Cardiology Flashcards
Genetic causes of familial hypercholesterolemia.
ApoB/E
ApoB
PCSK9 gain of function
Genetic causes of familial dysbetalipoproteinemia.
ApoE2/E2
Genetics of hypertriglyceridemia.
LPL gene
What electrolyte abnormalities worsen digoxin toxicity?
Hypokalaemia
Hypomagnesemia
Hypermagnesemia
Hypercalcaemia
What protein is the major component of cardiac relaxation?
Tropomyosin
Shunt fraction equation
(Aortic oxygen sats - mixed venous sats) / (pulmonary venous sats - pulmonary artery sats)
Which protein mutation is associated with ARVD?
Plakophilin 2 leading to desmosome dysfunction
What proteins are associated with HCM?
Alpha tropomyosin
Beta myosin heavy chain
Which form of metoprolol is used in hfpef?
Metoprolol succinate
What are the characteristic examination findings in HOCM?
Systolic murmur (AS and MR)
Softer - hand grip and squatting
Louder - standing and valsalva
Medications to avoid in HOCM?
Vasodilators
Diuretics
What is the medical management of HOCM?
Beta blockers
Ace inhibitors can be considered in severe symptomatic disease with low EF
What is the device management of HOCM?
2 or more major risk factors - for ICD
Survived SCA or VT - for ICD
What are the major risk factors of SCD in HOCM?
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
What is the mechanism of Levosimendin?
Calcium sensitiser
PDE inhibitor in high doses
Which inotrope is renoprotective in low doses.
Dopamine
In what circumstances is ICD placement not recommended?
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
What are the indications for ICD in secondary prevention?
Resuscitated ventricular arrhythmia without reversible cause
Spontaneous VT with heart disease
In what primary prevention settings would you consider ICD placement?
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)
What are the patient selection criteria for CRT?
NYHA 3-4
- Wide qrs >120 (LBBB)
- Low EF <35%
NYHA 2
- qrs >150
What are the indications for heart transplant?
Refractory class 3-4 heart failure
Severe ischaemia not amenable to intervention
Recurrent refractory ventricular arrhythmia
VO2 max <14ml/kg/min
What drugs should be avoided in heart failure (non exhaustive)
Nsaids
Thiazolidinediones
Diltiazem and verapamil
What is the mechanism of the PCSK9 inhibitors
PCSK9 causes LDL receptor internalisation and degradation.
Inhibition results in increased LDL receptors, reducing LDL serum levels
What are the indications for statin therapy in primary prevention?
Diabetes mellitus
LDL >4.9
10 year Cardiovascular risk >7.5%
What did the Promise study show regarding outcomes between CTCA and Functional studies in the setting of IHD investigation?
Equivalent hard endpoints
More coronary angio in anatomical imaging group
What is the indication for coronary calcium scoring?
Intermediate 10 year risk. (10-20%)
What is the ARR of cardiovascular death with FFR guided stent placement?
5%
What is the mechanism of ticagrelor mediated ventricular pauses and dyspnoea?
Adenosine
Is thrombectomy routine in stemi? Why/why not?
No
Increased stroke risk for no benefit
TOTAL TRIAL
What did the PRAMI study show regarding preventative PCI in the setting of ACS
Preventative PCI reduced non fatal MI if non culprit lesions was stented.
What did the CANTOS trial conclude regarding canakinumab use in the setting of IHD?
Reducing inflammation reduces cardiovascular events
Canakinumab increased death rate from sepsis
Overall, no mortality improvement
What are the high risk features of NSTEMI?
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
What did the RACE 2 trial show regarding heart rate goals in AF?
No difference in outcome between HR of 110 vs 80
A rhythm control strategy is chosen for a patient with AF. What is the preferred agent in the setting of
- Structurally normal heart
- Ischaemic heart disease
- Heart failure or structurally abnormal heart
- Flecainide
- Sotalol
- Amiodarone
What is the management of LQTS?
- Avoid competitive sports
- Avoid qt prolonging drugs
Previous VT - beta blocker and ICD
No VT, high risk - beta blocker and ICD
No VT, low risk - beta blocker
What is the management of VT in heart disease?
- Beta blocker and ICD
- Add antiarrhythmic (still symp)
- Catheter ablation (still symp)
What are the contraindications to prasugrel?
Age >75
Hepatic impairment
TIA or stroke
Ticagrelor contraindications
Hepatic impairment Weight <60 Bradycardia Gout ICH or peptic ulcers
What is the classical ecg finding in CPVT?
Bidirectional VT
What is the most common genetic cause of CPVT?
Ryanodine receptor mutation
Autosomal dominant
What do PCSK9 inhibitors increase?
VLDL
Which channel is responsible to maintaining the testing potential of ventricular cardiomyocytes?
Inward rectifier K channel currents
What are the three most common causes of aortic stenosis?
Calcification
Rheumatic heart disease
Congenital bicuspid valve
What are the causes of chronic AR?
Rheumatic disease Infective endocarditis Degenerative disease Collagen vascular disease Surgical/traumatic Aortic root dilation Inflammatory (AS, syphilitic aortitis)
What are the causes of mitral stenosis?
Rheumatic heart disease Degenerative Radiation associated Congenital Inflammatory (SLE and RA) Carcinoid disease Whipples disease Fabrys disease
What are the causes of chronic MR?
Degenerative disease Rheumatic heart disease Infective endocarditis Traumatic Drugs (bromocriptine, cabergoline)
Mechanism of ezetimibe?
Decreased cholesterol absorption.
Mechanism of fenofibrate?
PPAR agonist
Increase lipoprotein lipase
