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Cardiology Flashcards

1
Q

Antiplatelets and DOAC for AF and post ACS

A

AF
- 1st month - Triple
- 1-12 months - DOAC and antiplatelets
- > 12 months - DOAC only

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2
Q

Post ACS antiplatelets based on ischaemic risk or bleeding risk

A

High ischaemic risl
- >12 months - DAPT or aspirin + low dose riva

High bleeding risk
- 1-12 months, single antiplatelt

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3
Q

Stroke < 60, no cause
- Check for?
- If found

A

PFO

Should be closed if found

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4
Q

Treatment of Tuberous sclerosis
- Seizures
-pLAM

A

mTOR inhibitors
- Sirolimus first line

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5
Q

Antiepileptic causing weight loss

A

Topiramate

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6
Q

A/E of leviteracetam

A

Psychiatric
- Irritability, mood swings, suicidality

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7
Q

MoA of leviteracetam

A

Synaptic vesicle protein 2A inhibition -> inhibits Ca2+ currents

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8
Q

HLA-5701

A

Abacavir and hypersensitivity

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9
Q

HLA-5801

A

Allopurinol and DRESS

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10
Q

HLA*1502

A

CBZ and SJS
- Check in Han Chinese

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11
Q

Pyrodixine
- implication in GABA
- Deficiency - symptoms and cause

A

Required for GABA synthesis

Deficiency can cause seizures, peripheral neuropathy

Common cause isoniazid use - Give concomittant B6

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12
Q

Mechanism of cardiac contraction

A

Intracellular Ca - binds troponin C, changes shape to reveal actin

Actin binds myosin–> conformational change, cross bridge cycle and contraction

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13
Q

Cardiac relaxation mechanism

A

Troponin/tropomyosin blocks actin sites, so cannot bind myosin

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14
Q

Cardiac relaxation mechanism

A

Troponin/tropomyosin blocks actin sites

Actin cannot bind myosin

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15
Q

ACute rheumatic fever - which component of cardiac tissue contributes to molecular mimicry

A

Myosin

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16
Q

Pulsus paradoxus
- Definition
- 2 causes

A

> 10mmg Hg drop in SBP during inspiration

Causes
- Tamponade, pericardial effusion
- Severe asthma

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17
Q

U wave

A

Hypokalaemia

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18
Q

Carcinoid syndrome heart disease

A

Valvular

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19
Q

Rheumatic fever major criteria

A

SPACE
subcutaneous nodules, pancarditis, arthritis, chorea, erythema marginum

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20
Q

Rheumatic fever minor criteria

A

IHAT
Inflamm marers, Heart block, arthralgias, Temps

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21
Q

Single vessel revascularisation

A

PCI

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22
Q

Two vessel revascularisation
- scenarios

A

CABG if diabetic, LAD with high myocardium, high Syntax

Otherwise PCI

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23
Q

Triple vessel disease - scenarios

A

Low syntax, no diabetes - can do PCI

Otherwise CABG

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24
Q

Gene for Brugada

A

SCN5A

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25
Q

Genetics of Brugada

A

Autosomal dominant, variable pentrance

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26
Q

Pathophys of Brugada

A

Na channel - loss of function

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27
Q

Importance of ECG changes in Brugada assessment
- What are they
- Type 1 vs 2/3

A

RBBB and STE V1-V3

Type 1 - classic coved

Type 2/3- equivocal, need fleccanide challenge to unmask

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28
Q

Treatment of Brugada?

A

SCD/VT/syncope - ICD
Asymptomatic (ie not meeting criteria) - no treatment

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29
Q

Erlenmeyer flask abnormality

A

Gauchers

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30
Q

Rheumatic fever 2nd PPx?
- Mild MR or MS
- PR prolongation

A

10 years or until 21

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31
Q

Rheumatic fever 2nd PPx?
- Mod MR or MS
- Combined mild MR/MS

A

10 years until 35

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32
Q

Rheumatic fever 2nd PPx?
- Severe MR or MS
- Combined mod MR/MS

A

10 years until 40

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33
Q

Rheumatic fever, no cardiac involvement
- 2nd PPx?

A

5 years, until 21

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34
Q

Reversible PY12 inhibitor

A

Ticag

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35
Q

Irreversible PY12 inhibitor

A

Clopidogrel
Pasugral

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36
Q

Indications for revascularisation of stable coronary artery disease

A

Medical therapy inadequate:
- Refractory symptoms despite max
- Intolerant

High risk anatomy
- LM
- LM equivalent - Sev Prox LAD and LCx
- Triple vessel disease +/- reduced EF

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37
Q

B1 agonism

A

cardiac only - inotropy, chronotropy

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38
Q

B2 agonism

A

Lung and skeletal muscle

Bronchodilation and vasodilation

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39
Q

A1 agonism

A

Smooth muscle - vasoconstriction

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40
Q

A2 agonism

A

CNS depression
Smooth muscle dilatation - vasodilatation

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41
Q

Pathophys behind Raynauds

A

Impaired A2 adrenoreceptor antagonism in cold –> causing excess vasoconstriction

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42
Q

Avoid in Raynaud’s?

A

B2 blockers - cause vasoconstriction

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43
Q

Cardioselective BB

A

MANB
Metoprolol
aetenolol
Nibevilol
Bisoprolol

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44
Q

Most common cardiac manifestation Igg4 disease

A

Non-infectious aortitis

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45
Q

MoA of adenosine

A

AV node block (near arrest) –> breaks micro-re-entry circuits

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46
Q

CI to adenosine

A

Severe asthma
Severe IHD

47
Q

WPW + asymptomatic - Rx?

48
Q

Management of AF and WPW

A

Fleccanide (Na channel blocker) - avoid AV node blockade

49
Q

Management of WPW and AVRT

A

Depends on direction
- Orthodromic - forward through AV node, use AV node blocking

Anti-dromic - forward through accessory pathway, use Na channel blockers

50
Q

WPW and symptomatic

A

Catheter ablation

51
Q

Indications for EP study

A

Supraventricular
- Symptomatic - Aflutter, AVRT, AVNRT
- Refractory - AF

Ventricular
- Refractory - ectopics
- Idiopathic VT/VF

52
Q

Most common site of idiopathic VT

53
Q

Differentiate between anterior and posterior fascicular block

A

Both have RBBB
LARP

If LAD –> anterior fascicle blocked

If RAD –> Posterior fascicle blocked

54
Q

If both sinus node and AV node slowing?

A

Unlikely to have native both disease

Usually extrinsic –> parasympathetics, adenosine

55
Q

CRT indication

A

LVEF < 35%
Sinus
LBBB
QRS > 150

Maximal medical therapy

56
Q

Mode to prevent atrial tracking in pacing

57
Q

1st line for Congenital Long QT

A

Beta blocker (asym or symp)

58
Q

2nd line for Long QT

A

Stellate sympathetic ganglionectomy
Mexelitine

59
Q

ICD in Long QT

A

Any cardiac arrest

60
Q

Brugada management asymptomatic

61
Q

Brugada - when for ICD?

A

Previous SCA or syncope

62
Q

ARVT - treatment?

A

ICD - pretty much everyone

63
Q

HCM - ICD indications

A

Previous cardiac arrest

High risk - FHx SCD, syncope, structural changes

64
Q

Okay to excercise in which arrythmia syndromes?

A

Congenital Long QT 2 and 3

Brugada

65
Q

Reduced GLS with apical sparing

A

Cardiac amyloid

66
Q

Intepret GLS measurements

A

Measures EF

Should be negative - more negative, more normal

67
Q

Important uses of cMRI

A

Look for scar

Infiltrative/metabolic disease

68
Q

Measures of diastolic function TTE

A

A wave (atrial contraction) - dominant A wave, or low E/A indicates diastolic dysfunction (reliant on atrial contraction)

E measures passive LV filling. Rises with diastolic function.
High E/e’ indicates elevated filling pressures

69
Q

Management of ATTR cardiac amyloid

70
Q

Treatment of polyneuropathy associated with hATTR

A

inotersen

Nonsense signal
Prevents hepatic ttr production

71
Q

2nd line ATTR cardiac amyloid

72
Q

When to do surgical AVR

A

Young (<75) and low EUROscore

73
Q

MS repair (do if mod and above with/without symptoms)

A

Percutaneous

74
Q

When to do mitral clip

A

Functional MR, failing medical Rx

75
Q

Indications sMVR in MR

A

Severe + symptomatic

Asymptomatic but LV dysfunction

76
Q

MoA of digoxin

A

Inhibits Na/K ATPase - indirectly increases Ca influx

Increased vagal tone to heart - slows HR

77
Q

Does ivabradine help mortality?

A

No - improves hospitalisations/LV function

78
Q

Largest reduction in HF mortality - which drug?

A

Beta blockers

79
Q

SGLT’s in cardiac disease
- Reduce?

A

Reduce HF hospitalisation and CV mortality

80
Q

SiRNA that is nonsense signa to prevent PCSK9 production

A

Inclisiran

81
Q

PCSK-9 inhibitor

A

evolocumab

82
Q

Indications for PSCK9 inhibitor

A

Homozygous Fam hyperchol

Heterozygous fam hyperchol

High risk, High LDL despite max statin and ezetimibe

83
Q

Sequalae of high TG’s

A

pancreatitis

84
Q

Agents that can lower TG’s

A

Omega-3
Fibrates

85
Q

Management of hyperTG

A

Lifestyle

LDL lowering

86
Q

Sharp Y descent JVP

A

Constrictie pericarditis

87
Q

JVP goes up with inspiration?

A

Kussmaul sign, pericardial disease

88
Q

Fixed split S2

89
Q

Wide split S2

A

Delayed conduction down R bundle (delays P2)

A2 –> P2

90
Q

Paradoxical splitting S2

A

Delayed L bundle

91
Q

Single S2

A

Severe A or P disease

92
Q

S3

A

3 horses overload

Gallop –> DCM, HfPEF

93
Q

S4 - when won’t hear?

A

Requires atrial contraction - won’t hear in AF

94
Q

Most specific site of beta adrenergic receptors

A

B3 -lipolysis

95
Q

Medication with strongest likelihood of maintaining SR after DC cardioversion

A

Amiodarone

96
Q

Most common cause of sudden cardiac death

97
Q

Missed STEMI? - can’t do PCI after what timeframe?

98
Q

IE prophylaxis?
- High risk conditions
- High risk procedures

A

Cardiac
- Prosthetic valve or VAD
-Previous IE
- Congenita heart disease

Procedure - invasive oral/dental

99
Q

R ventricular lift

A

RVH

= pulmonary hypertension

100
Q

Use of cardiac CT

A

To exclude significant coronary artery disease

Classify medium risk to low risk

101
Q

Where does R bundle run after leaving IV septum?

A

Moderator band

102
Q

Thoracic aortic aneurysm diameter - when to operate?

103
Q

Thoracic aortic aneurysm diameter in congenital aortic disease - when to operate?

A

Marfan - > 5cm
Loey Dietz - > 4.5cm

104
Q

Cardiac componenet most important in active cardiac relaxation and recoil of sarcomere

105
Q

Mild Hyper TG

A

Treat with statins

106
Q

Mod hyper TG (4-10)

A

Treat with statin and fenofibrate

107
Q

High TG > 10

A

Treated with fibrate and fish oil

108
Q

1st line stress test

A

Excercise ECG

109
Q

CI to excercise ECG

A

Cannot excercise

Baseline LBBB, LVH or pacing

110
Q

If excercise stress cannot be performed, perform what test?

A

Stress imaging - SPECT or TTE

111
Q

CI to stress TTE

A

Extensive previous IHD and likely RWMA

112
Q

CI to vasodilator stress test

A

Severe asthma
Hypotension
Sinus node disease

Neeed to w/h caffeine/theophylline prior

113
Q

CI to inotropes stress test

A

DObutamine

LVOT
Recent MI
Frequent AF/ventricular arrythmia

114
Q

Major TTE criteria for HFpEF

A

Functional
- E/e’ > 15
- PASP > 35

VOlume
- LA > 40
- Elevated mass index

BPT (18 decks)

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