Cardiology

Question 1

Antiplatelet mechanisms

Answer 1

• Thromboxane A2i - Aspirin
• Antithrombin III activator - Heparins
• Coronary vasodilator - Nitrates
• Glycoprotein IIb/IIIa receptor antagonist - Abciximab, Tirofiban
• P2Y12 i - Clopidigrel, Ticagrelor
• Reversible direct thrombin i - Bivalirudin
• Increases effect of adenosine and non specific phosphodiesterase i - Dipyridamole

Question 2

HOCM

Answer 2

• Beta myosin heavy chain
• Diastolic dysfunction
• Myofibrillar hypertrophy with disorganized fashion myocytes and fibrosis on biopsy

Question 3

HOCM clinical features

Answer 3

• Syncope
• Sudden death
• Jerky pulse
• Large a waves
• ESM due to LVOT obstruction
• PSM due to MR

Question 4

HOCM echo findings

Answer 4

• MR
• SAM of anterior mitral valve leaflet
• asymmetric hypertrophy

Question 5

Variable intensity S1

Answer 5

Complete heart block
(also has cannon waves in JVP)

Question 6

Associations for Coarctation of Aorta

Answer 6

• Bicuspid aortic valve
• Turner’s syndrome
• Neurofibromatosis (NF1)
• Berry aneurysms

Buy Two New Berries for aorta

Question 7

ECG in hypokalemia

Answer 7

U waves, ST depression, T-wave inversion

Question 8

Nicorandil

Answer 8

Potassium channel activator

Adverse effects
1. Headache
2. Flushing
3. GI ulceration anywhere including anal ulcers

Contraindicated in LV failure

Question 9

S3

Answer 9

Diastolic rapid filling of ventricles
Normal in <30 years of age
- LV failure like dilated cardiomyopathy
- Constrictive pericarditis (pericardial knock)
- MR

Question 10

S4

Answer 10

Atrial contraction against stiff ventricles
- AS
- HOCM with double apical impulse
- HTN

Question 11

Collapsing Pulse

Answer 11

• AR
• PDA
• Hyperkinetic states

Question 12

Slow rising pulse

Answer 12

AS

Question 13

Pulsus alternans

Answer 13

Severe LV failure

Question 14

Pulsus paradoxus

Answer 14

• Severe asthma
• Cardiac tamponade

Question 15

Pulsus bisferiens

Answer 15

Mixed aortic valve disease

Question 16

Jerky pulse

Answer 16

HOCM

Question 17

Syndrome X

Answer 17

Angina like chest pain on exertion
- ST depression on stress ecg
- Normal Coronary angio

Question 18

Ebstein’s anomaly

Answer 18

Low insertion of tricuspid valve leading to large RA and small RV
- cyanosis
- hepatomegaly
- TR
- RBBB with WPW

Question 19

Important Cardiac genes

Answer 19

• SCN5A - Brugada
• MYBPC3 & MYH7 - HCM
• CAV3 - Hereditary long QT syndrome
• TTR - Transthyretin amyloidosis

Question 20

Adenosine interactions

Answer 20

• Dipyridamole - enhances action
• Aminophylline - reduces effect

Question 21

WPW associations

Answer 21

HOCM
MVP
Ebstein’s anomaly
Thyrotoxicosis
Secundum ASD

Question 22

Indications for stopping ETT

Answer 22

• ST elevation >2 mm
• ST depression >3 mm
• SBP > 230 mm Hg
• SBP falling more than 20 mm Hg
• HR falling more than 20% of starting HR

Question 23

Causes of ST depression

Answer 23

• Syndrome X
• Ischaemia
• Abnormal QRS
• Digoxin
• Hypokalemia

Remember SIADH

Question 24

Management of severe MS

Answer 24

Percutaneous mitral commisurotomy (PMC)
If fails, then valve replacement

Question 25

Difference between cardiac tamponade and constrictive pericarditis

Answer 25

Absent y descent on JVP for Tamponade

Question 26

Nicorandil important side effect

Answer 26

Ulcerations anywhere in the GI tract

Question 27

JVP Canon waves

Answer 27

Regular Canon waves: - VT with 1:1 ventricular-atrial conduction - AVNRT Irregular Canon waves: Complete heart block

Question 28

Cardiac resynchronisation therapy (biventricular pacing) candidates

Answer 28

- ECG: LBBB - TTE: LVeF<35%

Question 29

Prinzmetal Angina Management

Answer 29

Dihydropyridine CCB (Amlo or felodipine)

Question 30

Persistent ST elevation post MI and no CP

Answer 30

LV aneurysm

Question 31

Associations of MVP

Answer 31

M - Marfan V - (V) Wolff Parkinson White $ P - Pseudoxanthoma elasticum P - PDA R - tuRneR's syndrome O - Osteogenesis imperfecta L - Long QT syndrome A - ASD P - PCKD S - Severe cardiomyopathy E - Ehler Danlos

Question 32

Causes of DCM

Answer 32

**THIAMIN** T - Thiamine deficiency H - HTN I - IHD A - Alcohol and cocaine M - Myocarditis I - Infiltrative (hemochromatosis and Sarcoidosis) N - no cause (idiopathic)

Question 33

Associations of WpW

Answer 33

HoT As ME Ho - HOCM T - Thyrotoxicosis As - ASD Secundum M - MVP E - Ebstein's anomaly

Question 34

Drugs with serious contraindications

Answer 34

Verapamil in VT Nitrates in RV MI ACEi, Nitrates and Inotropes in HOCM