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Cardiology Flashcards

1
Q

In a hypertensive emergency, by how much should you aim to reduce BP?

A

MAP by 25% or diastolic BP by a third

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2
Q

Right side murmurs do not increase with inspiration - correct or incorrect?

A

RHS murmurs DO INCREASE with respiration, LHS murmurs do not.

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3
Q

What valvular abnormalities cause LVH?

A

AS and MR

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4
Q

What valvular abnormality causes RVH?

A

TR

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5
Q

What defect causes biventricular hypertrophy?

A

VSD

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6
Q

What congential heart defect is associated with Down’s syndrome?

A

ASD - ostium primum

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7
Q

Murmur associated with ASD?

A

Splitting S2 and systolic murmur

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8
Q

What is normal percentage oxygenation of R heart and pulmonary artery?

A

75%

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9
Q

How does ADS (ostium primum) present?

A

Congestive heart failure

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10
Q

Clinical signs of VSD?

A

Parasternal heave and displaced apex beat

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11
Q

Mechanism of action of adenosine

A

CCB as a consequence of alpha 1 receptor activation

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12
Q

Amiodarone mechanism of action

A

K+ channel blocker

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13
Q

What are the potential effects of cardiac catheterisation on hyperthyroidism?

A

Uses iodine containing contrast - toxic MNG will therefore worsen due to presence of autonomous thyroid nodules whereas in Graves disease it may improve due to transient inhibition of TPO with rising intrathyroidal iodine

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14
Q

What is the treatment for AF if Bbockers, rate limiting CCBs and digoxin are ineffective?

A

Cardioversion then pulmonary vein radiofrequency ablation if unsuccessful

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15
Q

Most anterior valve in heart and therefore most likely to be affected in stabbing of rpecordium

A

Pulmonary valve

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16
Q

What coronary artery supplies the AV node and subsequently causes complete heart block if blocked?

A

RCA. Also causes inferior lead changes

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17
Q

What does the LCA supply

A

50% of LV - anteriolateral, apex and intraventricular septum

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18
Q

What supplies the left apex

A

Left marginal artery

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19
Q

What artery is implicated in a posterior MI

A

Left circumflex artery. Also supplies lateral left ventricle

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20
Q

How much does diastolic BP fall by in pregnancy during second trimester?

A

10% due to 50% increase in cardiac output leading to increased PVR

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21
Q

What rhythm abnormality can sotalol cause?

A

Torsades de point
It is a class III agent (K blockade)

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22
Q

How does WPW appear on ecg

A

short pr interval, positive R wave in V1 and delta wave

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23
Q

What channel defect most likely causes long QT syndrome

A

K+ channel defect caused by LQT1 and 2 mutations

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24
Q

What is the mutation seen in HOCM?

A

Beta myosin heavy chain mutation

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25
What drugs should be avoided in fast AF with WPW
Adenosine, flecanide and digoxin - slow conduction outside accessory pathway but having no effect outside conduction system
26
Why do atrial myoxomas cause a diastolic 'flop'?
Because they aren't fixed to the atrial wall - will hence change sound when position changed
27
What MAP is associated with pulmonary hypertension?
>25mmHg
28
What pulmonary capillarly wedge pressure is associated with pulmonary hypertension
>12mmh
29
In what positional changes does the ES murmur in hypertrophic cardiomyopathy worsen?
Accentures with valsava, attenuates on squatting
30
What effect does valsava have on AS?
Quietens murmur due to reducing preload to heart. Squatting conversely increased PVR and increases ventricular filling - making murmurs loud in AS.
31
Causes of split second heart sound
ASD, RHF and pulmonary hypertension
32
Causes of TDP
Metabolic (hypo), amiodarone, TCAs, phenothiazides, IHD, MV prolapse
33
Treatment for TDP
IV Mg2+
34
Causes of reverse split second heart sound
AS, hypertrophic cardiomyopathy and MI with LBBB
35
Causes of fixed split second heart sound
RBBB
36
Murmur with MR
pan systolic murmur (also MR, TR and VSD)
37
How long should you continue anticoagulation after cardioversion
4 weeks
38
In what condition is adenosine CI?
asthma
39
What valves most commonly affected (in order) in IE (non IVDU)
MV, AV, then AS and MV, TV then PV
40
What antihypertensives are CI in lithium therapy
ACEI, ARB
41
What is the bacteria associated with IE <1y post prosthetic valve replacement
S epidermis
42
Most common bacteria in IE
S aureus
43
Type of pulse with PDA
Slowly collapsing (also seen in patients with severe AR)
44
With which condition is pulsus alterans seen
LVF
45
With which condition is slow rising pulse seen
aortic stenosis
46
With which condition is a jerky pulse seen
HOCM
47
With which condition is pulsus parodoxus seen
constrictive pericarditis, cardiac tamponade and severe asthma
48
ECG abnormalitiy in brugada
RBBB and anterior ST elevation
49
Most common gene abnormalities seen in HOCM
MYH7 and MYBPC3
50
Quiet 1st heart sound occurs with which conditions
MR, severe HF and LBBB (delayed systole of ventricles)
51
What is associated with Heyde syndrome and aortic stenosis
GI tract angiodysplasia (Heyde syndrome - increased shearing of VWF due to resistance over stenotic valve causing anaemia - plts unable to bind to damaged blood vessels in GI tract)
52
In which condition is flecanaide CI?
Hx IHD
53
What is ABX regimen for strep viridans IE
benzylpenicillin and gentamicin. Ceftriaxone can be given in less severe cases
54
Abnormalities associated with Marfarns
Aortic regurgitation (diastolic murmur lower sternal edge with wide pulse pressure) or mitral valve prolapse
55
What effect does positive pressure ventilation have on the lungs
increases venous return and causes a fall in cardiac output
56
WHat diuretic causes hypercalacaemia and hypochloraemic alkalosis
bendroflumethiazide
57
What does prochlorperazine, chlorperazine, metocloperamide and promethazine all have in common
All D2 receptor antagonists
58
What is the murmur with primary pulmonary hypertension
Intense P2 sound and also murmur Tricuspid regurg (pansystolic murmu loudest at left lower sternal edge)
59
What is the abnormality seen with heart block on eamination of JVP
cannon a waves
60
what is most likely to cause lower limb oedema - doxazocin or diltiazem
ddoxazocin - non dihydropyridine CCbs les likely to cause peripheral oedema
61
where does splitting 4th heart sound occur
after p wave
62
where does first sound heart occur
after qrs
63
where does second heart sound occur
after t wave
64
HLA positvity with BEhcet's disease
HLLA B51
65
what part of the heart is most arrythmogenic
coronary sinus
66
Most commonly affected valve in IVDU
Tricuspid
67
Most common valve in endocarditis in IVDU
Staph aureus
68
Ecg hyperkalaemia
Tall tented t Wide qrs Absent p
69
Ecg hypokalaemja
Inverted t waves U wave Prolonged pr St depression
70
J waves?
Hypothermia
71
Amyloidosis - linked to what lung condition
Bronchiectasis chronic inflammation
72
Negative concordance across chest leads .. more likely with vt or svt
Vt
73
When is adenosine CI in SVT
Asthma Use verapamil
74
Why avoid verapamil in WPW
Selective AVN blockade could encourage rapid conduction of atrial arrhythmia
75
Pan systolic murmur lodest at apex
Mitral regurg
76
S1 heart sound with early diastolic murmur in aortic area with patient sitting forward and in expiration
Aortic regurg
77
Mitral stenosis murmur
Mid to late diastolic Left lateral position
78
Post diastolic murmur left upper sternal edge
Pulmonary regurg
79
What is most common in turner's Bicuspid aortic valve or coarctation
Bicuscipud aortic valve
80
Difference in timing between carotid artery in stent thrombosis and in stent restenosis
Thrombosis most likely within first 30d and linked to DAPT REstenosis much later and not linked to DAPT
81
What murmur is a collapsing pulse associated with
Aortic regurg (third left intercostal space)
82
What murmurs (x2) re associated with marfans
Aortic and pulmonary regurg
83
what drug should be avoided in WPW
digoxin and beta blockeres
84
what antiarrythmic should be avoided in structural or ischaemic heart disease
flecanaide
85
bonsentan teratogenic?? yes or no
yes (sildenafil PDE5 inhib is ok)
86

MRCP (14 decks)

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