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MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Causes for prolonged QT interval
(DRUGS)

A
  • Amiodarone, sotalol, class 1a antiarrhythmic - –drugs
  • Tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
  • Methadone
  • Chloroquine
  • Terfenadine**
  • Erythromycin
  • Haloperidol / Risperidone
  • Ondansetron
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2
Q

Causes for prolonged QT interval
(CONGENITAL)

A
  • Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)
  • Romano-Ward syndrome (no deafness
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3
Q

Causes for prolonged QT interval
(METABOLIC)

A
  • Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
  • Acute myocardial infarction
  • Myocarditis
  • Hypothermia
  • Subarachnoid haemorrhage
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4
Q

Clinical Signs Severe AS

A
  • Soft second heart sound
  • Valvular gradient >40 mmhg
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5
Q

S3

A
  • caused by diastolic filling of the ventricle
  • considered normal if < 30 years old (may persist in women up to 50 years old)
  • LVF (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and MR
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6
Q

S4

A
  • may be heard in aortic stenosis, HOCM, hypertension
  • caused by atrial contraction against a stiff ventricle
  • therefore coincides with the P wave on ECG
    in HOCM a double apical impulse may be felt as a result of a palpable S4
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7
Q

Anti-Coagulants and its Antidotes

A
  1. Heparin - Protamine Sulphate
  2. Warfarin - Phytomenadione
  3. Dabigatran - Idarucizumab
  4. Apixaban, Rivaroxaban - Andexanet alfa
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8
Q

Features suggesting VT rather than SVT with aberrant conduction

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
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9
Q

First-line drug for Angina pectoris

A
  1. B-Blocker (Bisoprolol)
  2. Rate limiting CCB (Verapamil, Diltiazem)
    * Don’t prescribe B-Blocker with CCB (risk of AV block)
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10
Q

Prominent V waves on JVP

A

Tricuspid Regurgitation

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11
Q

JVP waves in A.Fib

A
  • Absent A waves
  • Absent X descent
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12
Q

Conditions having ‘Prominent X descent’ in JVP

A
  • Cardiac Tamponade
  • Constrictive Pericarditis
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13
Q

Most accurate method to determine LVEF

A

MUGA (Multi Gated Acquisition) Scan

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14
Q

Early Diastolic Murmur

A
  • Aortic Regurgitation
  • Graham-Steel murmur (PR)
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15
Q

Murmur of ASD

A

Systolic Ejection Murmur

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16
Q

Ejection Systolic Murmur
(Louder on Expiration)

A
  • AS
  • HOCM
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17
Q

Ejection systolic murmur
(Louder on Inspiration)

A
  • Pulmonary Stenosis
  • ASD
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18
Q

Holosystolic

A
  • TR (Louder on inspiration)
  • MR
  • VSD
19
Q

Late Systolic Murmur

A
  • Coarctation of Aorta
  • MVP
20
Q

Mid-Late Diastolic murmur

A
  • MS
  • Austin flint murmur (severe AR)
21
Q

Coarctation of Aorta - Associations

A

Associations
- Turner’s syndrome
- bicuspid aortic valve
- berry aneurysms
- neurofibromatosis

22
Q

Causes for Aortic regurgitation

A
  • Valve disorders (bicuspid AV, Aortic dissection)
  • Spondyloarthropathies (AS)
  • Aortic root disease (RHD, IE, Calcific Valve disease, Connective tissue disorder)
23
Q

William Syndrome

A

Supra-valvular Aortic Stenosis

24
Q

Bisferiens Pulse

A
  • HOCM
  • Severe AR
25
Q

Pulsus Paradoxus

A
  • Cardiac tamponade
  • Severe Asthma
26
Q

Pulsus alternans

A

Left Ventricular Failure

27
Q

What is Dipyridamole?

A
  • phosphodiesterase inhibitor used with Aspirin for secondary prevention following TIA if clopidogrel is not tolerated
28
Q

Cannon Waves on JVP

A

Regular Cannon
-V.Tach (1:1 Ventricular-Atrial conduction)
- AVNRT
Irregular cannon
- Complete heart Block

29
Q

Quincke’s Sign

A
  • Nail bed Pulsations in AR
30
Q

S2 sound
- Loud?
- Fixed spilt?
- Reverse split?
- Widely spilt?
- Soft?

A
  • Loud - SHTN
  • Fixed split - ASD
  • Reverse Split - LBBB/sev. AS/WPW B/PDA/ RV Pacing
  • Widely split - RBBB/Deep inspiration/PS/ MR
  • Soft - AS
31
Q

ECG changes in Brugada syndrome (SCN5A)

  • Autosomal Dominant
A
  • ST elevation and negative T waves in V1-3
  • Partial RBBB
  • ECG changes more pronounced after administration of Flecainide or ajmaline
32
Q

Factors that increases BNP

A
  • Left ventricular hypertrophy
  • Ischaemia
  • Tachycardia
  • Right ventricular overload
  • Hypoxaemia (including pulmonary embolism)
  • GFR < 60 ml/min
  • Sepsis
  • COPD
  • Diabetes
  • Age > 70
  • Liver cirrhosis
33
Q

Factors that decreases BNP

A
  • Obesity
  • Diuretics
  • ACE inhibitors
  • Beta-blockers
  • Angiotensin 2 receptor blockers
  • Aldosterone antagonists
34
Q

Indications for stopping Exercise Tolerance Test

A
  • exhaustion / patient request
  • ‘severe’, ‘limiting’ chest pain
  • > 3mm ST depression
  • > 2mm ST elevation.Stop if rapid ST elevation and pain
  • systolic blood pressure > 230 mmHg
  • systolic blood pressure falling > 20 mmHg
  • attainment of maximum predicted heart rate
  • heart rate falling > 20% of starting rate
    arrhythmia develops
35
Q

M/C cause of native valve Endocarditis

A

Streptococcus Viridians

36
Q

Leading cause of Infective Endocarditis

A

Staph. Aureus

37
Q

M/C cause of Prosthetic valve Endocarditis

A

Staph. Epidermidis
<2 months Post valve replacement

38
Q

what is Moxonidine

A

Centrally acting Anti-Hypertensive
Stimulates Imidazoline receptors > Reduced sympathetic outflow > decreases PVR

39
Q

Initial Blind Therapy for Infective Endocarditis

A

Native valve
- amoxicillin, consider adding low-dose gentamicin

If penicillin allergic, MRSA or severe sepsis
- vancomycin + low-dose gentamicin

If prosthetic valve
- vancomycin + rifampicin + low-dose gentamicin

40
Q

DOC for Prosthetic valve endocarditis caused by staphylococci

A
  • Flucloxacillin + rifampicin + low-dose gentamicin
  • If penicillin allergic or MRSA
    vancomycin + rifampicin + low-dose gentamicin
41
Q

DOC for Native valve endocarditis caused by staphylococci

A
  • Flucloxacillin
  • If penicillin allergic or MRSA
    vancomycin + rifampicin
42
Q

DOC for Endocarditis caused by fully-sensitive streptococci (e.g. viridans)

A
  • Benzylpenicillin
  • If penicillin allergic
    vancomycin + low-dose gentamicin
43
Q

DOC for Endocarditis caused by less sensitive streptococci

A
  • Benzylpenicillin + low-dose gentamicin
  • If penicillin allergic
    vancomycin + low-dose gentamicin
44
Q

Indications for surgery in IE

A
  • Severe valvular incompetence
  • Aortic abscess (often indicated by a lengthening PR interval)
  • Infections resistant to antibiotics/fungal infections
  • Cardiac failure refractory to standard medical treatment
  • Recurrent emboli after antibiotic therapy

MRCP (4 decks)

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