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MRCP 2 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Posterior MI - ECG

A

Tall R waves V1-2

Reciprocal changes of STEMI are typically seen:
Horizontal ST depression
Tall, broad R waves
Upright T waves
Dominant R wave in V2

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2
Q

Wolff-Parkinson White - define

A

Congenital accessory conducting pathway between the atria and ventricles leading to atrioventricular re-entry tachycardia (AVRT).

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3
Q

Management of WPW

A

Radiofrequency ablation of the accessory pathway

Medical therapy:
sotalol
amiodarone
flecainide

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4
Q

Long QT syndrome - define

A

Delayed repolarization of the ventricles.

May lead to ventricular tachycardia/torsade de pointes

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5
Q

Congenital causes of a prolonged QT interval

A

Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)

Romano-Ward syndrome
(no deafness)

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6
Q

Drugs causes of prolonged QT interval

A

Amiodarone/sotalol

Tricyclic antidepressants, selective serotonin reuptake inhibitors
Methadone

Erythromycin

Haloperidol

Ondanestron

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7
Q

ECG features of hypokalaemia

A

U waves

Small or absent T waves

Prolong PR interval

ST depression

Long QT

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8
Q

Most common cause of infective endocarditis

A

Staphylococcus aureus

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9
Q

Streptococcus viridans

A

Streptococcus mitis

Streptococcus sanguinis

Poor dental hygiene

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10
Q

Commonly colonize indwelling lines and are the most cause of endocarditis in patients following prosthetic valve surgery

A

Staphylococcus epidermidis

After 2 months the spectrum of organisms which cause endocarditis return to normal

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11
Q

Streptococcus bovis

A

Associated with colorectal cancer

Streptococcus gallolyticus

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12
Q

Management of HOCM

A

Amiodarone

Beta-blockers or verapamil for symptoms

Cardioverter defibrillator

Dual chamber pacemaker

Endocarditis prophylaxis

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13
Q

Drugs to avoid in HOCM

A

Nitrates

ACE-inhibitors

Inotropes

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14
Q

Arrhythmogenic right ventricular cardiomyopathy - Define and treatment

A

Autosomal dominant

Right ventricular myocardium is replaced by fatty and fibrofatty tissue

Sotalol

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15
Q

Turner’s syndrome

A

45,X

Bicuspid aortic valve (15%), Coarctation of the aorta (5-10%)

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16
Q

Cardiac resynchronisation therapy

A

For patients with heart failure and wide QRS

Biventricular pacing

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17
Q

What drug is contraindicated in VT

A

Verapamil

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18
Q

First-degree heart block

A

PR interval > 0.2 seconds

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19
Q

Second-degree heart block

A

Type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs

Type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex

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20
Q

Third-degree (complete) heart block

A

No association between the P waves and QRS complexes

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21
Q

Cardiac tamponade - features

A

Beck’s triad:

Hypotension
Raised JVP
Muffled heart sounds

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22
Q

ECG features of tamponade

A

Electrical Alternans

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23
Q

Contraindicated to the use of Ranolazine

A

Liver dysfunction

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24
Q

Treatment of torsades de pointes

A

IV magnesium sulfate

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25
Q

Native valve endocarditis caused by S.aureus - treatment?

A

IV Flucloxacillin

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26
Q

Prosthetic valve endocarditis caused by staphylococci - treatment?

A

Flucloxacillin + rifampicin + low-dose gentamicin

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27
Q

Electrolyte causes of prolonged QT interval

A

Hypocalcaemia

Hypokalaemia

Hypomagnesaemia

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28
Q

Interpretation of ABPI

A

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD

1.0 - 1.2: normal

0.9 - 1.0: acceptable

< 0.9: likely PAD.
Values < 0.5 indicate severe disease

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29
Q

INR 5.0-8.0 (minor bleeding)

A

Stop warfarin
+
Give intravenous vitamin K 1-3mg

Restart when INR < 5.0

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30
Q

Most specific ECG finding in acute pericarditis

A

PR Depression

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31
Q

Positive response to acute vasodilator testing in PAH - treatment?

A

Calcium channel blocker - Nifedipine

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32
Q

Negative response to acute vasodilator testing in PAH - treatment?

A

Prostacyclin analogues: treprostinil, iloprost

Endothelin receptor antagonists
Non-selective: bosentan
Selective antagonist of endothelin receptor A: ambrisentan

Phosphodiesterase inhibitors: Sildenafil

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33
Q

ANGINA Treatment:

A

1st line: PRN GTN + Aspirin + Statin

2nd line: BB or CCB (dont mix BB with Diltiazem or Verapamil -> risk of CHB).

3rd line: Add on CCB/BB (whatever was missed in 2nd line)

4th line (if no hypotension after 3rd line) ISMN/nicorandil

5th line (if no hypotension after 4th line) Add on ISMN or nicorandil (wtv was missed)

6th line (if hypotension after 5th line):
HR<70: RANOLAZINE (contraindicated in severe renal/liver disease)
HR>70: IVABRADINE (contraindicated in Sick sinus syndrome)

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34
Q

Electrical alternans

A

Cardiac tamponade

35
Q

Beck’s triad

A

Cardiac tamponade:

Hypotension
Raised JVP
Muffled heart sounds

36
Q

Aortic dissection - Management of Type A

A

Type A - ascending aorta

IV Labetalol + Surgery

37
Q

Aortic dissection - Management of Type B

A

Type B - descending aorta, distal to left subclavian origin

Medically manage with IV labetalol

38
Q

Arrhythmogenic right ventricular cardiomyopathy - ECG

A

T wave inversion in V1-3

39
Q

Major bleeding in patients with Warfarin - management

A

Stop warfarin

Give intravenous vitamin K 5mg

Prothrombin complex concentrate - if not available then FFP*

40
Q

Drugs to avoid using in WPW

A

(ABCD)

Adenosine
Beta blockers
Calcium channel blockers
Digoxin

41
Q

Common causes of Acute pericarditis

A

Viral infections (Coxsackie)
Tuberculosis
Uraemia
Post-myocardial infarction

42
Q

Ranolazine - contraindicated when?

A

Severe Kidney Disease

43
Q

Cannon V waves

A

Right sided heart failure

44
Q

Pansystolic murmur

A

Tricuspid or Mitral regurgitation

45
Q

Kussmaul’s sign

A

Paradoxical elevation of the JVP on inspiration

Seen in Constrictive Pericarditis, Cardiac tamponade and Restrictive cardiomyopathy

46
Q

Reversal of dabigatran

A

Idarucizumab

47
Q

Dabigatran - MOA

A

Direct thrombin inhibitor

48
Q

Hypertension in diabetics

A

ACE inhibitors/ARBs are first-line regardless of age

49
Q

Warfarin - MOA

A

Inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form

This in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C.

50
Q

Ejection systolic murmur, fixed splitting of S2

A

Atrial Septal Defects (ASD)

51
Q

Wolff-Parkinson-White syndrome - ECG

A

Short PR interval - (Pre-excitation syndrome)

Wide QRS with a slurred upstroke (delta wave)

52
Q

Deeply inverted or biphasic T waves in V2-V3 suggests

A

Wellen’s Syndrome

High risk of critical LAD stenosis

53
Q

Features of left ventricular hypertrophy on an ECG

A

Deep S waves in V1 and V2 and tall R-waves in V5 and V6

54
Q

Empirical treatment of choice in prosthetic valve endocarditis

A

IV vancomycin + rifampicin + low-dose gentamicin

55
Q

Anticoagulation in MS patient with AF

56
Q

Tall

Long fingered

Downward lens dislocation

Learning difficulties

DVT

A

Homocystinuria

Treatment is vitamin B6 (pyridoxine) supplements.

57
Q

Investigation for PE in severe CKD?

58
Q

Indication for use of Ivabradine in HF

A

Sinus rhythm >75

LEVF <35%

59
Q

U waves

Small or absent T waves (occasionally inversion)

Prolong PR interval

ST depression

Long QT

A

Hypokalaemia

60
Q

What drug should NOT be used in VT.

61
Q

Short stature

Shield chest, widely spaced nipples
webbed neck

Bicuspid aortic valve (15%), Coarctation of the aorta (5-10%)

Primary amenorrhoea

A

Turner’s Syndrome (45 XO)

62
Q

Most common cause of infective endocarditis - IVDUs

A

Staphylococcus aureus

63
Q

Commonly colonize indwelling lines and are the most cause of endocarditis in patients following prosthetic valve surgery

A

Staphylococcus epidermidis

64
Q

Streptococcus bovis

A

Infective Endocarditis

Colorectal cancer

Streptococcus gallolyticus is most linked with colorectal cancer

65
Q

Features of Cholesterol embolisation

A

Eosinophilia

Purpura

Renal failure

Livedo reticularis

66
Q

Management of SVT

A

Vagal manoeuvres

Intravenous adenosine (6-12-18)
contraindicated in asthmatics -

Verapamil is a preferable option (and would also be the next step after adenosine)

Electrical cardioversion

67
Q

Prevention of episodes of SVT

A

Beta-blockers

Radio-frequency ablation

68
Q

New AF in mitral regurgitation - what do you do?

A

Refer for mitral valve replacement

69
Q

Treatment for Torsades de pointes

A

IV Magnesium sulphate

70
Q

Patients with heart failure and an ejection fraction < 35% who are euvolaemic and are already taking an ACE-inhibitor and a beta-blocker - management?

A

Aldosterone antagonist

71
Q

Mitral stenosis - valve cross sectional area of less than 1cm2 which is an indication for?

72
Q

Treatment acute idiopathic or viral pericarditis

A

Combination of NSAIDs and colchicine

73
Q

Most important risk factor for aortic dissection

A

Hypertension

74
Q

Inherited long QT syndrome, sensorineural deafness

A

Jervell and Lange-Nielsen syndrome

75
Q

Inherited long QT syndrome - no deafness

A

Romano-Ward syndrome

76
Q

Non-dihydropyridine calcium channel blockers

A

Diltiazem and verapamil

77
Q

INR > 8.0 (minor bleeding)

A

Stop warfarin, give intravenous vitamin K 1-3mg

78
Q

Major bleeding on warfarin

A

Stop warfarin

Give intravenous vitamin K 5mg

Prothrombin complex concentrate

79
Q

Indications of surgery in MR:

A
  1. EF < 60%
  2. Left ventricular end systolic diameter > 40mm
  3. New onset of AF or PHT
  4. High likelihood of durable repair with low surgical risk and absence of risk factors
80
Q

Xanthelasma is often associated with

A

Hypercholesterolaemia

81
Q

The most characteristic ECG finding in arrhythmogenic right ventricular dysplasia (ARVD) is

A

Epsilon wave

(a small positive deflection at the end of the QRS complex)

82
Q

Prominent V waves on JVP

A

Tricuspid regurgitation

83
Q

Empirical treatment of choice in native valve endocarditis

A

IV amoxicillin

MRCP 2 (13 decks)

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