic

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69
Q

acyanotic heart disease with shunt

A

ASD, VSD, PDA, CoA

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70
Q

cyanotic disease without shunt

A

congen AS, CoA

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71
Q

cyanotic disease with shunt

A

ToF, ebsteins anomaly, complete transposition of great vessels,

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72
Q

acyanotic disease without shunt

A

lefy hypoplastic heart, pulmonary antresia, pulmonary stensis, tricuspid atresia

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73
Q

ASD signs , what is shown on ecg

A

ASD- split HS2 , Left parasternal heave

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74
Q

types of ASD, which is more common, ECG findings for both

A
  1. Secundem= most common , ECG shows RBBB, RAD, AFFETCS MITRAL VALVE
  2. primium- affects AV valve, ecg shows RBBB
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75
Q

VSD- what type of shunt

A

Left- right shunt

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76
Q

what type of murmur VSD

A

pansystolic if a large VSD
Ejection systolic if small VSD

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77
Q

which congenital heart defect causes machinery murmur

A

PDA

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78
Q

PDA- signs

A

prem babies
wide pulse pressure
bounding pulse
left subclavicular thrill,
machinery murmur

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79
Q

when is prostaglandin given in congenital heart defects and WHY

A

prostaglandin prevents the natural closing of DA- to allow blood flow in TGA, hypoplastic left heart syndrome, CoA

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80
Q

ebsteins anomaly: causes, symptoms

A

Low insertion of the tricuspid valve resulting in a large atrium and small ventricle.

ass’d with:
patent foramen ovale/ ASD
White syndrome
lithium

signs:
prominent a wave
RBBB, WOLF parkinson white syndrome, cyanosis, pansystolic murmur, tricuspid regurg

Ebstein’s anomaly → tricuspid regurgitation → pansystolic murmur, worse on inspiration

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81
Q

how soon can drive after permanent pacing

A

1 week

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82
Q

warfarin management of INR (when to stop, hold, give vit k)

A

see phone screenshot

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83
Q

intervention of choice for severe mitral stenosis

A

Percutaneous mitral commissurotomy

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84
Q

BNP - actions:

A

vasodilator: can decrease cardiac afterload
diuretic and natriuretic
suppresses both sympathetic tone and the RAAS

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85
Q

marker of severity in AS

86
Q

methadone commonly causes ?ECG change and causes death

87
Q

dilated cardiomyopathy can be caused by deficiency in what

A

selenium deficiency

88
Q

how does hydralazine reduce bp

A

increases GMP= smooth muscle relaxation

89
Q

which aa most likely affected following MI causing complete heart block

A

r coronary aa

90
Q

which sided murmur best heard on inspiration

A

RIGHT sided murmur
Aortic ejection systolic
Tricuspid regurg

91
Q

Dipyridamole MOA

A

phosphodiesterase inhibitor

92
Q

first line HTN in pregnancy management

A

po labetalol

2nd lie (if CI or not tolerated)= nifedipine

93
Q

when to thrombolyse in PE

A

hypotension + massiv ePE

94
Q

how does complete heart block affect heart sounds

A

variable S1

95
Q

ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave - which condition?

A

Arrhythmogenic right ventricular cardiomyopathy

ECG abnormalities in V1-3, typically T wave inversion- EPSILON wave

96
Q

A Swan-Ganz catheter is inserted to enable measurement of the pulmonary capillary wedge pressure in which chamber

A

left atrium

97
Q

which type of antiHTN med impairs glucose tolerance

98
Q

wolf parkinson white drug treatment

A

Flecainide

99
Q

prosthetic heart valves: anticoagulation
for mechanical VS bioprosthetic

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

100
Q

ECG changes in ASD

101
Q

how does SVCO affect JVP

A

non pulsatile raised JVP

102
Q

which type of murmur most associated with LBBB

A

AS

LBBB= MOST CONCERNING== == AS == WORST murmur

103
Q

persistent ST elevation following recent MI, no chest pain

A

left ventricular aneurysm

104
Q

o2 sats rising in the right ventricle, == what type of defect?

A

ventricular defect

105
Q

right side of heart noral o2 sats

A

approx 70%

106
Q

carcinoid syndrome

A

TIPS

Tricuspid Insufficiency
Pulmonary Stenosis

107
Q

murmurs best heard on inspiration/ expiration

A

RILE
Right-sided murmur → heard best on Inspiration
Left-sided murmur → heard best on Expiration

BUT: AS = louder on expiration

108
Q

AS MR ARMS PS TR

A

AS ej systolic
MR pansystolic
AR mid diastolic
MS late diastolic
PS ej systolic
TR pansystolic

109
Q

ASD type of murmur

A

ej systolic, loudest on expiration (same as PS)

110
Q

tetralogy of fallot
cyan or acyan
murmur
cause
shunting

4 features of ToF

A

4 features
-VSD
-RVHypertrophy
-RV outflow tract obstruction-pulmonary stenosis
-overriding aorta

boot shape heart
ej systolic murmur (Pulm stenosis)
R—L shunt!!

Mx
surgery in 2 stages
beta blockers may help cyanotic spells

ej systolic

111
Q

VSD murmur
what conditions VSD associated with 4

A

pansystolic

Downs
Edwards
Pataut
cru di chat

post MI

112
Q

Co A murmur

A

late systolic

113
Q

S4== on ecg

114
Q

S1 what valves close

A

atrial valves- tricuspid and mitral

115
Q

S2 what valves close

A

Aortic and pulmonary

116
Q

S3 causes

A

diastolic filling of the ventricle
- normal if < 30 years old
-LVF (e.g. dilated cardiomyopathy)
-constrictive pericarditis (PERICARDIAL KNOCK)
- mitral regurgitation

117
Q

S4 causes

A

AS
HOCM
HTN
ECG IS P WAVE

118
Q

obese people, inferior MI, hyperkalemia, LBBB, L ANTERIOR hemiblock ====ecg change, WPW RIGHT accessory pathwy

119
Q

causes of RAD

A

RVH
left POSTERIOR hemiblock
lateral MI
cor pulmonale
PE
ostium secundum ASD
WPW* - LEFT-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people

120
Q

ARB MOA

A

block effects of angiotensin II at the AT1 receptor

121
Q

first line HTN treatment for diabetics

A

ACEi or ARB REGARDLESS of age

122
Q

most common cardiac tumour

A

atrial myxoma

123
Q

most common location atrial myxoma

A

left atrium

124
Q

CFs atrial myxoma

A
  • systemic: dyspnoea, fatigue, weight loss,
    pyrexia of unknown origin, clubbing
    -emboli
    -atrial fibrillation
    -mid-diastolic murmur, ‘tumour plop’
    -echo: pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum
125
Q

LVEF <40% affects driving how?

A

cannot drive if <40%

126
Q

amiodarone half life

A

20-100 days

127
Q

Tendon xanthoma, tuberous xanthoma, xanthelsma & palmar xanthoma: most associated with what type of hyper lipidaemia
Eruptive xanthoma: E-FL(familial hypertriglyceridaemia)

A

remnant hyperlipidaemia & familial hypercholesterolemia

128
Q

Eruptive xanthoma: associated with what type of hyperlipdaemia/hypertriglyceridaemia

A

E-FL(familial hypertriglyceridaemia)

129
Q

what is brugada syndrome
inheritance
most common in ? population

A

inherited cardiac disease- can cause sudden death
inheritance- aut dominant
common in asians

130
Q

ECG changes brugada syndrome

what can be given to diagnose/investigate if brugada syndrome

Tx

A

ST elevation followed by negatvie T wave

partial RBBB

administration of flecainide or ajmaline - will make ecg changes more visible

Tx= ICD

131
Q

indication for temporary pacemaker

A
  • symptomatic/haemodynamically unstable bradycardia, not responding to atropine
  • post-ANTERIOR MI: type 2 or complete heart block

-trifascicular block prior to surgery

132
Q

sacubitril MOA

A

prevents the degradation of natriuretic peptides such as BNP and ANP.

133
Q

management pulmonary arterial hypoertension

A
  1. test whether responsive to asodilators. If YES– give calcium channel blocker eg nifedipine
  2. no response (maj of pts)
    prostacyclin analogue eg iloprost
    or
    endothelin receptor antagonist eg bosentan
134
Q

mechanical valve replacement– antithrombotic therapy?

A

warfarin (upside down M)

135
Q

Takayasu’s arteritis

A

large vessel vasculitis
occlusion of aorta
absent limb pulse

Systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)

Mx= steroids

136
Q

pan-systolic murmur
prominent/giant V waves in JVP
pulsatile hepatomegaly
left parasternal heave

signs ==?

A

tricuspid regurgitation

137
Q

prolonged PR causes

A

MILD RASH
Myotica dystrophica
IHD
Lyme
Digoxin toxicity
Rheumatic fever
Aortic abscess
Sarcoidosis
Hypokalemia

138
Q

Tx PDA

A

indomethacin as a neonate
or ibuprofen

GIVE IF ECHO SHOWS PDA one week after delivery- in neonatal period

139
Q

STOP STATINS in which type of antibiotic?
what happens

A

clarIthromycin– MACROLIDES
and pregnancy
statin+ clarithromycin = RHABDOMYOLISIS

140
Q

gynacomastia common in hypo or hyperthyroid

A

Gynaecomastia is seen HYPERTHYROIDISM

141
Q

WPW syndrome- what is it
- ECG changes
- associated conditions
- management

A

WPW= re entry tachycardia

ECG
short PR interval
wide QRS complexes with delta wave
LAD if right sided accessory pathway(more common)
RAD if left sided accessory pathway
LAD if right sided accessory pathway

Associations of WPW
HOCM
mitral valve prolapse
Ebstein’s anomaly
thyrotoxicosis
secundum ASD

Mx:
radiofrequency ablation of accessory pathway
medical therapy: sotalol, fleicanide, amiodarone

142
Q

causes pf psuedohyponatremia

A

high cholesterol

143
Q

heart failure LVEF<35% start which medication/

A

SUBCUBITRIL VALSARTAN (if still symptomatic on beta blocker and ACE inhibitor

IVRABRADINE if >35%

144
Q

Mitral stenosis severe- valve replacements

A

1st Balloon Percutaneous mitral commissurotomy
fails:
2nd surgical
fails:
3rd catheter replacement

145
Q

egg on side appearance paeds cardiac condition

A

= TGA - CYANOTIC

146
Q

HOCM what type of mm fibre affected

A

beta myosin HEAVY CHAIN

147
Q

long qt syndrome: which electrolyte channel causes this

A

potassium channel- LOSS of function
Blocking of the K channels

148
Q

ECG Changes in severe hypokalemia

A

: I know ‘U’ are ‘depressed’ because got no ‘T’ and ‘Pot’, but dont worry U got ‘long QT’ and ‘long PR’.

u wave
ST depression
T wave inversion
low potassium

long qt
long PR

149
Q

psudoxanthoma elasticum CFs

A

GI haemorrhage
incr risk IHD
retinal angyloid streaks
plucked chicken skin
mitral valve prolapse

150
Q

Pulmonary arterial hypertension patients with positive response to vasodilator testing TX???

A

should be treated with calcium channel blockers

151
Q

hocm treatment

A

ABCDE
Amiodarone
Betablocker or verapamil for symptoms
Cardiac defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

152
Q

Associations of X condition???
Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

153
Q

dilated cardiomyopathy affect on heart sounds

and causes of dilated cardio myopathy

A

causes 3rd heart sound

Causes of DCM - THIAMIN
Thiamine deficiency (wet beri-beri)
Hypertension
Ischaemic heart disease
Alcohol (and cocaine)
Myocarditis
Infiltrative (haemochromatosis and sarcoidosis)
No cause (idiopathic)

154
Q

VT rather than SVT with aberrant conduction features

A

AV dissociation
fusion or capture beats
positive QRS concordance in chest leads
marked left axis deviation
history of IHD
lack of response to adenosine or carotid sinus massage
QRS > 160 ms

155
Q

a paradoxical rise in the JVP during inspiration

A

constrictive pericarditis

157
Q

post PCI- time frame for re-stenosis and thrombosis

A

stent thrombosis in first 4 weeks
re-stenosis-3-6 months

IF ASAP after pci— then likely thrombosis

158
Q

Cholesterol emboli CFs and mneumonic
and what can trigger it

A

PERL

Purpura
eosinophilia
renal failure
livedo reticularis

majority of cases are secondary to vascular surgery or angiography

159
Q

clopidogrel MOA

A

antagonist of P2y ADP receptor= inhibits platelet action
need to stop 7 days before surgery
concurrent PPI use may make clopi less effective

160
Q

Causes of:

eruptive xanthoma

Palmar xanthoma

Tendon xanthoma,tuberous xanthoma and xanthelasma

A

eruptive xanthoma=
familial hypertriglyceridaemia
lipoprotein lipase deficiency
(T in erupTive)

Palmar xanthoma= remnant hyperlipidaemia (familial hyperchol less)
palms remain sweaty

Tendon xanthoma,tuberous xanthoma and xanthelasma=
remnant hyperlipid AND familial hypercholesterolaemia

161
Q

when to stop exercise tolerance test
and how to remember it

A

when to stop exercise tolerance test

The 23 rule!!

2 mm ST elevation, 3 mm ST depression , SBP> 230 mmHg , SBP falling more than 20mmHg , HR falling more than 20%.

162
Q

takotsubo cardiomyopathy

A

ST elevation
balloon heart, octopus pot

165
Q

CT angiography of the chest is organized, which demonstrates an intimal flap proximal to the brachiocephalic vessels==== is this TYPE A OR TYPE B aortic dissection

A

type A= needs surgery and iv labetalol

166
Q

PCI - what type of antiplatelets do pts need to be on and for how long

A

aspirin for life
+/- clopidogrel pending type of stent

167
Q

when should primary pci take timeframe

A

within 120 minutes

if not possible
thrombolysis within 12 hrs of onset with altepalse

168
Q

stroke + leg DVT =?
likely cause
Ix

A

patent foramen ovale– ASD OR VSD
Ix= echo

169
Q

poor prognostic factors HOCM

A

Poor prognostic factors

-syncope
-family history of sudden death
-young age at presentation
-non-sustained VT on 24 or 48-hour Holter monitoring
- abnormal BP changes on exercise
-An increased septal wall thickness

170
Q

conditions associated with CoA

A

acyanotic condition

Turners
biscusipid aortic valve
neurofibromatosis
berry aneurysms

171
Q

complete heart block: 5 features

A

syncope
regular bradycardia
WIDE pulse pressure
JVP cannon waves
Variable intensity of S1

172
Q

first line treatment of prinzmetal angina

A

dihydropyridine calcium channel blocker
FELODIPINE

173
Q

which med used in angina medication can cause ulcers anywhere in the body

A

Nicorandil

174
Q

troponin role

A

troponin = component of THIN filaments

troponIN = thIN

175
Q

ticagrelor MOA

A

inhibits ADP binding to platelet receptors

176
Q

rheumatic heart disease 4 features

A

The 4 As of rheumatic fever:
caused by group-A-strep
high ASO-titre
presence of Aschoff bodies and Anitschkow cells

177
Q

what type of heart mumur can VSD go on to cause in addition to the existing pansystolic

A

AR
other complications o VSD:
Eisenmengers complex ( due to prolonged pulm HTN from L=r shunt
R heart failure
pulm HTN

178
Q

which coronary aa supplies AVN and SAN

A

R coronary

179
Q

MOA sacubitril/valsartan

A

prevents the degradation of natriuretic peptides such as BNP and ANP.

180
Q

cholesterol embolism CFs

A

complication of coronary angiography
cholesterol emboli may break off and cause renal disease

CFs
eosinophilia
purpuric rash- renal
renal failure
livedo reticularis

181
Q

for AF which type of med is ONLY used

A

DOAC

eg apixaban
dabigatran
edoxaban
rivaroxaban

182
Q

whcih part of P QRS ST is used in DC cardioversion

A

Electrical cardioversion is synchronised to the R wave

183
Q

how to remember risks for statin induced myopathy

A

thin old diabetic lady

184
Q

tracer used in PET scan

A

Fluorodeoxyglucose

185
Q

Furosemide MOA

A

inhibits Na K Cl co transporter at thick ascending loop of henle

186
Q

bumetanide MOA and what type of diuretic is it

A

bumetanide= loop diuretic
MOA= inibits na k cl co transporter at thick ascending loop of henle

187
Q

causes of restricted cardiomyopathy (5)

A

SLASH

SLASH: sarcoidosis lofflers amyloid scleroderma haemochromatosis

188
Q

Causes of ST depression (5)

A

SIADH: mnemonic for ST depression causes

syndrome X
Ischemia
Abnormal qrs
Digoxin
Hypokalemia

189
Q

how to treat uraemic pericarditis

A

haemdialysis

190
Q

thiazide/thiazide like drugs MOA

A

inhibition of sodium reabsorption at start of DCT

191
Q

Persistent ST elevation following recent MI, no chest pain = ???

A

left ventricular aneurysm

192
Q

GTN moa

A

dilates systemic veins

193
Q

What is lutembachers syndrome

A

AF and progressive RH Failure
L parasternal heave
mid diastolic murmur
L to R shunt

194
Q

SVT prophylaxis in pregnancy

A

metoprolol

195
Q

If high-risk of failure of cardioversion (previous failure), offer electrical cardioversion after at least 4 weeks treatment with ???????

A

If high-risk of failure of cardioversion (previous failure), offer electrical cardioversion after at least 4 weeks treatment with amiodarone

196
Q

centrally acting antihypertensive (3)

A

CMM= central news cnn
Clonidine
Methyldopa
Moxonidine

197
Q

pt unable to do stress echo due to eg pain, trauma reasons- what to do

A

dobutamine stress echo

198
Q

how does valsava affect body

A

decrease venous return to heart

199
Q

how does severe heart failure affect aldosterone

A

increases plasma aldosterone concentration

200
Q

post inferior MI= what is most likely to happen

A

AV node block

201
Q

multifocal tachycardia is mANAGEMENT

A

RATE LIMITING CA CHANNEL BLOCKER= VERAPAMIL

three different P wave morphologies are seen

202
Q

L parasternal heave which type of heart murmur

203
Q

regulary vs irregular cannon a waves meaning

A

REGULAR cannon waves = atrioventricular nodal re entry

IRREG= complete heart block

204
Q

post MI which antidepressant to start

A

sertraline

205
Q

post MI complete heart block- which coronary aa most likely affected

A

right coronary artery

206
Q

which antihytertensive can cause lithium toxicity

A

ramipril ACEi

207
Q

when to use anti lipid meds in T2DM

A

NICE specifically state that we should not use QRISK2 for type 1 diabetics. Instead, the following criteria are used:
older than 40 years, or
have had diabetes for more than 10 years or
have established nephropathy or
have other CVD risk factors

208
Q

EZETIMIBE moa

A

NPC1L1 inhibitor

209
Q

Which type of anti htn med causes gum hypertrophy

A

amlodipine/ ca channel blockers

210
Q

NSTElevation in V1-3 caused by? which aa

A

posterior descending artery

211
Q

culture-negative endocarditis causative organism for a farmer

A

culture-negative endocarditis
coxiella
treat with doxy
coxy doxy

M R C P (18 decks)

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