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Part 1 MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How does clopidogrel prevent haemostasis? Name 3 other drugs that similarly behave

A

Prevents ADP binding to P2Y12 to stop activation of GPIIb/IIIa.
This prevents fibrinogen-mediated cross linking of platelets
Other members: Ticagrelor, prasurgel, ticodipine

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2
Q

How and when do you treat patent ductus arteriosus?

A

NSAIDs inhibit prostagladin synthesis to close duct
Give 1 week post-natally

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3
Q

How is PDA identified in terms of…
Cyanosis
Pulse
Palpation
Auscultation

A

non-cyanotic (cyanosis late stage)
Collapsing pulse, wide pulse pressure
L subclavicular thrill, heaving apex beat
Continuous machinery murmur

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4
Q

With ADP inhibitors, which…
Is most associated with dyspnoea
Is less effective with PPIs
is best for those with high bleed risk?

A

Ticagrelor causes breathlessness
Clopidogrel
Clopidogrel

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5
Q

What does this trace show?
Who is it more likely in?
How is it treated?

A

Multi-focal Atrial Tachycardia
Severe COPD/CCF
Correct electrolytes + hypoxia
Rate-limiting beta blockers

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6
Q

Name which congenital heart condition matches the oxygen saturation findings
Rise in pulmonary artery
Rise in pulmonary artery + right ventricle
Rise in PA + RV + RA
Fall in aorta
Fall in aorta and LV
Fall in aorta + LV + RA

A

Patent ductus arteriosus: Aorta and pulm artery connected
VSD: L>R shunt
ASD: LR shunt then blood moves into ventricle

Eisemenger: Pulm hypertension –> sclerosis –> RL shunt instead

PDA + Eisenmenger
VSD + Eisenmenger
ASD + Eisenmenger

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7
Q

How do loop diuretics work?

A

Act on the *Na-K-Cl Cotransporter (NAKCC) in thick ascending limb of Henle to reduce NaCl reabsorption.

*More selectively NaKCC

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8
Q

What are the main side effects of loop diuretics

A

Electrolyte loss loss: Low sodium, potassium, magnesium, calcium, chloride (H+ causing met alkalosis)
Hydration loss (renal impairment and hypotension)
Hearing loss
Glucose and Gout Gain

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9
Q

In a patient with ‘tearing’ back pain, what other clinical features indicate aortic dissection?

A

Hypertension
Pulse deficit: Absent central pulses, >20mmHg variation in blood pressure
Aortic regurgitation
+ vessel specific deficits eg angina, paraplegia, limb ischaemia

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10
Q

What anti-clotting therapy would you advise in the following scenarios?
1. Secondary prevention of stable cardiovascular disease?
2. Post-ACS/PCI
3. VTE on antiplatelet

A
  1. Typically antiplatelets but give anticoagulant instead if need for anticoagulation exists (eg AF, PE etc)
  2. Triple therapy (2 anti-platelets, 1 anticoagulant) for up to 6 months post-event, then dual therapy (1 of each) to reach 12 months
  3. Give anticoags 3-6 months; continue indefinitely if low ORBIT score
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11
Q

What is an early diastolic murmur indicative of?
What other clinical signs can be observed?

A

Aortic regurgitation
Pulse: Wide pressures, collapsing pulse, nailbed pulsation (Quincke’s sign)
De Musset’s sign
Mid-diastolic murmur (lie pt on side): Known as Austin-Flint. Severe AR causes MS due to backflow preventing full mitral valve closure

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12
Q

How can the causes of aortic regurgitation be organised by
Acuity
Pathology

A

Valve disease
Acute: Infective endocarditis
Chronic:
- Rheumatic fever
- Calcific disease
- CTDs
- Bicuspid aortic valves

Aortic root dilatation
Acute: Dissection
Chronic
- Bicuspid aortic valve
- Ank spond
- HTN
- Marfan’s syndrome

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13
Q

Why are ACEIs renoprotective?

A

Inhibition of AT 1 to 2
Reduced AT2 results in vasodilation and reduced blood pressure.
Reduced BP in efferent (distal) arterioles leads to reduced glomerular pressure
.’. reduced strain on filtration barriers in kidney

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14
Q

What are the main side effects of ACEIs

A

Cough
Angioedema within a year
Hyperkalaemia
Hypotension after first dose

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15
Q

Who should be shown caution with ACEIs

A

Prengancy + breastfeeding should be avoided
Renovascular disease
Aortic stenosis
Potassium >=5.0mmol

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16
Q

What is the general principle for U+E monitoring with ACEIs?

A

Ok to have
<=30% rise in creat from baseline
Increased potassium to 5.5

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17
Q

Significant renal impairment can be seen in what condition following commencement of ACEIs

A

Bilateral Renal Artery Stenosis

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18
Q

Mid-late diastolic murmur, dyspnoea and pink sputum indicates what?

A

Mitral stenosis

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19
Q

Aside from mid-late diastolic murmur, what other sounds can be heard in mitral stenosis?

A

Loud S1 (progresses to S2 if severe)
Opening snap

20
Q

What imaging aids diagnosis of MS?

A

Echo is most useful: <1sqcm diameter (usually 4-6sqcm)
CXR can show splayed carina, elevated L main bronchus, double right heart border, cardiomegaly

21
Q

How is mitral stenosis managed?

A

If AF: Anticoagulate with warfarin, consider DOAC if mild MS
If symptomatic: Perc balloon valvulotomy, mitral valve surgery (commisurotomy, valve replacement)

22
Q

Outline post-PCI care

A

Increased clot risk given synthetic material so need…
Aspirin indefinitely
Clopidogrel for months at discretion of cardiology

23
Q

What are the procedural complications of PCI?

A

Haematoma: At access site, if hypotension/flank pain think retroperitoneal
Femoral pseudoaneurysm: Pulsatile mass, femoral bruits, compromised distal pulses
Embolisation: Of atherosclerosis cholesterol. Purpura, renal impairment, blue toes

24
Q

What are the longer term PCI complications?

A

Restenosis in 5-20% patients, typically 2-6 months. More likely in DM, renal impairment, stents in venous bypass grafts
Stent thrombosis 1-2%

25
Q

pan-systolic murmur
prominent/giant V waves in JVP
pulsatile hepatomegaly
left parasternal heave

Indicates what murmur

A

Tricuspid regurgitation

26
Q

What are the causes of tricuspid regurgitation

A

RV infarction
Pulmonary hypertension
Infective endocarditis
Rheumatic heart disease
Apical displacement (Ebstein’s abnormality)
Carcinoid syndrome (Lung >GI cancers)

27
Q

Which arrhythmia should verapamil be avoided in?

A

VT
Shock if shocked
Amiodarone/lidocaine/procainamide if not
If drugs dont work, ICD

28
Q

What are the causes of mitral stenosis?

A

Rheumatic fever (by far most common)
Developmental (mucopolysaccharidosis, fibroelastosis)

29
Q

What are the causes of a prolonged PR interval?

A

Myotica dystrophica
Ischaemia/idiopathic
Lyme
Digoxin

Rheumatic fever
Aortic abscess
Sarcoidosis
Hypokalaemia, heart block

30
Q

For adenosine what is the…
MOA
Indication
drugs it is affected by

A

A1 agonist in AV node, induces heart block
Inhibition of AC –> reduced cAMP –> increased K efflux –>hyperpolarisation
Dipyridamole Enhances Aminophylline Reduces (DEAR)

31
Q

What are the side effects of adenosine?

A

BRONCHOSPASM
Chest pain
Enhance accessory pathway conduction

32
Q

How is PAD managed via
Lifestyle/Co-morbid
Meds
Surgical

A

Quit smoking, HTN, DM, Obesity. Exercise is very helpful.

Atorvastatin 80mg, Clopidogrel (not aspirin)
Naftidrofuryl oxalate: Vasodilate in severe cases
Cilostazol: PDE inhibitor

Revascularisation
Endo: <10cm
Surgical: >10cm

33
Q

Bradycardia with features of heart failure suggests what?

A

Complete heart blockW

34
Q

What JVP changes can be seen in CHB?

A

Cannon A waves

35
Q

What are the most common causes of aortic regurgitation?

A

<65yrs: bicuspid valve
>65yrs: Calcification

36
Q

Unstable angina, downsloping ECG findings and normal CT angio suggests what

A

Syndrome X

37
Q

What condition is most associated with aortic dissection?

A

Biscuspid aortic valve
Increases by six fold

38
Q

In a patient with progressive exertional dyspnoea, what would suggest PAH?

A

Right ventricular heave, tricuspid regurgitation, Raised JVP with A waves

39
Q

How is PAH managed?

A

Acute vasodilator testing
<20mmHg: oral CCBs
>20mmHg: treprostinil, iloprost / -sentans/PDEIs

If progressive, consider heart-lung transplant

40
Q

What are the side effects of thiazides?

A

Gout, glucose tolerance, Gets rid of Na, K
Hypercalcaemia
Pancreatitis

41
Q

Unexplained collapse in a 30 year old male with the following ECG. Hx of early cardiac death. What is the diagnosis?

A

concave V1-3 ST elevation, negative T wave after
WITH
Hx cardiac instability (collapse, prev death, VT)
Brugada syndrome

42
Q

How is Brugada syndrome further investigated and managed

A

ECG changes can be exacerbated by flecainide or ajmaline
Managed with implantable cardioversion

43
Q

What is the purported pathology of brugada syndrome?

A

Sodium ion channelopathies
SC5NA gene present in 20-40% patients

44
Q

Biological vs Mechanical valves: Go!

A

Biological: No long term anticoagulation
Mechanical: Lower failure rate

45
Q

Outline VT management

A

Stable
Amiodarone
Lidocaine: Caution if LV impairment
Procainamide
DO NOT GIVE VERAPAMIL

Unstable
Shock

46
Q

What is the treatment for magnesium sulphate toxicity?

A

Calcium gluconate

47
Q
A

Part 1 MRCP (2 decks)

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