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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Nicorandil MOA and Side Effects ?

A

a nitrate and a non-selective potassium channel activator

GI ulcers including Anal Ulcers, Upset, Headaches Flushing

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2
Q

Investigations for DVT and/or PE in Pregnancy ?

A

If Pregnant and Suspicious of DVT —> Duplex USS

If Pregnant and No DVT on USS –> V/Q

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3
Q

Valve Replacement concepts

A

Aspirin - Bioprosthetic (A –> B)

Warfarin (+ Aspirin) - Mechanical (W –> upside down = M)

INR targets

2.5 for A fib and PE/DVT
3.0 for aortic valve
3.5 for recurrent DVT
3.5 for mitral vale AM

The following factors favor choice of a mechanical valve:

-For aortic valve replacement, age <55 years

-For mitral valve replacement, age <70 years

-No contraindication to anticoagulation with a vitamin K antagonist (VKA)

-Presence of an additional indication for anticoagulation (eg, an existing mechanical valve)

-High-risk of morbidity/mortality with reintervention (eg, porcelain aorta)

The following factors favor choice of a bioprosthetic valve:

-Patient’s life expectancy is shorter than the expected effective longevity of a bioprosthetic valve

-Reoperation after mechanical valve thrombosis occurring despite good long-term control of anticoagulation and absence of structural defects

-Anticoagulation with a VKA is contraindicated, cannot be managed appropriately, or is not desired by the patient.

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4
Q

Associations with Patent Foramen Ovale

A

Migraine

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5
Q

Aortic Stenosis Facts

A

Crescendo - Decrescendo Ejection Systolic Murmur
Opening Snap
Narrow Pulse Pressure
Slow Rising Pulse
Soft S2 + Paradoxical Splitting
Stroke Adam Attack

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6
Q

Management of Aortic Stenosis

A

If Asymptomatic -
Watch and Wait
No nitrates/ACEi - decrease afterload and precipitate hypotension

If
1. Symptomatic  
2. BP drop on exercise tolerance test  
3. Heart failure  
4. Pulmonary hypertension  
5. Severe stenosis <0.6cm2
6. Valvular Gradient > 40mmHg + LVH

Then TAVI/Open 
Often Coronary Angio Prior TRO CAD

If TAVI/Open Contraindicated –> Balloon valvuloplasty

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7
Q

Acute Idiopathic/Viral Pericarditis Management

A

1st Line - NSAIDs + Colchine for 3 months
2nd Line - NSAIDs + Steroids + Colchicine
3rd Line - Azathioprine or IVIG + Anakinra

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8
Q

Long QT Syndrome Drugs and Other Causes

A

AntiArrythmics - Amiadarone , Sotalol - Class 1a
AntiBiotics - Erythromycin
AntiCsyhotics - Haloperidol, Quetiapine, Risperidone
AntiDepressants - SSRI, TCA
AntiEmetics - Ondansetron

Romano Ward
Jervell-Lange-Nielsen syndrome

HypoCalcemia
HypoKalemia
HypoThermia
ACS
SAH

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9
Q

Complications Post MI

A

0-24 hours
Sudden Cardiac Death
Ventricular Arrythmias
Acute Left Ventricular Failure (Most Important Predictor of Post MI Outcome - Killip Class)

1-3 days
Fibrinous Pericarditis

3-7 days
Papillary Muscle Rupture and MR
Left Ventricular Free Wall Rupture
Pseudoaneurysm
Ventricular Free Wall Rupture

7 days - 6 weeks
Dressler Syndrome
Reinfarction
CCF

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10
Q

Centrally Acting Antihypertensives

A

MMC

methyldopa
moxonidine
clonidine

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11
Q

DVLA Guidelines

A

successful catheter ablation 2 days

pacemaker insertion 1 week

Prophylactical ICD 1 month

sustained ventricular arrhythmia with ICD
6 months

PCI 1 week

ACS 1 month but 1 week if successfully treated with Angioplasty

CABG 1 month

Heart transplant 6 weeks

aortic aneurysm of 6cm annual review

aortic aneurysm of 6.5 cm disqualifies patients from driving

ICD G.2 Permanent

HTN G.2 Permanent BP Sys >180 , Dias >100

HF G.2 EF <40 or symptomatic

Angina Permanent if happened in rest

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12
Q

Brugada , WPW and Jervell and Lange-Nielsen Syndrome Genes

A

SCN5A - Brugada (+ KCNE3, CACNB2)

PRKAG2 - Wolff-Parkinson White

KCNQ1 - Jervell and Lange-Nielsen syndrome + hearing loss

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13
Q

Pulmonary
Hypertension

A

Causes
HIV
Cocaine
Anorexigens (e.g. fenfluramine)
10% Autosomal Dominant

Clinical Signs
Large A waves
Right Parasternal Heave
Loud P2
Tricuspid Regurgitation

Management
Stabilize + Anticoagulated for ?PE because of Right Heart Strain

Acute Vasodilator Testing
If + response = Oral CCB
If - response

  1. prostacyclin analogues: treprostinil, iloprost
  2. endothelin receptor A antagonists - Teratogenic / Limb Edema Common SE
    2.1 non-selective: bosentan (deranged LFTs)
    2.2 selective : ambrisentan
  3. phosphodiesterase inhibitors: sildenafil

Heart Transplant if progressive Symptoms

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14
Q

Differentials for REGULAR Broad Complex Tachycardia

A

Ventricular tachycardia (VT)

Supraventricular tachycardia (SVT) with aberrant conduction due to bundle branch block

SVT with any metabolic disturbance that slows supraventricular action potential propagation — hyperkalaemia, sodium channel blockade, severe acidosis

Antidromic AVRT — re-entrant tachyarrhythmia seen in Wolff-Parkinson-White syndrome

Accelerated idioventricular rhythm (AIVR)

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15
Q

Drug Contraindicated in Ventricular Tachycardia

A

Verapamil

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16
Q

Furosemide inhibits Na/K/2Cl- in the Ascending or Descending Limb of the Loop of Henle

A

Thick Ascending Limb

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17
Q

Mechanism of Action of Hydralazine

A

Increases cGMP causing smooth muscle dilatation to a greater extent in ARTERIOLES > VEINS

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18
Q

Long QT Syndrome due to Gain of Function or Loss of Function of Na or K channels

A

Loss of Function
K Channels

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19
Q

Which Cardiac Marker Rises First ?

A

Myoglobin

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20
Q

Which Cardiac Marker is used for re-infarction ?

A

CK-MB - returns to normal after 2-3 days
Troponin T - elevated for 10 days

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21
Q

Wolf Parkinson White Syndrome Associations

A

HOCM
Mitral valve prolapse
Ebstein’s anomaly
Thyrotoxicosis
Secundum ASD

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22
Q

Differentiating Type 1 and Type 2 WPW Syndrome

A

Type A (left-sided pathway): dominant R wave in V1 & Right Axis Deviation

Type B (right-sided pathway): no dominant R wave in V1 & Left Axis Deviation

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23
Q

Hypertension in Pregnancy defined by

A

systolic > 140 mmHg or diastolic > 90 mmHg

or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

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24
Q

Difference between Chronic HTN , Gestational Hypertension and Pre-Eclampsia

A

> 140/90 before Pregnancy or before 20 weeks

Gestational Hypertension - AFTER 20 week WITHOUT proteinuria/edema

Pre-eclampsia - AFTER 20 weeks WITH proteinuria/edema
If High Risk take 75mg Aspirin OD from 12 weeks

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25
Antihypertensives in Pregnancy
Labetalol Nifedipine (if asthmatic) Hydralazine Methyldopa
26
Mechanism of Actions of Antiplatelets
Aspirin --> Inhibit COX 1 --> Inhibit release of TXA2 from platelets --> Reducing Aggregation Clopidogrel/Ticagrelor ---> ADP Receptor Antagonist / PYG12 inhibitors ---> Reduced activation of GIIb/IIIa receptors Tirofiban/Eptifibatide/Atciximab ---> GIIb/IIIa receptor inhibitors ---> Preventing Fibrogen bridges between GIIb/IIIa receptors Dipyridamole ---> Phosphodiesterase Inhibitors --> Decrease cAMP to AMP conversion which activates Ca pumps and Decreasing influx of Ca via Voltage Gated Ca Channels ---> Reduced Ca intracellularly --> Reduced release of pro-aggregates like ADP and TXA2 Dipyridamole --> Also inhibit uptake of Adenosine by Platelets --> Increasing Extracellular levels of Adenosine --> Vasodilation Dabigatran --> Direct Thrombin Inhibitor Bivalirudin --> Reversible direct thrombin inhibitor Heparins --> Activates antithrombin III
27
Stable Angina Management
GTN Non DHP CCB (Verapamil) BB Increase all to Max Tolerated DOSE DHP CCB + BB If on Monotherapy and Cant add CCB or BB then add : 1. a long-acting nitrate - Asymmetric dosing if Standard Release w/ nitrate free interval 2. ivabradine 3. nicorandil 4. ranolazine If on 2 drugs only add 3rd drug whilst awaiting PCI or CABG assessment
28
INR Targets A fib / DVT / PE - 2.5 Aortic Valve - 3.0 Mitral Valve - 3.5 Recurrent DVT - 3.5 BUT Bioprosthetic Valve Bioprosthetic Valve PLUS DVT Recurrent DVT or DVT on Warfarin
(bioprosthetic) valve > no need for warfarin > long term aspirin (bioprosthetic) valve + DVT > if given warfarin (here would be second line after DOAC) > INR 2.5 DVT recurrence or DVT while on warfarin > INR 3.5 Metallic aortic valve > warfarin INR 3.0
29
PE anticoagulation management
if neither apixaban or rivaroxaban are suitable then either LMWH followed by dabigatran or edoxaban OR LMWH followed by VKA if the patient has active cancer DOAC if renal impairment is severe (e.g. < 15/min) then LMWH, unfractionated heparin or LMWH followed by a VKA APLS (Triple Positive) ---> LMWH followed by a VK
30
High and Moderate Risk Factors for Pre-Eclampsia ?
High Risk Factors - 1. HTN disease in Previous Pregnancy 2. CKD 3. Autoimmune SLE APLS 4. T1DM or T2DM 4. Chronic HTN Moderate Risk Factors 1. first pregnancy 2. >/=40 3. Pregnancy Interval > 10 years 4. BMI >/= 35 5. Family History of Pre-eclampsia 6. Multiple Pregnancy >1 High OR >/=2 Moderate = Aspirin 75-150mg OD from 12 weeks until birth Pre-Eclampsia - >160/110 + Proteinuria/Edema Admit urgently SEVERE PRE ECLAMPSIA FEATURES hypertension: typically > 160/110 mmHg and proteinuria as above proteinuria: dipstick ++/+++ headache visual disturbance papilloedema RUQ/epigastric pain hyperreflexia platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome Do Oral Labetalol Delivery is definitive management
31
24 vs 72 hour Holter for Palpitations
Bloods and ECG review 24 hour if daily 72 hour if less frequent than daily If Holter NAD --> Implantable or External Loop recorder
32
Antibiotics for Infective Endocarditis
Empirically - Native 1. Amoxicillin +/- Gentamicin 2. If MSRA / Septic / Pen Allergic --> Vancomycin +/- Gentamicin Empirically - Prosthetic 1. Vancomycin + Rifampicin + Gentamicin Staphylococci - Native 1. Flucloxicillin 2. Vancomycin + Gentamicin Staphylococci - Prosthetic 1. Flucloxicillin + Rifampicin + Gentamycin 2. Vancomycin + Rifampicin + Low dose Gentamicin Streptococci (Viridans) 1. BenzylPen 2. Vancomycin + Gentamicin Streptococci (Others) - 1. BenPen + Gentamicin 2. Vancomycin + Gentamicin
33
Aortic Regurgitation Management
surgery: 1. symptomatic patients with severe AR 2. asymptomatic patients with severe AR who have LV systolic dysfunction
34
Aortic Regurgitation Causes
Valve - Bicuspid, RHD, Calcification, Connective Tissue Disease Aortic Root - Bicuspid, Syphillis , HTN , Marfan/Ehler Danlos Acute - IE, Dissection
35
Drugs Contraindicated in HOCM
Nitrates - Vasodilate Inotropes ACEi - Reduce Afterload DHP CCB's Digoxin B2 Agonist - Vasodilate
36
HOCM Signs
Crescendo Decrescendo Ejection Systolic Murmur MR SAM ASH Mitral Regurgitation Asymmetric Septal Thickening Systolic Anterior Movement of Mitral Valve S4 Pulsus Bifirengens Paradoxical Splitting of S2 Tripple Ripple RHF and LHF Symptoms
37
Aortic Stenosis Management
If Asymptomatic --> Observe If Aymptomatic + Valve Gradient >40mmHg + LVF --> Valve Replacement If Symptomatic --> Valve Replacement ---> Coronary Angiogram Prior as CVD usually Co-exist then SURGICAL Correction if Low Risk / Young If High Risk --> TAVR Balloon Valvuloplasty --> Children without Calcification or Adults not for Replacement
38
Peripheral Arterial Disease Management
5HT1-B agonist: Sumatriptans 5HT-2 Antagonists: Risperidone - Olanzapine - Cyproheptadine Naftidrofuryl 5HT3 antagonists: Ondansetron
39
Drugs Triggering Hypertensive Crisis and Secondary HTN
Phenelzine (MAOI) steroids the combined oral contraceptive pill NSAIDs leflunomide
40
Poor Prognostic Factors for HOCM
syncope family history of sudden death young age at presentation non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring abnormal blood pressure changes on exercise Septal thickening >3cm
41
What vessels vasodilate and Vasoconstrict in Exercise
GI / Kidneys --> Vasoconstriction Skin does both Skeletal muscle dilates
42
When do we stop a ETT and Contraindications for ETT ?
Contraindications 1.MI < 7 days ago 2. unstable angina 3. uncontrolled hypertension (systolic BP > 180 mmHg) or 4.hypotension (systolic BP < 90 mmHg) 5. aortic stenosis 6. left bundle branch block: this would make the ECG very difficult to interpret Stop if: 1.exhaustion / patient request 2. 'severe', 'limiting' chest pain 3. > 3mm ST depression 4. > 2mm ST elevation.Stop if rapid ST elevation and pain 5. systolic blood pressure > 230 mmHg 6. systolic blood pressure falling > 20 mmHg 7. attainment of maximum predicted heart rate 8. heart rate falling > 20% of starting rate 9. arrhythmia develops
43
Causes of Dilated CardioMyopathy
Causes of DCM - THIAMIN 1. Thiamine deficiency (wet beri-beri) 2. Hypertension 3. Ischaemic heart disease 4. Alcohol (and cocaine) 5. Myocarditis 6. Infiltrative (haemochromatosis and sarcoidosis) 7. No cause (idiopathic) 8. Selenium Deficiency
44
Cardiac Syndrome X What is it ?
Angina on Exertion ST depression on ETT BUT normal coronary arteries on angiography
45
What are the features of SVT with Aberrancy vs V Tach
Ventricular Tachy if : 1. AV dissociation 2. fusion or capture beats 3. positive QRS concordance in chest leads 4. left axis deviation 5. history of IHD 6. lack of response to adenosine or carotid sinus massage 7.QRS > 160 ms
46
In Eclampsia what's the dose of Magnesium Sulphate ? What is the reversal agent for Magnesium Sulphate Toxicity ?
4g in 5-10 minutes with an infusion 1g/hour Calcium Gluconate
47
Pulmonary HTN Murmurs
Tricuspid Regurgitation - Pansystolic Early Diastolic Murmur at the Pulmonary Area (Graham-Steele Murmur)
48
What feature seen in Auscultation of Complete Heart Block ?
Variable Intensity of S1
49
Causes of Loud S2, Soft S2, Fixed Split S2, Widely Split S2 and Paradoxical S2 split
Causes of a loud S2 1. hypertension: systemic (loud A2) or pulmonary (loud P2) 2. hyperdynamic states 3. atrial septal defect without pulmonary hypertension Causes of a soft S2 aortic stenosis Causes of fixed split S2 atrial septal defect Causes of a widely split S2 deep inspiration RBBB pulmonary stenosis severe mitral regurgitation Causes of a reversed (paradoxical) split S2 (P2 occurs before A2) LBBB severe aortic stenosis right ventricular pacing WPW type B (causes early P2) patent ductus arteriosus
50
ECG Findings for AVRT and AVNRT
AVNRT, retrograde P waves occur early, so we either don't see them (buried in QRS) or partially see them (pseudo R' wave at terminal portion of QRS complex) In AVRT, retrograde P waves occur later, with a long RP interval > 70 msec AVNRT is the most common regular, narrow-complex tachycardia. If 2:1 Block then think Atrial Flutter BUT QUESTIONS IF TACHCARDIA WITH >150 Think Atrial Flutter atrial flutter rate: 250-350 (block usually 2:1, or 3:1) atrial fibrillation: 400-600 (inconsistent impulse transmit)
51
Afib > 48 hours Cardioversion and Anticoagulation Guidelines
If Afib > 48 hours then Anticoagulated for 3 weeks --> Cardiovert --> 4 weeks anticoagulated AFTERWARDS Alternatively ... TOE and Immediate Heparinized and Cardioversion. If Afib with > 48 hours + RECURRENT A FIB or FAILED CARDOVERSION then Anticoagulated for 4 weeks along with AMIODARONE or SOTALOL
52
Amiodarone Half Life and Why is a loading dose 300mg 10-30 mins followed by 900mg infusion / day given ?
20-100 days Highly Lipophilic and reduced bioavailability hence need loading dose and maintenance dose to maintain therapeutic levels
53
Is OS - Primum or Secundum LBBB ?
Trick Question - Neither ASD - Primum - RBBB with LEFT Axis Deviation (Primary School LEFT alone by parents) ASD - Secundum - RBBB with RIGHT Axis Deviation (Secondary School on the RIGHTPath to Success)
54
Swan Ganz Catheter measures pressure within which chamber of the heart ?
Swan LAke - Left Atrium
55
Amiodarone MOA
Potassium Channel Blocker
56
Prophylaxis for SVT in Pregnancy
Metaprolol
57
Treatment for Mitral Stenosis Severe (Loud S1/Symptomatic)
percutaneous mitral valve commissurotomy >>>if unsuccessful >>surgical replacement >> if unsuitable >>transcatheter valve replacement
58
Causes of PR Prolongation
idiopathic ischaemic heart disease digoxin toxicity hypokalaemia* rheumatic fever aortic root pathology Lyme disease sarcoidosis myotonic dystrophy
59
When to Start DOAC post Stroke Vs TIA
2 weeks for Stroke Immediately for TIA (If no cerebral infarction or hemorrhage)
60
Rheumatic Heart Disease Histology Findings ?
Aschoff Bodies - Granulomatous Nodules AND Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus) OTHER ones to remember : Councilman bodies -> hepatitis C, yellow fever Mallory bodies -> alcoholism (hepatocytes) Call-Exner bodies-> granulosa cell tumor Schiller-Duval bodies -> yolk-sac tumor
61
Jones Criteria Recall for Rheumatic Heart Disease
The rheum professor wore specs and I called him Papi Evidence of recent strep infection: + 2 major or (1 major + 2 minor) Major: SPECS Sydenham's Chorea, Polyarthritis, Erythema Marginatum, Carditis + Valvulitis, Subcut nodules Minor: PAPI Pyrexia, arthralgia, prolonged PR interval inflammatory markers - raised ESR/CRP
62
post acute coronary syndrome (medically managed): add ticagrelor to aspirin, stop ticagrelor after 12 months post percutaneous coronary intervention: add prasugrel or ticagrelor to aspirin, stop the second antiplatelet after 12 months
63
Marker of Aortic Stenosis Severity
S4
64
Arrhythmogenic Right Ventricular Cardiomyopathy Recall Inheritance Pattern ECG findings Management
Autosomal Dominant Mutations in Cardiac Desmosomes Right Ventricle replaced by Fibro Fatty Tissue ECG : T wave INVERSION in leads V1-V3 with EPSILONE WAVE (A notch at the end of QRS complex) Management 1. Sotalol 2. Catheter ablation to prevent VTachy 3. ICD Naxos disease an autosomal recessive variant of ARVC a triad of ARVC, palmoplantar keratosis, and woolly hair
65
Whats Naxos Disease ?
Autosomal recessive variant of ARVC a triad of ARVC, palmoplantar keratosis, and woolly hair
66
Pritmental Angina Treatment ?
Worse at Rest due to Vasospasm DHP CCB BETA BLOCKER CONTRAINDICATED ***** as they trigger vasospasm
67
Aortic Dissection Standford and Debakey Classification
Standford Type A : Ascending Aorta Type B : Descending Aorta , Distal to Left Subclavian Artery Debakey Type 1 : Originates in ASCENDING Aorta and extends distally Type 2 : Localized to Ascending Aorta Type 3 : Originates at DESCENDING Aorta and moves distally
68
Management for Aortic Dissection
Type A - Surgical Management Type B - Conservative with IV Labetalol
69
If ?Aortic Dissection patients not suitable/risky for CT then what is the next best investigation of Choice ?
TOE
70
How do Thiazide Diuretics cause HYPOKALEMIA
BLOCK sodium reabsorption at proximal DCT & INCREASE sodium delivery to distal DCT
71
Poor Prognostic Factors in Infective Endocarditis ?
Low Complement Levels Staphylococcus Aureus Prosthetic Valve Culture Negative Organisms Staphylococcus - 30% mortality Streptococcus - 15% mortality
72
Bleeding and INR rules
Major Bleed: STOP, Vit K 5mg iv, PCC INR >5, Bleed: STOP, Vit K 1-3mg iv, Resume <5 INR >8 , No bleed: STOP, Vit K 5mg po, Resume <5 INR 5-8: HOLD 1-2 dose
73
Gold Standard Investigation for Myocarditis ?
Structural CMR
74
Statins MOA ?
Inhibit HMG-CoA Reductase --> Decreasing Intrahepatic Cholesterol Synthesis
75
Biggest Risk Factor for Stent Thrombosis ?
Premature withdrawal of antiplatelets Diabetes is a risk factor for RESTENOSIS
76
HOCM Histology
myofibrillar hypertrophy with chaotic and disorganized fashion myocytes ('disarray') and fibrosis on biopsy
77
Causes of 1. Pulsus Alternans 2. Pulsus Paradoxus 3. Collapsing Pulse 4. Bisferiens pulse 5. 'Jerky' pulse
1. Pulsus Alternans - Severe LVF 2. Pulsus Paradoxus - Severe Asthma or Cardiac Tamponade 3. Collapsing Pulse - AR, PDA, hyperkinetic states (anemia, thyrotoxic, fever, exercise/pregnancy) 4. Bisferiens - Mixed Aortic Valve disease and HOCM 5. Jerky - HOCM
78
MOA of dipyridamole
Non Selective Phosphodiesterase Inhibitor Reduce uptake of Adenosine Vasodilatation
79
4P's of Tricuspid Regurgitation
Parasternal Heave Pulsatile Hepatomegaly Pan Systolic Murmur Prominent V waves
80
Actions of BNP
vasodilator: can decrease cardiac afterload diuretic and natriuretic suppresses both sympathetic tone and RAAS
81
QT Prolongation Causes Mnemonics AT CHESS MATCH
Amiodarone Tricyclic antidepressants Congenital (Jervell-Lange-Nielsen, Romano Ward syndrome) Hypothermia Erythromycin Sotalol Subarachnoid haemorrhage Myocarditis/methadone Antipsychotics Terfenadine Chloroquine/ciprofloxacin/citalopram HYPOkalaemia, *calcaemia, *magnesaemia (MKC) Ondansetron
82
ACEi dilate EFFERENT or AFFERENT ?
EFFERENT
83
Mnemonic for Amiodarone Side Effects 4L's
4 L's Light - photosensitiity and cataracts, Liver - steatohepatitis Lungs - fibrosis Levothyroxine - amiodarone can cause hypothyroidism or hyperthyroidism
84
Indications for Temporary Pacemaker ?
1. Symptomatic/ hemodynamically unstable bradycardia, not responding to atropine 2. Post-ANTERIOR MI: type 2 or complete heart block 3. Trifascicular block prior to surgery post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and
85
Pacing Transcutaneous vs Pacing Post Cardiac Surgery
Transcutaneous Pacing in an Emergency is only VENTRICULAR but Post Cardiac Surgery it is Atrial OR Ventricular with Epicardial Wires
86
Cardiovascular findings in Eisenmenger Syndrome: Central cyanosis (differential cyanosis in the case of a PDA) Clubbing Jugular venous pulse wave may be A-wave dominant, and, in the presence of a significant tricuspid regurgitation, the V wave may be prominent; central venous pressure may be elevated. Precordial palpation reveals a right ventricular heave and, frequently, a palpable S 2. Loud P 2 High-pitched early diastolic murmur of pulmonic insufficiency Right-sided fourth heart sound Pulmonary ejection click Single S 2 As the pulmonary vascular resistance progressively rises, the holosystolic murmur of a nonrestrictive VSD shortens and softens, first becoming early systolic in timing, before disappearing entirely as the shunt is reversed. The continuous murmur of a PDA disappears when Eisenmenger physiology develops; a short systolic murmur may remain audible.
87
5 Cyanotic Heart Disease Hand Signs
Truncus Arteriosus Transposition of Great Vessels Tricuspid Atresia Tetralogy of Fallot TAVPD
88
What do we not give in Right Ventricular Infarction ?
NITRATES !!!!
89
Investigation of Choice for PE when renally impaired ?
V/Q mismatch
90
Male or Female is a Risk Factor for Statin induced Myopathy ?
Female !!!!
91
Why does Thiazides cause Hypokalemia ?
More Na delivered to DCT More Na absorbed in exchange for K+ and H+
92
Cardiac Scans and Why we do them ?
SPECT >> myocardial perfusion + viability. MUGA >> Left Vent EF after cardiotoxic drugs. Cardiac CT >> suspected IHD Cardiac MRI >> congintal heart dis , Rt and lt vent mass, type of cardiomyopathy , myocardial perfusion è use of gadolinium. Gadolinium - cardiac MRI FDG - PET Technetium - MUGA, MIBA and SPECT
93
Most Common Cyanotic Heart Disease Vs Most Common Cyanotic Heart Disease at Birth
TOF Vs TGA

MRCP Part 1 (18 decks)

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