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BPT > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ODYSSEY LONG TERM Trial

A

Demonstrated that alirocumab (a PCSK9 inhibiter) reduced LDL by 61% at 24 weeks (2015)

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2
Q

OSLER

A

Demonstrated that evolocumab (a PCSK9 inhibiter) reduced LDL by 61% at 24 weeks (2015)

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3
Q

FOURIER

A

Evolocumab in stable atherosclerosis resulted in a 15% reduction of composite end points (CV death. MI. stroke etc) but no mortality reduction (2017)

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4
Q

ODYSSEY-OUTCOMES

A

Alirocumab post ACS reduces all cause mortality by 15% (2018)

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5
Q

ORION-10

A

Inclisiran: Small interfering RNA.6 monthly injection Knocks down PCSK9 expression60% reduction in LDL

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6
Q

CLEAR Harmony

A

Bempedoic acid; blocks ATP citrate lyase (prodrug) 16% reduction in LDL but 3% get gout (2019)

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7
Q

Acute pericarditis risk factors for hospitalisation

A

Fever >38CSubacute presentationCardiac tamponade (or haemodynamic compromise) Large pericardial effusion >20mmImmunosuppression AnticoagulationTrauma No improvement after 7d of NSAID Troponin rise

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8
Q

Treatment of acute pericarditis

A

First line: NSAID + colchicine If ACS: aspirin specifically + colchicine If NSAID contraindicated: glucocorticoid + colchicine Activity restriction Treat underlying cause Drainage if: - Large effusion - Malignancy or infection - Tamponade Beta blocker if HR>70 + symptoms despite NSAID

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9
Q

Initial treatment of ACS

A
  • Nitrate (ex. RV infarct) - Beta blocker (ex. RV infarct) - Antiplatelets: Aspirin + P2Y12 - Anticoagulation - K>4 Mg>1 - Cease NSAIDs
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10
Q

Heritable aortopathy

A

MELT - Marfan Syndrome FBN1/2 - Ehlers-Danlos Syndrome (EDS) Alpha-1 procollagen type III - Loeys-Dietz TGF-beta receptor - Turner Syndrome (dissection in particular) X deletion (45.X +/- mosaicism)

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11
Q

Marfan Syndrome gene mutation

A

FBN1/2

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12
Q

Ehlers-Danlos Syndrome (EDS) gene mutation

A

Alpha-1 procollagen type III

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13
Q

Loeys-Dietz gene mutation

A

TGF-beta receptor

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14
Q

Definition of aortic aneurysm

A

Aorta >50% of expected diameter involving all three layers

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15
Q

Aortic dissection risk factors

A
  • Age. male - Atherosclerosis and its associated risk factors - Bicuspid aortic valve -Aortic coarctation - Instrumentation of AV or aorta - Intense exercise Cocaine use
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16
Q

Lenegre Disease

A

Progressive fibrosis of cardiac skeleton in under 60s resulting in heart block

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17
Q

Lev disease

A

Sclerosis of left heart skeleton in over 70s resulting in heart block

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18
Q

Underlying cause of heart block in over 50% of cases

A

Fibrosis and sclerosis; idiopathic

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19
Q

Cause of 40% of cases of AV block

A

Ischaemia

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20
Q

Identify the rhythm

A

Mobitz I - Wenckebach

21
Q

Initial treatment of unstable Mobitz II heart block

A

Isoprenaline (or dobutamine/adrenaline/dopamine) + transcutaneous (TV) pacing Not atropine

22
Q

Initial treatment of unstable Mobitz I heart block

A

Atropine + transcutaneous (TV) pacing

23
Q

Identify the arrhythmia

A

Mobitz II

24
Q

Identify the arrhytmia

A

Third degree heartblock

25
Q

Drugs which may cause AV block

A

Beta blockers Verapamil Adenosine Digoxin

26
Q

LBBB ECG criteria

A

QRS>120msec Broad/slurred R in I. aVL. V5. V6R wave peak>60msec V5. V6 Absent or narrow q waves in I. V5. V6

27
Q

Name the abnormality

A

Left posterior fasicular block Right axis deviation rS in I and aVL qR in III and aVF

28
Q

Name the ECG abnormality

A

Left anterior fasicular block - QRS<120 - Marked left axis deviation - qR in aVL

29
Q

HFpEF risk calculator

A

H2FPEF score - Heavy - 2 points - HTN - 1 point - atrial Fibrillation - 3 points - Pulmonary HTN (PASP >35) - 1point - Elderly >60 - 1 point - Filling pressure E/e’ >9 - 1 point

30
Q

NYHA - II symptoms

A

Mild symptoms with normal activity

31
Q

NYHA III symptoms

A

Marked limitation of physical activity due to symptoms

32
Q

NYHA IV symptoms

A

Symptoms at rest or unable to do any physical activity without symptoms

33
Q

Four cardinal features of acute pericarditis

A
  1. Left retrosternal chest pain (worse supine. better leaning forward) 2. Pericardial friction rub 3. ECG changes (STE widespread) 4. Pericardial effusion
34
Q

Beck’s triad

A

Diagnosis of cardiac tamponade 1. Hypotension 2. Soft heart sounds 3. JVP distention

35
Q

Classes of pulmonary hypertension

A

Group 1: Pulmonary arterial hypertension Group 2: Left sided heart disease Group 3: Chronic lung disease Group 4: Pulmonary arterial obstruction Group 5: Unidentified

36
Q

Group 1 pulmonary hypertension

A

Group 1 ? Pulmonary arterial hypertension Idiopathic Heritable - Most commonly due to BMPR2 mutationDrug/toxin related Secondary to non cardiopulmonary disease - World wide schistosomiasis is the most common cause of pulmonary HTN

37
Q

Group 2 pulmonary hypertension

A

Group 2 ? Left sided heart disease Heart failure (most common cause of PHN accounting for 70% of cases) Valvular disease Congenital disease

38
Q

Physical exam findings of PHTN

A

NAME?

39
Q

Group 4 pulmonary hypertension

A

Group 4 ? Pulmonary arterial obstruction Chronic PE

40
Q

Group 5 PHTN

A

Group 5 ? Unidentified Haematological disorders Metabolic Renal failure Tumour Fibrosing mediastinitis

41
Q

Targeted therapies for PHTN

A
  • Prostacyclin pathway agonists (e.g. epoprostenol) - Endothelin receptor antagonists (e.g. ambrisentan) - PDE-5 inhibitors (e.g. sildenafil)
42
Q

Jet velocity diagnostic of severe aortic stenosis

A

4 m/s

43
Q

Mean gradient diagnostic of severe aortic stenosis

A

40mmHg

44
Q

Valve area diagnostic of severe aortic stenosis

A

<1cm^2

45
Q

Diagnosis of low-flow. low-gradient aortic stenosis

A

Echo demonstrating mean pressure gradient <40mmHg. AVA <1cm^2. LVEF <50 AND low-dose dobutamine stress echo - Dobutamine will show if there is contractile reserve and if so increase LVEF. If AVA remains low but MG resolves indicative of true AS

46
Q

Left posterior fasicular block ECG definition

A

Right axis deviationrS in I and aVLqR in III and aVF

47
Q

Brugada algorithm for diagnosing VT

A
  1. Absence of RS in all precordial leads (YES VT SN=.1; SP1) 2. R to S >100msec in any precordial (YES VT SN=0.66; SP=0.98) 3. AV dissociation (YES VT SN=0.82l SP=0.98) 4. VT morphology in V1-2 AND V6 (YES VT SN=0.99; SP=0.97) - RBBB; V1 R smooth - V6 QS complex NO = SVT
48
Q

CHA2DS2-VASc score

A

Congestive heart failure Hypertension Age over 75 (2pts) Diabetes Stroke or TIA history (2 pts) Vascular disease including MI Age 65-75 Female sex

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