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RACP short cards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Genetic causes of familial hypercholesterolemia.

A

ApoB/E
ApoB
PCSK9 gain of function

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2
Q

Genetic causes of familial dysbetalipoproteinemia.

A

ApoE2/E2

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3
Q

Genetics of hypertriglyceridemia.

A

LPL gene

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4
Q

What electrolyte abnormalities worsen digoxin toxicity?

A

Hypokalaemia
Hypomagnesemia
Hypermagnesemia
Hypercalcaemia

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5
Q

What protein is the major component of cardiac relaxation?

A

Tropomyosin

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6
Q

Shunt fraction equation

A

(Aortic oxygen sats - mixed venous sats) / (pulmonary venous sats - pulmonary artery sats)

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7
Q

Which protein mutation is associated with ARVD?

A

Plakophilin 2 leading to desmosome dysfunction

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8
Q

What proteins are associated with HCM?

A

Alpha tropomyosin

Beta myosin heavy chain

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9
Q

Which form of metoprolol is used in hfpef?

A

Metoprolol succinate

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10
Q

What are the characteristic examination findings in HOCM?

A

Systolic murmur (AS and MR)

Softer - hand grip and squatting

Louder - standing and valsalva

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11
Q

Medications to avoid in HOCM?

A

Vasodilators

Diuretics

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12
Q

What is the medical management of HOCM?

A

Beta blockers

Ace inhibitors can be considered in severe symptomatic disease with low EF

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13
Q

What is the device management of HOCM?

A

2 or more major risk factors - for ICD

Survived SCA or VT - for ICD

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14
Q

What are the major risk factors of SCD in HOCM?

A 
Prior sustained ventricular arrhythmia 
Family history of SCD due to HCM
Syncope of cardiac origin 
Multiple episodes of NSVT
Massive LV hypertrophy >3cm
LV apical aneurysm 
End stage dis are with EF <50%
CMR with extensive LGE
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15
Q

What is the mechanism of Levosimendin?

A

Calcium sensitiser

PDE inhibitor in high doses

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16
Q

Which inotrope is renoprotective in low doses.

A

Dopamine

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17
Q

In what circumstances is ICD placement not recommended?

A

Reversible cause of VT/VF
Expected survival <1 year
If catheter ablation is a treatment option
Severe psychiatric illness
Class 4 heat failure who are not transplant or CRT candidates
Syncope without structural heart disease
Active infection

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18
Q

What are the indications for ICD in secondary prevention?

A

Resuscitated ventricular arrhythmia without reversible cause

Spontaneous VT with heart disease

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19
Q

In what primary prevention settings would you consider ICD placement?

A

MI 40 days prior with EF <30%
NYHA 2-3 with cardiomyopathy and EF <35%
Syncope with structural heart disease
Underlying disorder with high risk for ventricular arrhythmia (long qt, brugada, ARVD)

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20
Q

What are the patient selection criteria for CRT?

A

NYHA 3-4

  • Wide qrs >120 (LBBB)
  • Low EF <35%

NYHA 2
- qrs >150

21
Q

What are the indications for heart transplant?

A

Refractory class 3-4 heart failure
Severe ischaemia not amenable to intervention
Recurrent refractory ventricular arrhythmia
VO2 max <14ml/kg/min

22
Q

What drugs should be avoided in heart failure (non exhaustive)

A

Nsaids
Thiazolidinediones
Diltiazem and verapamil

23
Q

What is the mechanism of the PCSK9 inhibitors

A

PCSK9 causes LDL receptor internalisation and degradation.

Inhibition results in increased LDL receptors, reducing LDL serum levels

24
Q

What are the indications for statin therapy in primary prevention?

A

Diabetes mellitus
LDL >4.9
10 year Cardiovascular risk >7.5%

25
Q

What did the Promise study show regarding outcomes between CTCA and Functional studies in the setting of IHD investigation?

A

Equivalent hard endpoints

More coronary angio in anatomical imaging group

26
Q

What is the indication for coronary calcium scoring?

A

Intermediate 10 year risk. (10-20%)

27
Q

What is the ARR of cardiovascular death with FFR guided stent placement?

A

5%

28
Q

What is the mechanism of ticagrelor mediated ventricular pauses and dyspnoea?

A

Adenosine

29
Q

Is thrombectomy routine in stemi? Why/why not?

A

No
Increased stroke risk for no benefit

TOTAL TRIAL

30
Q

What did the PRAMI study show regarding preventative PCI in the setting of ACS

A

Preventative PCI reduced non fatal MI if non culprit lesions was stented.

31
Q

What did the CANTOS trial conclude regarding canakinumab use in the setting of IHD?

A

Reducing inflammation reduces cardiovascular events

Canakinumab increased death rate from sepsis

Overall, no mortality improvement

32
Q

What are the high risk features of NSTEMI?

A 
Repetitive or prolonged (<10 min) CP
Elevated cardiac biomarker 
Dynamic ECG changes 
Transient St elevation (>0.5mm)
Haemodynamic compromise 
Sustained VT 
Syncope 
PCI in last 6 months 
Prior CABG 
Diabetes 
Chronic kidney disease 
Left ventricular systolic dysfunction
33
Q

What did the RACE 2 trial show regarding heart rate goals in AF?

A

No difference in outcome between HR of 110 vs 80

34
Q

A rhythm control strategy is chosen for a patient with AF. What is the preferred agent in the setting of

  1. Structurally normal heart
  2. Ischaemic heart disease
  3. Heart failure or structurally abnormal heart
A
  1. Flecainide
  2. Sotalol
  3. Amiodarone
35
Q

What is the management of LQTS?

A
  1. Avoid competitive sports
  2. Avoid qt prolonging drugs

Previous VT - beta blocker and ICD
No VT, high risk - beta blocker and ICD
No VT, low risk - beta blocker

36
Q

What is the management of VT in heart disease?

A
  1. Beta blocker and ICD
  2. Add antiarrhythmic (still symp)
  3. Catheter ablation (still symp)
37
Q

What are the contraindications to prasugrel?

A

Age >75
Hepatic impairment
TIA or stroke

38
Q

Ticagrelor contraindications

A 
Hepatic impairment 
Weight <60
Bradycardia
Gout 
ICH or peptic ulcers
39
Q

What is the classical ecg finding in CPVT?

A

Bidirectional VT

40
Q

What is the most common genetic cause of CPVT?

A

Ryanodine receptor mutation

Autosomal dominant

41
Q

What do PCSK9 inhibitors increase?

A

VLDL

42
Q

Which channel is responsible to maintaining the testing potential of ventricular cardiomyocytes?

A

Inward rectifier K channel currents

43
Q

What are the three most common causes of aortic stenosis?

A

Calcification
Rheumatic heart disease
Congenital bicuspid valve

44
Q

What are the causes of chronic AR?

A 
Rheumatic disease  
Infective endocarditis 
Degenerative disease 
Collagen vascular disease 
Surgical/traumatic 
Aortic root dilation 
Inflammatory (AS, syphilitic aortitis)
45
Q

What are the causes of mitral stenosis?

A 
Rheumatic heart disease
Degenerative 
Radiation associated 
Congenital 
Inflammatory (SLE and RA)
Carcinoid disease
Whipples disease 
Fabrys disease
46
Q

What are the causes of chronic MR?

A 
Degenerative disease
Rheumatic heart disease 
Infective endocarditis 
Traumatic
Drugs (bromocriptine, cabergoline)
47
Q

Mechanism of ezetimibe?

A

Decreased cholesterol absorption.

48
Q

Mechanism of fenofibrate?

A

PPAR agonist

Increase lipoprotein lipase

RACP short cards (30 decks)

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