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MRCP - Passmed > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Monitoring required when using Mg sulfate?

A

Urine output

RR

O2 sat

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2
Q

What to do if respiratory depression when giving Mg Sulfate?

A

Calcium gluconate

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3
Q

Cardiac CP + Bradycardia + Low BP is suggestive of what? which structure is affected?

A

Suggestive of MI with complete heart block

RCA occlusion - as this supplies SA and AV nodes

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4
Q

Effect of thiazide diuretics on bones?

A

Reduced renal excretion of calcium

-> increased osseous matter + reduced risk of fractures

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5
Q

Contraindications to statins?

A

Macrolides - -mycin abx (stop until course is complete)

Pregnancy (stop 3 months before) - cholesterol cruical for foetal development + teratogenic risk

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6
Q

Main ECG change for hypercalcaemia?

A

Short QT

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7
Q

Main cause of infective endocarditis in colorectal ca?

A

Streptococcus bovis most commonly:

->Streptococcus gallolyticus

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8
Q

Pathogenesis of arrhytmogenic RV cardiomyopathy?

A

Right ventricular myocardium is replaced by fatty and fibrofatty tissue

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9
Q

Pathophysiology of long QT?

A

Loss of function of K+ channel / blocked K+ channel

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10
Q

ECG changes in Brugada syndrome? How can these changes be made apparent?

A

Convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave

Partial right bundle branch block

Exaggerate this by administering flecainide or ajmaline

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11
Q

Mutation in Brugada syndrome?

A

SCN5A gene - encodes myocardial Na channel protein

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12
Q

What examination sign is an early sign of LVF?

A

Gallop rhythm - S3 sound

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13
Q

Pathophysiology of HOCM?

A

Mutation to gene encoding B-myosin heavy chain protein or myosin-binding protein C

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14
Q

Which factors are affected by Warfarin?

A

10, 9, 7, 2

Warfarin was invented in 1972

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15
Q

Which medication used for HTN can impact HbA1c?

A

Thiazide diuretics - impaired glucose tolerance

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16
Q

Heart murmur in ebstein’s anomaly?

A

Tricuspid regurg - pansytolic murmur worse on inspiration

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17
Q

VSD murmur?

A

pansystolic murmur worse on expiration

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18
Q

Which cause of endocarditis is associated with poor dental hygiene? examples?

A

Streptococcus viridans - examples:

  • Streptococcus mitis
  • Streptococcus sanguinis
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19
Q

ECG changes for hypothermia?

A

bradycardia

‘J’ wave (Osborne waves) - small hump at the end of the QRS complex

first degree heart block

long QT interval

atrial and ventricular arrhythmias

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20
Q

What are aschoff bodies?

A

These are the ganulomatous nodules found in rheumatic heart fever

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21
Q

Which part of ECG wave is electrical cardioversion sync’d to?

A

The R wave

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22
Q

How to reduce risk of developing pre-eclampsia?

A

Low dose aspirin (75-150mg)

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23
Q

Causes of loud S2?

A
  • HTN (systemic or pulmonary)
  • Hyperdynamic states
  • Atrial septal defect w/out pulmonary HTN
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24
Q

Heart sounds in complete heart block?

A

Variable intensity of S1

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25
Q

ECG changes for WPW?

A

Short PR interval

Wide QRS compled w/ slurred upstroke (delta wave)

LAD (if r-sided accessory pathway)
or
RAD (if l-sided accessory pathway)

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26
Q

Which patients with DVT / PE should be considered for IVC filters?

A

Recurrent PE / DVT

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27
Q

Strongest indication for thrombolysis in PE?

A

Hypotension

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28
Q

Antithrombotic therapy in prosthetic valves?

A

Aspirin only

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29
Q

HTN in diabetics? change in age?

A

ARB / ACEi regardless of age

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30
Q

What can increase BNP levels? (not hf)

A

CKD egfr <60

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31
Q

What can decrease BNP levels?

A

ACEi
ARB
Diuretics

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32
Q

Effects of BNP?

A

Vasodilation
Diuretic + Natriuretic
Suppresses sympathetic tone + RAAS

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33
Q

What is a bisferiens pulse? When is it seen?

A

This is a double pulse caused by 2 systolic peaks

Seen in mixed aortic valve disease

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34
Q

BNP below what level makes HF highly unlikely?

A

<100

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35
Q

GRACE MI scoring markers:

A

age

heart rate, blood pressure

cardiac (Killip class) and renal function (serum creatinine)

cardiac arrest on presentation

ECG findings

troponin levels

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36
Q

Ix of choice for HOCM?

A

TT Echo

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37
Q

Takayasu’s arteritis is an obliterative arteritis affecting the ….

A

Aorta

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38
Q

Rate limiting CCBs in AF, when to be avoided?

A

Avoid in patients with AF and HFrEF

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39
Q

Indications for urgent valvular replacement in endocarditis?

A

Severe congestive cardiac failure refractory to standard medcical tx

Severe valvular incompetence

Overwhelming sepsis despite antibiotic therapy (+/- perivalvular abscess, fistulae, perforation)

Recurrent embolic episodes despite antibiotic therapy

Pregnancy

Aortic abscess (can see lengthening of PR interval)

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40
Q

Which type of MI may you need a temporary pacemaker with?

A

Post-anterior MI when there is type 2 or complete heart block

Complete heart block is common after inferior MI and can be managed conservatively if haemodynamically stable

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41
Q

What does persistent ST elevation follow recent MI not associated with CP mean?

A

L Ventricular aneurysm

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42
Q

1st line ix for stable chest pain of suspected CAD?

A

CT cornary angio w/ contrast

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43
Q

What drug is CI in VT?

A

Verapamil

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44
Q

What are the main medications used for pharmacological cardioversion in AF?

A

Amiodarone

Flecainide - if not structural heart disease

45
Q

When for valve replacement in AS?

A

If assymptomatic generally observe

If symptomatic
OR
If valvular gradient >40 w/ features like LV systolic dysfunc

-> surgery

46
Q

Angina mx?

A

1st BB or CCB (If CCB on its own rate-limiting one if not other type)

2nd Dual therapy
If can’t tolerate dual add one of:
- Long acting nitrate
- Ivabradine
- Nicorandil
- Ranolazine

3rd If on dual therapy only add 3rd whilst awaiting PCI / CABG

47
Q

Strongest RF for Infective endocarditis?

A

Prev episode of infective endocarditis

48
Q

Features that suggest …. instead of …..

A

AV dissociation

Fusion or capture beats

Positive QRS concordance in chest leads

Marked left axis deviation

History of IHD

Lack of response to adenosine or carotid sinus massage

QRS > 160 ms

49
Q

What medication should be avoided in RV infarct? Why?

A

In RV infarct - RV dysfunction -> hypotension and peripheral blood increase (eg raised JVP)

Nitrates reduce preload and can worsen this

49
Q

What to do in mx of STEMI if can’t PCI in 120 mins?

A

Fibrinolysis within 12 hours of onset of symptoms

50
Q

Which medications should be avoidede in WPW cause they can percipitate VT / VF?

A

Verapamil

Digoxin

51
Q

Initial blind abx therapy for infective endocarditis?

A

Native valve:
-> Amox +- low-dose gent
-> Vanc + low-dose gent (pen-allergic)

Prosthetic valve:
-> Vanc + Rifampicin + low-dose gent

52
Q

Features of cholesterol embolisation?

A

eosinophilia
purpura
renal failure
livedo reticularis

53
Q

Describe the NYHA classes of HF?

A

Class I - No sx + limitation
Class II - Mild sx + fatigue with ordinary activity
Class III - Moderate sx + fatigue with less than ordinary activity
Class IV - Severe + unable to exert / present at rest

53
Q

When is 3rd heart sound normal? When is it heard otherwise?

A

Caused by diastolic filling of ventricle

Normal if <30 - can be upto 50 in women

Heard in LVF (dilated cardiomyopathy), constrictive pericarditis and mitral regurg

54
Q

Target INR for mechanical valves

A

Anticoagulate with Warfarin
Aortic - 3.0
Mitral - 3.5

Mechanical valve anticoagulation is 1st thing in the AM (A then M)

55
Q

Causes of loud / soft S2?

A

Loud - HTN

Soft - AS

56
Q

Causes of fixed split and reverse split S2?

A

Fixed split - ASD

Reveresed split - LBBB

57
Q

ECG changes in hypokalaemia?

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

58
Q

Most common cause of IE if < 2 months post valve surgery?

A

Stpah epidermis

59
Q

How do the following drugs work?
Heparin
Clopidogrel
Abciximab
Dabigatran
Rivaroxaban

A

Heparin - Activates anti-thrombin III
Clopidogrel - P2Y12 inhibitor
Abciximab - Glp IIb/IIIa inhibitor
Dabigatran - direct thrombin inhibitor
Rivaroxaban - Direct factor X inhibitor

60
Q

What are features of severe AS?

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

61
Q

What are the features of cardiac syndrome x? how is managed?

A

Angina like CP upon exertion
ST depression on stress test
NORMAL CORONARIES

Nitrates may be beneficial

62
Q

Mx of HOCM?

A

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

63
Q

What drugs to avoid in HOCM?

A

nitrates
ACE-inhibitors
inotropes

64
Q

What happens to BP in pregnancy?

A

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

65
Q

Most common cause of death after MI?

A

VF

66
Q

How to measure QT interval?

A

QT interval: Time between the start of the Q wave and the end of the T wave

67
Q

What is Jervell-Lange-Nielsen syndrome and Romano-Ward syndromes? How do they differ?

A

JLN + RW syndromes are inherited syndromes of long QT intervals

JLN - sensorineural hearing loss
RW - no hearing loss

68
Q

Causes of cannon a waves - regular and irregular?

A

Regular cannon waves
-> ventricular tachycardia (with 1:1 ventricular-atrial conduction)
-> atrio-ventricular nodal re-entry tachycardia (AVNRT)

Irregular cannon waves
-> complete heart block

69
Q

When is CK-MB better than Troponin?

A

CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days (troponin T remains elevated for up to 10 days)

70
Q

When to stop ACEi in CKD?

A

A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)

71
Q

MoA of hypokalaemia in thiazaide diuretics?

A

increased delivery of sodium to the distal part of the distal convoluted tubule

72
Q

What is normal MV area - what is it in severe MS?

What is the intervention of choice for severe MS?

A

Normal area 4-6cm2 -> Severe MS <1cm2

Intervention:
- MV commussurotomy -> if this fails then valve replacement

73
Q

When is mitral valve repair used?

A

Mitral regurg / prolapse

74
Q

Cause of soft S1?

A

Caused by closure of MV and TV valves

  • Long PR
  • MR
75
Q

Cause of loud S1?

A

Caused by closure of MV and TV valves

  • MS
76
Q

Cause of soft S2?

A

Caused by closure of AV and PV valves

  • Soft in AS
77
Q

What can happen to S2 during inspiration?

A

Physiological splitting of S2

78
Q

What is S3 caused by? when is this normal when is it abnormal?

A

caused by diastolic filling of the ventricle

-> considered normal if < 30 years old (may persist in women up to 50 years old)
-> heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

79
Q

When can you get S4? What causes it?

A

S4 caused by atrial contraction against stiff ventricle hence coincides with P wave on ECG

Can be in AS, HOCM or HTN
-> In HOCM double apical impulse maybe felt due to palpable S4

80
Q

What is Sacubitril? How does it work?

A

Sacubitril is a neprilysin inhibitor -> prevents degradation of BNP and ANP

ANP and BNP work similarly -> natriuresis and vasodilation

81
Q

Management of VF / pulseless VT when identified?

A

1 shock ASAP -> 2 minutes of CPR

(If monitored patient eg in CCU upto 3 successive shocks -> CPR)

82
Q

Which infective endocarditis has a good prognosis?

A

Streptococci infection

83
Q

Poor prognostic factors in infective endocarditis?

A

Staphylococcus aureus infection

prosthetic valve (especially ‘early’, acquired during surgery)

culture negative endocarditis

low complement levels

84
Q

How can you remember causes of different parts of JVP wave?

A

A= Atrial contraction
C= Closure of triCuspid
x descent= Vent cont
V= passiVe filling of atrium
Y descent= Tricuspid opening

85
Q

Adverse reactions associated with Ivabradine

A

visual effects, particular luminous phenomena, are common

headache

bradycardia, heart block

86
Q

Nicorandil MoA?

A

K+ channel activator + nitrate

87
Q

Driving advice - angioplasty (elective)

A

1 week off

88
Q

Driving advice - CABG

A

4 weeks off (4 letters)

89
Q

Driving advice - ACS

A

4 weeks
(1 week if treated successfully with angioplasty)

90
Q

Pacemaker insertion - Driving advice

A

1 week

91
Q

ICD - Driving advice?

A

If for sustained ventricular arrhytmia - 6 months

Prophylactic - 1 month

Permanent bar for Group 2 vehicles

92
Q

Ablation for arrhythmia - advice re driving?

A

2 days off

93
Q

Aortic aneurysm - driving advice

A

If >6cm notify and annual review

If >6.5cm disqualified

94
Q

Heart transplant - driving advice

A

Don’t drive for 6 weeks no need to notfiy

95
Q

HTN - Driving advice

A

Drive unless side-effects

Group 2 vehicles - if resting >180/100 can’t drive

96
Q

Causes of LAD?

A

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

97
Q

Causes of RAD?

A

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people

98
Q

What to do re-Warfarin if patient is having emergency surgery?

A

If surgery can wait 6-8 hours - 5mg Vit K IV

If surgery can’t wait - 25-50 U/kg 4 factor prothrombin complex

99
Q

Causes of raised BNP?

A

Lung issues - COPD / Pneumonia
Sepsis
Cardiac causes - AF, valve disease
Older age
Chemo
Female sex
HTN
Reduced excretion - renal issues eg CKD

100
Q

Causes of low BNP?

A

Obesity
Flash pulmonary oedema
Pericardial constriction
Use of ARBs, ACEi and Diuretics

101
Q

How to reduce frequency of SVTs?

A

BBs

Radio-frequency ablation

102
Q

DVLA advice in HF?

A

Symptomatic HF rules you out from Group 2 licence

Need to become assymptomatic and also LVEF >40%

103
Q

Which factor is most associated with sudden death within first 6m after MI?

A

Low LVEF

Those with systolic heart failure post MI can be up to 10x more likely to die than those that do not have an MI

104
Q

Causes of eruptive xanthomas? What are these?

A

Causes of eruptive xanthoma:
-> familial hypertriglyceridaemia
-> lipoprotein lipase deficiency

Eruptive xanthoma are due to high triglyceride levels and present as multiple red/yellow vesicles on the extensor surfaces (e.g. elbows, knees)

105
Q

What is WPW associated with?

A

HOCM

mitral valve prolapse

Ebstein’s anomaly

thyrotoxicosis

secundum ASD

106
Q

What are some causes of myocarditis?

A

viral: coxsackie B, HIV

bacteria: diphtheria, clostridia

spirochaetes: Lyme disease

protozoa: Chagas’ disease, toxoplasmosis

autoimmune

drugs: doxorubicin

107
Q
A

MRCP - Passmed (16 decks)

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