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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what is the most common form of cardiomyopathy?

A

Dilated cardiomyopathy (DCM) accounting for 90% of cases

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2
Q

what determines timing of aortic stenosis management?

A

AVR surgical repair if symptomatic, otherwise cut-off is gradient of 40 mmHg

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3
Q

ECG features of wolf parkinsons white

A

short PR interval

wide QRS complexes with a slurred upstroke - ‘delta wave’

left axis deviation if right-sided accessory pathway
(most commonly causes left axis deviation)

right axis deviation if left-sided accessory pathway

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4
Q

Management WFW

A
  1. radioablation of accessory pathwya
  2. sotalol (but not if in AF as this can trigger VF). Amiodarone or fleccanide
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5
Q

Persistent ST elevation following recent MI, no chest pain

A

left ventricular aneurysm

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6
Q

Drugs to avoid in HOCM

A
  • nitrates
  • ACE-inhibitors
  • inotropes
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7
Q

contraindications to thiazide like diuretics

A

gout

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8
Q

Amiodarone - Mechanism of action

A

blocks voltage-gated potassium channels which prolongs repolarisation and the action potential duration

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9
Q

Magnesium sulfate toxicity (given to pre-eclampsia/ eclampsia) - signs and treatment

A

Symptoms of magnesium sulfate toxicity include loss of deep tendon reflexes, respiratory depression, and cardiac arrest.

Calcium gluconate is treatment

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10
Q

Which antiarrhythmic may precipitate ventricular fibrillation (VF) in patients in VT

A

verapamil

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11
Q

Irregular cannon ‘a’ waves

A

complete heart block

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12
Q

Indications for a temporary pacemaker

A

symptomatic/haemodynamically unstable bradycardia, not responding to atropine

type 2 or complete heart block post-ANTERIOR MI

trifascicular block prior to surgery

post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and haemodynamically stable

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13
Q

where does Furosemide and bumetanide exert its action?

A

Furosemide and bumetanide are loop diuretics that act by inhibiting the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl

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14
Q

what medication to hold when starting course of erythromycin/ clari?

A

statin

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15
Q

which murmur is associated with dilated cardiomyopathy?

A

mitral regurg

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16
Q

The most specific ECG finding in acute pericarditis is ?

A

PR depression

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17
Q

causes of changes to Second heart sound (S2)

A

Second heart sound (S2)
loud: hypertension
soft: AS
fixed split: ASD
reversed split: LBBB

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18
Q

What normally happens to blood pressure during pregnancy?

A

Falls in first half of pregnancy before rising to pre-pregnancy levels before term.

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19
Q

Mechanical valves - target INR:

A

aortic: 3.0
mitral: 3.5

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20
Q

Pulmonary arterial hypertension (PAH) may be defined as …

A

a resting mean pulmonary artery pressure of >= 25 mmHg.

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21
Q

drug that should not be given in VT

A

verapamil

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22
Q

what should be prescribed to substitute ACEi like ramipril if patient develops cough?

A

ARBs eg. candesartan

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23
Q

INR target for recurrent DVT

A

3.5

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24
Q

patients on warfarin having emergency surgery:

A

If surgery can wait for 6-8 hours - give 5 mg vitamin K IV

If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex

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25
Q

most accurate non-invasive assessment of coronary artery disease (CAD)

A

Contrast enhanced cardiac CT

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26
Q

hypercalcaeiuma features on ECG

A

shortened QT

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27
Q

Management of HOCM

A

ABCDE
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

Drugs to avoid:
nitrates
ACE-inhibitors
inotropes

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28
Q

When to avoid rate limiting CCBs?

A

Rate-limiting calcium channel blockers (diltiazem and verapamil) should be avoided in patients with atrial fibrillation (AF) with heart failure with reduced ejection fraction (HFrEF) due to their negative inotropic effects.

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29
Q

SVT prophylaxis

A
  1. Beta blockers
    Metoprolol is safest if pregnant
  2. Ablation if accessory pathway
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30
Q

statins monitoring

A

LFTs at baseline, 3 months and 12 months

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31
Q

what is the only calcium channel blocker licensed for use in heart failure?

A

amlodipine

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32
Q

management of pulmonary hypertension

A

1) Acute vasodilator testing with intravenous epoprostenol or inhaled nitric oxide.

If there is a positive response -
oral calcium channel blockers

If there is a negative response to acute vasodilator testing (the vast majority of patients)
a) prostacyclin analogues: treprostinil, iloprost

b) endothelin receptor ANTagonists
non-selective: bosentan

selective antagonist of endothelin receptor A: ambrisentan

c) phosphodiesterase inhibitors: sildenafil

combination therapy often required in negative response

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33
Q

it is important to asymmetically dose which cardiac drug?

A

isosorbide mononitrate is correct. An asymmetric dosing regimen would involve taking the morning dose as normal, then taking the second dose in the early afternoon. This allows a sufficiently long nitrate-free period and helps reduce tolerance.

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34
Q

J waves on ECG

A

hypothermia

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35
Q

U waves on ECG

A

Hypokalaemia -

36
Q

delta waves on ECG

A

delta waves are associated with Wolff Parkinson White syndrome.

37
Q

ECG features of digoxin

A

down-sloping ST

depression (‘reverse tick’, ‘scooped out’)

flattened/inverted T waves

short QT interval

arrhythmias e.g. AV block,

bradycardia

38
Q

management of angina

A

aspiring + statin + GTN spray

  1. b-blocker or CCB
    f a calcium channel blocker is to be used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be selected.
  2. b-clocker AND CCB
  3. one of the drugs + long acting nitrate or nicorandil or ivabradine or ranolazine
39
Q

Left ventricular ejection fraction equation

A

Left ventricular ejection fraction = (stroke volume / end diastolic LV volume ) * 100%

40
Q

Systemic vascular resistance equation

A

Systemic vascular resistance = mean arterial pressure / cardiac output

41
Q

how does digoxin work?

A

increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve

42
Q

most common cardiac defect seen in patients with Down’s syndrome?

A

Endocardial cushion defects account for about 40%

43
Q

HTN in pregnancy

A

1/2 risk factors - start aspirin

Labetalol is first-line for pregnancy-induced hypertension, Nifedipine (e.g. if asthmatic)

women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed

44
Q

which electrolyte abnormalities are most associated with long QT?

A

electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia

45
Q

How do ACEi cause cough?

A

ACE inhibitors prevent the breakdown of inflammatory peptides such as bradykinin and cough is a frequent side effect.

46
Q

what is Ebstein’s anomaly

A

associated with lithium use in pregnancy

congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle.

signs:
- tricuspid regurgitation
pansystolic murmur, worse on inspiration
- right bundle branch block → widely split S1 and S2
- Wolff-Parkinson White syndrome
- associated with atrial septal defects
- right heart failure: hepatomegaly, cyanosis, prominent “a” wave in JVP or giant “v” waves

47
Q

Syndrome X

Features and management

A

also called microvascular angina

angina-like chest pain on exertion
ST depression on exercise stress test
but normal coronary arteries on angiography

Management
nitrates may be beneficial

48
Q

Aortic dissection mx

A

type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)

49
Q

indications for implantable cardiac defibrillators

A

Indications
long QT syndrome
hypertrophic obstructive cardiomyopathy
previous cardiac arrest due to VT/VF
previous myocardial infarction with non-sustained VT on 24 hr monitoring, inducible VT on electrophysiology testing and ejection fraction < 35%
Brugada syndrome

50
Q

The most accurate method to determine the left ventricular function?

A

MUGA (multigated acquisition) scan

51
Q

Brugada syndrome features

A

autosomal dominant

mutation in in the SCN5A gene (which encode the myocardial sodium ion channel protein)

ECG changes:
1) convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave
2) partial right bundle branch block
3) the ECG changes may be more apparent following the administration of flecainide or ajmaline - this is the investigation of choice in suspected cases of Brugada syndrome

52
Q

Aschoff bodies

A

describes the granulomatous nodules found in rheumatic heart fever

53
Q

PDE 5 inhibitors (e.g. sildenafil) should NOT be given with which drugs?

A

contraindicated by nitrates and nicorandil

high risk of life threatening hypotension

54
Q

Atrial myxoma - commonest site =

A

left atrium
at the fossa ovalis border

55
Q

feature helps distinguish marfans vs homocisteinuria

A

Marfans = Mitral valve prolapse may cause a late-systolic murmur

56
Q

Long QT syndrome is due to loss of what function?

A
  • usually due to loss-of-function/blockage of K+ channels
57
Q

which antibiotic promotes acquisition of MRSA

A

Ciprofloxacin

58
Q

definitive treatment of atrial flutter

A

radiofrequency ablation of the tricuspid valve isthmus is curative for most patients

59
Q

cholesterol embolisation signs

A

cholesterol emboli may break off causing renal disease
the majority of cases are secondary to vascular surgery or angiography. Other causes include severe atherosclerosis, particularly in large arteries such as the aorta

Features
eosinophilia
purpura
renal failure
livedo reticularis

60
Q

Myopathy is more common with which statins?

A

in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)

61
Q

warfarin target DVT and AF

A

venous thromboembolism:
target INR = 2.5, if recurrent 3.5
atrial fibrillation, target INR = 2.5

62
Q

What is the most common cause of death in patients following a myocardial infarction?

A

Ventricular fibrillation

63
Q

how many months after valve replacement does the spectrum of organisms that cause endocarditis return to normal.

A

2 mo

64
Q

method to detect mutated oncogenes

A

Polymerase chain reactions

65
Q

Complete heart block heart auscultation

A

causes a variable intensity of S1

66
Q

all heart failure patients should take what drugs at least

A

both an ACE-inhibitor and a beta-blocker.

67
Q

what is Syndrome X?

what are the diagnostic findings

management?

A

microvascular angina

angina-like chest pain on exertion downsloping
ST depression on exercise stress test
but normal coronary arteries on angiography

Management
nitrates may be beneficial

68
Q

The most important factor predicting outcomes post-STEMI

A

new systolic heart failure (low ventricular ejection fraction)

69
Q

which anti-anginal may be associated with visual disturbances?

A

Ivabradine use may be associated with visual disturbances including phosphenes and green luminescence

70
Q

only secreted by the adrenal medulla?

A

Adrenaline is exclusively secreted by the adrenal medulla

noradrenaline is also excreted

71
Q

what does troponin I bind to?

A

actin to hold the troponin-tropomyosin complex in place

72
Q

upper limb blood pressure is greater than that in the lower limbs

A

coarctation of the aorta

73
Q

Cardiac action potential - movement of ions

A

Phase 0: Rapid depolarisation Rapid sodium influx

Phase 1: Early repolarisation Efflux of potassium

Phase 2: Plateau
Slow influx of calcium

Phase 3: Final repolarisation Efflux of potassium

Phase 4: Restoration of ionic concentrations
Resting potential is restored by Na+/K+ ATPase
There is slow entry of Na+ into the cell decreasing the potential difference until the threshold potential is reached, triggering a new action potential

74
Q

Pulmonary capillary wedge pressure (PCWP)

A

measurement obtained through the use of a Swan-Ganz catheter.

It provides an indirect estimation of left atrial pressure, which reflects the pressure in the left side of the heart.

This is important for assessing patients with acute pulmonary oedema, as it helps to determine the cause and guide appropriate treatment.

75
Q

Patients with MI secondary to cocaine use should be given

A

IV benzodiazepines as part of acute (ACS) treatment

76
Q

The administration of adenosine is contraindicated by

A

her history of asthma. Verapamil should therefore be given.

77
Q

pulmonary hypertension heart sound

A

loud S2 (due to a loud P2)

78
Q

mechanism of action of flecainide

A

sodium channel blocker.

79
Q

Atrial fibrillation - pharmacological cardioversion:

A

amiodarone or flecainide

80
Q

patent ductus arteriosus - What pulse abnormality?

A

large volume, bounding, collapsing pulse

81
Q

which drugs impact adenosine function

A

Dipyridamole Enhances the action.
Aminophylline Reduces the action

DEAR

82
Q

effect of amiodarone on the thyroid

A

amiodarone can cause hypothyroidism due to the high iodine content of amiodarone causing a Wolff-Chaikoff effect*

if patient develops hypothyroidism, continue amiodarone and add levothyroxine

amiodarone can also cause thyrotoxicosis
type 1: excess iodine used to make thyroid hormones. Goitre present.
mx. stop amiodarone, give carbimazole

type 2: Amiodarone-related destructive thyroiditis, no goitre present.
mx. stop amiodarone. give steroids.

83
Q

In the Vaughan Williams classification of antiarrhythmics lidocaine is an example of a:

A

Class Ib agent

84
Q

Complete heart block causes what on auscultation

A

variable intensity of S1

85
Q

most common acyanotic and cyanotic heart defects

A

Acyanotic - most common causes
ventricular septal defects (VSD)

cyanotic - TOF (lifelong), but at birth TGA is most common

86
Q

septal defects

A

atrial septal defect –> ejection systolic murmur louder on inspiration

ventricular systolic defect –> pansystolic (‘harsh’ in character)

87
Q

NYHA Classification of HF

A

NYHA Class I
no symptoms
no limitation

NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

MRCP Part 1 (21 decks)

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