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MRCP PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Indications for AVR
(THREE)

A

Severe symptomatic aortic stenosis
Severe symptomatic aortic regurgitation
Infective endocarditis

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2
Q

Mechanical vs bioprosthetic valve

A

Mechanical long lasting and durable
Mechanical requires life long anticoagulation with warfarin

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3
Q

Signs of severity in aortic stenosis
(FIVE)

A

Quiet second heart sound
Long duration of murmur
Low volume pulse
Forceful apex beat
Fourth heart sound

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4
Q

Differentials for ejection systolic murmur
(FOUR)

A

Aortic stenosis
Aortic sclerosis
HOCM
Mitral regurgitation in pansystolic murmur

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5
Q

Aortic stenosis vs pulmonary stenosis
(THREE)

A

Each loudest over respective areas
Aortic loudest expiration, pulmonary loudest inspiration
RV heave in pulmonary stenosis

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6
Q

Management of symptomatic aortic stenosis
(FIVE)

A

Referral to surgeons for valve replacement
Mechanical valve
Bioprosthetic valve
TAVI - transcatheter aortic valve implantation
Beta blockers
Avoid ACE-i, nitrates (increase gradient over valve)

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7
Q

Long term management of mechanical valves
(TWO)

A

Serial echos to monitor functions
Long term anticoagulation

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8
Q

Indications for MVR
(THREE)

A

Mitral stenosis
Mitral regurgitation
Infective endocarditis

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9
Q

Causes of new systolic murmur in MVR

A

Valve incompetence
New mumurs such as AS and TR

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10
Q

Signs of tricuspid regurgitation
(THREE)

A

Pansystolic murmur
Giant V waves in JVP
Left sternal thrill

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11
Q

Second heart sound in ASD

A

Fixed split second heart sound
All other causes of split second heart sound vary with respiration

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12
Q

Aortic stenosis murmur character

A

Crescendo-decrescendo
Ejection systolic
Loudest in aortic area
Loudest in expiration
Radiates to carotids

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13
Q

Mitral regurgitation murmur character

A

Pansystolic
Loudest at apex
Radiates to axilla
Loudest in expiration

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14
Q

Signs of severe MR
(FIVE)

A

Signs of pulmonary hypertension
Raised JVP
Loud P2
S3
Right ventricular heave
Displaced thrusting apex

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15
Q

Mitral regurgitation differentials
(THREE)

A

Mitral valve prolapse
Tricuspid regurgitation
VSD

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16
Q

Symptoms of MR
(THREE)

A

Dyspnoea
Reduced exercise tolerance
Fluid overload

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17
Q

Indications for mitral valve replacement
(FOUR)

A

Symptomatic mitral disease
Pulmonary hypertension/fluid overload
Declining ejection fraction
Acute MR following MI

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18
Q

Causes of MR
(FIVE)

A

Age related degeneration
Mitral prolapse (connective tissue disease eg Ehler’s Danlos)
Papillary muscle rupture (MI)
Rheumatic fever
Infective endocarditis

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19
Q

Causes of AS
(THREE)

A

Congenital bicuspid valve
Age related calcification and degeneration
Rheumatic heart disease

20
Q

Investigations for MR
(SIX)

A

ECG - AF and p mitrale (bifid p wave)
CXR - cardiomegaly
Urine dip - blood and protein in infective endocarditis
Fundoscopy - roth spots
Temperature - IE
Echo

21
Q

Investigations for AS
(THREE)

A

ECG - LVH, prolonged PR
CXR - often normal
Echo

22
Q

Signs of Marfan’s
(THREE)

A

Arachnodactyly (long thin fingers)
Hypermobile joints
High arched palate

23
Q

Inheritance of Marfan’s

A

Autosomal dominant
Affects fibrillin gene

24
Q

Cardiac complications of Marfan’s
(THREE)

A

Aortic root/aortic dilation
Aortic regurgitation
Mitral valve prolapse

25
Q

Symptoms of pulmonary stenosis
(FOUR)

A

SOBOE
Right sided heart failure
Pre-syncope
Syncope

26
Q

Pulmonary stenosis murmur character

A

Pansystolic/ejection murmur
Loudest in pulmonary area
Loudest on inspiration
Can have widely split second heart sound

27
Q

Causes of pulmonary stenosis
(FIVE)

A

Congenital
Tetralogy of fallot
Noonans syndrome
Carcinoid syndrome
Rheumatic fever

28
Q

Investigations for pulmonary stenosis
(TWO)

A

Echo
ECG - RVH, RBBB, p pulmonale (tall p waves)

29
Q

Conditions associated with mitral valve prolapse
(FIVE)

A

Marfans syndrome
Ehler-Danlos syndrome
Osteogenesis imperfecta
PCKD
HOCM

30
Q

Mitral regurgitation murmur character

A

Pansystolic murmur
Loudest at apex
Radiates to axilla
Split second heart sound
S3

31
Q

Concerning features in PDA on echo
(FOUR)

A

Raised pulmonary pressures
RV dilation
Tricuspid regurg
Left ventricular dysfunction

32
Q

Clinical findings in keeping with severe PDA
(THREE)

A

Right ventricular heave
Collapsing pulse
Evidence of left ventricular failure

33
Q

Why are right sided murmurs louder on inspiration?

A

On inspiration increased venous return
Increased venous return increases flow across valves in right side of heart

34
Q

What does the ductus arteriosus connect?

A

Left pulmonary artery
Descending aorta

35
Q

What is eisenmenger’s syndrome

A

Reversal of a left to right shunt

36
Q

Signs of eisenmenger’s syndrome

A

Clubbing
Split second heart sound
Right ventricular heave

37
Q

Complications of eisenmengers syndrome
(FOUR)

A

Infective endocarditis
Hypoxia
Right ventricular failure
Paradoxical embolism

38
Q

Causes of clubbing (all systems)
(EIGHT)

A

Subacute endocarditis
Cyanotic congenital heart disease
Lung cancer
TB
Bronchiectasis
ILD
Cystic fibrosis
IBD

39
Q

What is tetralogy of fallot?

A

Ventricular septal defect
Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis

40
Q

Types of cyanotic congenital heart disease
(SEVEN)

A

Tetralogy of fallot
Transposition of the great arteries
Pulmonary atresia
Pulmonary stenosis
Tricuspid atresia
Eisenmengers
Ebsteins

41
Q

Causes of constrictive pericarditis
(FIVE)

A

Viral pericarditis
Bacterial pericarditis
Post surgical pericarditis
Post radiation pericarditis
TB

42
Q

Causes of restrictive cardiomyopathy
(SEVEN)

A

Endomyocardial fibrosis
Loffler’s
Sarcoidosis
Scleroderma
Amyloidosis
Haemochromatosis
Radiation

43
Q

Causes of diastolic dysfunction (preserved systolic)

A

Constrictive pericarditis
Restrictive cardiomyopathy

44
Q

Diagnosis of infective endocarditis

A

Dukes criteria - 2 major, 1 major + 3 minor, 5 minor
Major:
Typical organism in two blood cultures - staph aureus, strep viridans
Echo findings - vegetation/abscess/dehiscence
Minor:
Pyrexia >38
Echo suggestive of IE
Embolic phenomena
Vasculitic phenomena - roth spots, oslers nodes
Blood cultures positive but not typical organism

45
Q

Causes of mitral stenosis
(THREE)

A

Rheumatic fever (most common)
Degenerative
Congenital (rare)

46
Q

Aortic regurgitation murmur character

A

Early diastolic murmur
Loudest sat forward in expiration
Austin flint murmur - rumbling mid diastolic murmur

47
Q

TAVI vs AVR

A

TAVI in patients with higher pre-operative risk due to comorbidities and frailty
AVR remains gold standard
MDT and patient decision

MRCP PACES (5 decks)

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