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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Prominent V waves on JVP -?

A

Tricuspid regurg

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2
Q

Symptoms of tricuspid regurgitation

A

Pansystolic murmur
Prominent/giant V waves in JVP
Pustile hepatomegaly
Left parasternal heave

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3
Q

Causes of tricuspid regurg

A

Right ventricular infarction
Pulmonary HTN e.g. COPD
Rheumatic heart disease
IE (esp in IVDUs)
Ebsteins anomaly
Carcinoid syndrome

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4
Q

What dose of adrenaline is used in cardiac arrest?

A

1 in 10,000

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5
Q

What are the shockable rhythms?

A

VT/VF

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6
Q

What are the non shockable rhythms?

A

Asystole
PEA

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7
Q

Ratio of chest compressions to ventilation breaths

A

30:2

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8
Q

What should you do to VT/VF originally?

A

Shock

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9
Q

What should be given ASAP for a non-shockable rhythm?

A

Adrenaline 1mg in 10,000

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10
Q

When is adrenaline given in a VF/VT arrest?

A

After the third shock after compressions are restarted

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11
Q

When should adrenaline be repeated?

A

Every 3 - 5 mins

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12
Q

When and who should amiodarone be given to?

A

VF/pulseless VT
After 3 shocks have been administered

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13
Q

Reversible H causes of cardiac arrest

A

Hypoxia
Hypothermia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia
Hypovolaemia

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14
Q

Reversible T causes of cardiac arrest

A

Thrombus
Tamponade
Toxins
Tension pneumothorax

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15
Q

What murmur does ASD give in adults?

A

Ejection systolic murmur louder on inspiration

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16
Q

What murmur does mitral regurg give?

A

Pansystolic murmur
Louder on expiration

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17
Q

How would tertatology of fallot present?

A

Cyanosis in early childhood

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18
Q

A loud ejection systolic murmur could be what?

A

Aortic stenosis
Hypertrophic obstructive cardiomyopathy

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19
Q

An ejection systolic murmur which is louder on inspiration?

A

Pulmonary stenosis
ASD

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20
Q

What does a pansystolic murmur indicate?

A

VSD
Mitral/tricuspid regurg

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21
Q

What does a continous machine like murmur indicate?

A

Patent ductus arteriosus

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22
Q

Definition of pulmonary aterial hypertension

A

Resting mean pulmonary pressure of > 25mmHg

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23
Q

Which gender is pulmonary arterial HTN more common in?

A

Female

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24
Q

What age does pulmonary arterial HTN present?

A

30-50 y/o

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25
Q

Causes of pulmonary arterial HTN

A

Secondary to chronic diseases
HIV
Cocaine
Anorexigens (e.g. fenfluramine)
10% autosomal dominant inheritance

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26
Q

Presentation of pulmonary arterial HTN

A

Progressive exertional dyspnoea
Exertional syncope
Exertional chest pain
Peripheral oedema
Cyanosis
Right ventricular heave, loud P2, raised JVP, tricuspid regurg

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27
Q

What is the most common cause of death in patients following cardiac arrest?

A

Ventricular fibrillation

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28
Q

What drugs should be avoided in HOCM?

A

ACEIs
Nitrates
Inotropes

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29
Q

What does HOCM stand for?

A

Hypertrophic obstructive cardiomyopathy

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30
Q

Inheritance of HOCM

A

Autosomal dominant

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31
Q

Management of HOCM

A

Amoidarone
Beta blockers / verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

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32
Q

What is the biggest risk factor of PCI stent thrombosis?

A

Withdrawl of anti-platelet therapy

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33
Q

Which two drugs together have shown to reduce mortality in stable heart failure?

A

Carvedilol
Bisoprolol

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34
Q

Give an example of a vagal manouvre

A

Carotid sinus massage

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35
Q

Management of a narrow complex tachycardia with no adverse features

A
  1. Vagal manouvres
  2. IV adenosine
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36
Q

Doses of adenosine to try in SVT

A

6mg
Then 12mg (if no response)
Then 18mg (if no response)

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37
Q

If the SVT is not responding to IV adenosine, what diagnosis should you consider?

A

Atrial flutter

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38
Q

If you find AF < 48 hrs of onset what can you consider?

A

Chemical or electrical cardioversion

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39
Q

What are the ACSs?

A

STEMI
NSTEMI
unstable angina

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40
Q

2 main pathologies of ACS

A
  1. Artery narrowing
  2. Plaque rupture causing occlusion
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41
Q

RFs of ischaemic heart disease

A

Male
FH
Increasing Age
smoking
DM
HTN
Hypercholesteraemia
Obesity

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42
Q

Presentation of ACS

A

Central / left sided chest pain
Radiating to jaw or left arm
Heavy / constricting
Dyspnoea
Sweating
Vomiting

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43
Q

who often may not experience chest pain in ACS?

A

Elderly
Diabetics

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44
Q

Two most important Ix of ACS

A

ECG
Troponins

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45
Q

What leads indicate anterior part of heart?

A

V1-V4

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46
Q

What leads indicate inferior part of heart?

A

II, III, aVF

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47
Q

What leads indicate lateral part of the heart?

A

I, V5-6

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48
Q

Tx of STEMI

A

PCI
300mg aspirin
Likely 2nd antiplatelet therapy depending on guidelines
Anti=emetics/analgesia
Nitrates

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49
Q

If a patient presents with an NSTEMI what is used to decide on further management?

A

GRACE risk stratisification tool

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50
Q

What should be performed in a patient with an NSTEMI?

A

Coronary angiography

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51
Q

2ndry prevention of ACS

A

Aspirin
2nd antiplatelet if appropriate
BB
ACEI
Statin

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52
Q

Definition of STEMI

A

ST elevation on ECG
Elevated troponins

53
Q

Defiintion of NSTEMI

A

ECG changes but no ST elevation
Elevated troponins

54
Q

Who should nitrates be used in caution with?

A

Hypotension

55
Q

STEMI criteria on ECG

A

Clinical Sx consistent with ACS (generally > 20 mins) and persistent ECG changes in >2 leads of
- 2.5mm (usually >2.5 squares) ST elevation in leads V2-V3 in < 40s or >2mm ST elevation in V2-V3 >40 y/o (MEN)
- 1.5mm ST elevation in women in V2-V3
- 1mm ST elevation in other leads
- new LBBB

56
Q

Two types of coronary reperfusion therapy

A

PCI
Fibrinolysis

57
Q

Tx of NSTEMI / unstable angina

A

aspirin 300mg
fondaparinux if no immediate PCI planned
GRACE Score
- if low risk (<3%) -> ticagrelor/conservative management
- if intermediate/high risk (>3%) -> PCI

58
Q

What does the GRACE score look at?

A

Age
HR
BP
Kilip class
Renal function
Cardiac arrest on presentation ?
ECG changes ?
Troponins

59
Q

Poor prognostic factors after ACS

A

Age
Development or prescence of HF
PVD
Reduced systolic BP
Kilip class
Initial serum crt elevation
elevated initial tropnonins
Cardiac arrest on admission
ST segment deviation

60
Q

Kilip class

A

I - No clinical signs of HF
II - Lung crackles - S3
III - Frank pulmonary oedema
IV - Cardiogenic shock

61
Q

Definition of acute pericarditis

A

Inflammation of the pericardial sac, lasting 4-6 weeks

62
Q

Causes of acute pericarditis

A

Viral (coxsackie)
TB
Uraemia
Post MI
Radiotherapy
Connective tissue (SLE, RA)
Hypothyroid
Malignancy (breast / lung)
Trauma

63
Q

What causes early post MI Acute pericardiits? (1-3 days)

A

Fibrinous pericarditis

64
Q

What causes late (weeks - months) acute pericarditis post MI?

A

Dresslers syndrome (autoimmune pericarditis)

65
Q

Presentation of acute pericarditis

A

Chest pain
- often pleuritic
- relieved by sitting forwards
Dry cough
Flu like symptoms
SOB
Pericardial rub

66
Q

ECG changes in acute pericarditis

A

Global / widespread (rather than territories)
Saddle shaped ST elevation
PR depression

67
Q

Ix for acute pericarditis

A

ECG
Transthoracic ECHO
Bloods (30% raised trop)

68
Q

Treatment of acute pericarditis

A

Most can be managened as OPs
Tx underlying cause if possible
Avoid strenuous physical activity until symptom resolution and normalization of inflammatory markers
For viral pericarditis or acute idiopathic - NSAIDs and colchicine

69
Q

What is adenosine used in?

A

To terminate supraventicular tachycardias

70
Q

Who should adenosine not be used in?

A

Asthmatics

71
Q

S/Es adenosine

A

Chest pain
Bronchospasm
Transient flushing
WPW syndrome

72
Q

What is amiodarone used for?

A

Class III anti arrythmic agent used in the treatment of atrial, nodal and ventricular tachycardias

73
Q

S/Es amiodarone

A

Thyroid dysfunction - both hypo and hyper
Corneal deposits
Pulmonary fibrosis / pneumonitis
Liver fibrosis / hepatitis
Peripheral neuropathy / myopathy
Photosensitivity
Slate grey appearance
Thrombophlebitis and injection site reactions
Bradycardia
QT prolongation

74
Q

Tx of angina

A

Aspirin and statin
Sublingual GTN for attacks
BBs or CCBs depending on contraindications

75
Q

What should beta blockers not be used in conjunction with and why?

A

Verapamil
Complete heart block

76
Q

If in Tx for angina if a patient is taking both a CCB and a BB when should you add in a third drug?

A

When waiting for PCI

77
Q

What is recommended to avoid nitrate tolerance?

A

Asymetric dosing interval (to maintain a daily nitrate free period of 10-14 hrs)

78
Q

What is an aortic dissection?

A

Tear in the tunica intima of the wall of the aorta

79
Q

RFs for aortic dissection

A

HTN
Trauma
Bicuspid aortic valve
Marfans syndrome / Elos danlos syndrome
Turners and noonans syndromes
Pregnancy
Syphillis

80
Q

Presentation of aortic dissection

A

Chest / back pain
- tearing in nature, maximal pain at onset
Pulse deficit
- weak or absent carotid, brachial or femoral pulse
- variation >20mmhg in systolic BP in both arms
Aortic regurg
HTN
Other features depend on involvement of other arteries
- coronary - angina
- spinal arteries - paraplegia
- distal aorta - limb ischaemia
Non specific ECG changes

81
Q

Type A stanford classiciation of aortic dissection

A

Ascending aorta
2/3 of cases

82
Q

Type B standford classication of aortic dissection

A

Descending aorta, distal to left subclavian origin
1/3 of cases

83
Q

Two classifcation systems of aortic dissection

A

Debakey
Stanford

84
Q

Type 1 debakey classifcation of aortic dissection

A

Origins in the ascending aorta to at least the aortic arch and beyond is distally

85
Q

Type II debakey classification of aortic dissection

A

Origins in and is confined to the ascending aorta

86
Q

Type III debakey classifcation of aortic dissection

A

Origins in the descending aorta, rarely extends proximally but will extend distally

87
Q

Ix of aortic dissection

A

CXR - widended mediastinum
CT angio chest abdo pelvis
Transeosophageal ECHO

88
Q

Management of type A aortic dissection

A

Surgery
Target BP 100-120 whilst awaiting intervention

89
Q

Management of type B aortic dissection

A

Conservative management
Bed rest
Reduce BP with IV labetolol

90
Q

What is aortic regurgitation?

A

Leaking of the aortic valve that causes blood to flow in the reverse direction during ventricular diastole

91
Q

Causes of AR

A

Valve
- Rheumatic disease
- calcific valve disease
- connective tissue e.g. RA/SLE
- Bicuspid aortic valve
- infective endocarditis
Aortic root
- Bicuspid aortic valve
- Spondyloarthopathies e.g. AS
- HTN
- Syphillis
- Marfans / ehler danlos syndrome
- aortic dissection

92
Q

Presentation of aortic regurg

A

Early diastolic murmur
Collapsing pulse
Wide pulse pressure
Nailbed pulsation (quinckes sign)
Head bobbing (de mussets sign)

93
Q

Investigations of aortic regurg

A

ECHO

94
Q

Management of AR

A

Medical Tx of assosiated HF
Surgery in symptomatic patients or asymptomatic patients with severe LV dysfunction

95
Q

Presentation of aortic stenosis

A

Chest pain
SOB
Syncope / pre syncope
ESM

96
Q

Features of murmur in aortic stenosis

A

ESM
Radiates to carotids
Decreased following the valsalva manouvre

97
Q

Features of severe Aortic stenosis

A

Slow rising pulse
Narrow pulse pressure
Delayed ESM
Soft / absent S2
S4
Thrill
Duration of murmur
LVH or LVF

98
Q

Causes of aortic stenosis

A

Degenerative calcification
Bicuspid aortic valve
Williams syndrome (supravalvular aortic stenosis)
Post rheumatic disease
HOCM

99
Q

Management of aortic stenosis

A

If asymptomatic then observe is general rule
Symptomatic - valve replacement
If asymptomatic but valve gradient > 40mmHg with features of LVSD then could consider surgery

100
Q

Options for aortic valve replacement

A

Surgical
Transcatheter AVR
Balloon valvuloplasty

101
Q

What is arrythmogenic right ventricular cardiomyopathy?

A

An inherited disease which presents with syncope or sudden death.
Right ventricular myocardium is replaced by fatty and fibrofatty tissue

102
Q

Inheritance of ARVC

A

Autosomal dominant

103
Q

Presentation of ARVC

A

Palpitations
Syncope
Sudden cardiac death

104
Q

Ix of ARVC

A

ECG; TWI in V1-3 typically, epsilon waves
ECHO
MRI

105
Q

Management of ARVC

A

Sotalol
Catheter ablation to prevent ventricular tachycardia
Implantable defib

106
Q

Definition of paroxysmal AF

A

Recurrent episodes > 2 which terminate spontaneously
Last < 7 days (usually < 24 hrs)

107
Q

Definition of persistent AF

A

AF that is not self terminating (usually last > 7 days)

108
Q

Presentation of AF

A

Palpitations
SOB
CP

109
Q

What pulse is felt in AF?

A

Irregularly irregular

110
Q

Diagnosis of AF

A

ECG

111
Q

Two key parts of management of AF

A

Rate/rhythm control
Reducing stroke risk

112
Q

Another name for rhythm control in AF

A

Cardioversion

113
Q

1st line tx for rate control of AF

A

Beta blocker
Rate limiting CCB (diltiazem)
If one doesnt work recommends combi therapy with above and possibly digoxin

114
Q

Criteria for cardioversion in AF and why

A

When AF converted to sinus then high risk for thrombus to move and cause stroke
symptoms < 48 hrs or
anticoagulated for a period of time prior to attempting cardioversion

115
Q

What scoring system is often used to determine anti-coagulation in AF?

A

CHASDVASC score

116
Q

Score of 0 in CHADSVASC

A

No tx

117
Q

Score of 1 in CHASVASC

A

Males - consider anticoagulation
Females - no Tx

118
Q

Score of 2 in CHASVASC

A

Treat with NOAC or anticoagulation

119
Q

Two scenarios where cardioversion can be used in AF

A

Electrical in a patient as an emergency if haemodynamically unstable
Electrical or pharmacological as an elective procedure where a rhythm control stratergy is preferred

120
Q

What drugs are used for pharmacological cardioversion?

A

Amiodarone if structural heart disease
Flecanide or amoiodarone otherwise

121
Q

If AF symptoms started > 48 hrs ago, how long should anti-cogulation be given before cardioversion?

A

3 weeks

122
Q

If there is a high risk of cardioversion failrue what should be given prior to electical cardioversion?

A

4 weeks of amiodarone or soltadol

123
Q

Following electrical cardioversion how long should patients be anti coagulated for?

A

4 weeks

124
Q

After a TIA, when should anti-coag be started for AF in the absence of a haemorrhage?

A

Immediately

125
Q

After an acute stroke in the absence of haemorrhage, when should anti - coag for AF start?

A

After 2 weeks

126
Q

Who should NOT be offered rate control in AF?

A

Reversible cause
Heart failure primarily thought to be caused by AF
New onset AF < 48 hrs
atrial flutter whos condition is more suitable for suitable for an ablation strategy
Rhythm control strategy more suitable based on clinical judgement

127
Q

What agents are used to maintain sinus rhythm in patient with HX OF AF?

A

Beta blockers
Dronedarone
Amoidarone (particularly if co exisiting HF)

128
Q
A

MRCP Part 1 (7 decks)

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