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MRCP PART 1 > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

How do Thiazide diurectics cause hypokalaemia?

A
  1. Increased sodium delivery to collecting ducts –> Na/K exchanger to release more K into urine
  2. Activation of RAAS 2ndry to hypovolaemia
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2
Q

How do Thiazide diurectics work?

A

Inhibit Na reabsorption at the DCT by blocking Na/Cl symporter

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3
Q

What drug should be avoided in the management of VT?

A

Verapimil due to risk of hypotension, VF and cardiac arrest

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4
Q

Which drugs are used in the management of VT

A
  1. Amiodarone
  2. Lidocaine
  3. Procainamide
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5
Q

What is the treatment for magnesium induced respiratory depression?

A

Calcium Gluconate

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6
Q

What is the most common cause of cyanotic congenital heart disease in neonates?

A

Transposition of the Great Arteries (TGA)

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7
Q

What are the most common causes of cyanotic heart disease?

A
  1. VSD
  2. ASD
  3. PDA
  4. Coarctation of the aorta
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8
Q

What is the anti thrombotic therapy for patients with mechanical valve?

A

Warfarin and aspirin

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9
Q

What is the anti thrombotic therapy for patients with prosthetic heart valves?

A

Aspirin

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10
Q

What are the poor prognostic factors for HOCM?

A
  1. Syncope
  2. FHx of sudden death
  3. Non - sustained VT on monitoring
  4. Abnormal BP changes on exercise
  5. Septal wall thickness >3cm
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11
Q

What JVP waveform is associated with VT/heart block?

A

Cannon ‘a’ waves

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12
Q

What JVP waveform is seen in tricuspid regurgitation?

A

V wave

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13
Q

What is the curative management for A. flutter?

A

Radiofrequency ablation of tricuspid valve isthmus

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14
Q

What causes A. flutter?

A

Re-entrant circuit in the right atrium involving tricuspid valve isthmus

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15
Q

What is the pathophysiology for Arrhythmogenic Right Ventricular Cardiomyopathy?

A

Fatty and fibrofatty tissue in the myocardium of the right ventricle.
Autosomal dominant

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16
Q

What is the management for ARVC?

A
  • Sotalol
  • Catheter ablation - prevent VT
  • ICD
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17
Q

What happens in Ebstein’s anomaly?

A

Low insertion of tricuspid valve –> large atrium and small ventricles

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18
Q

What are the clinical features of Ebstein’s anomaly?

A
  • cyanosis
  • ‘a’ waves
  • hepatomegaly
  • tricuspid regurgitation - pansystolic murmur
  • RBBB
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19
Q

Which murmur is associated with VSD?

A

Pansystolic murmur

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20
Q

What are the features of VSD?

A
  1. Failure to thrive
  2. Feature of heart failure
  3. Cyanosis - late feature due to Eissenmenger syndrome
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21
Q

What is the most common cause of death post MI?

A

Ventricular fibrillation

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22
Q

What type of heart block is seen post inferior MI?

A

AV blocks

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23
Q

What is the persistent ST-elevation and LVF suggestive of post MI?

A

Left ventricular aneurysm - weaken myocardium due to ischaemic damage

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24
Q

Which murmur is associated with mitral regurgitation?

A

Early - to - mid systolic murmur

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25
Q

What is the MoA of Fondaparinux?

A

Activates antithrombin III and potentiates the action of Xa

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26
Q

Which murmur is associated with Aortic regurgitation?

A

Early diastolic murmur
Mid-diastolic Austin flint murmur (severe AR)

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27
Q

What are the ECG abnormalities associated with ARVC?

A
  1. TWI in V1-V3
  2. Epsilon waves - terminal notch in QRS complex
    3.
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28
Q

What pulse is associated with Aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure

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29
Q

What is the initial blind therapy for native valve endocarditis?

A

Amoxicillin +/- gentamicin
Vanc if pen allergic

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30
Q

What is the initial blind therapy for prosthetic valve endocarditis?

A

Vancomycin + Rifampicin + Gentamicin

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31
Q

Why does Amiodarone have a long half life?

A

Highly lipophilic so widely absorbed by tissues

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32
Q

What is the MoA Amiodarone?

A

Class III antiarrhythmic - acts by blocking K channels –> prolongs action potential

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33
Q

What is the management of multifocal atrial tachycardia?

A

Rate limiting CCB - Verapamil

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34
Q

What is the MoA of Bivalirudin?

A

Reversible direct thrombin inhibitor

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35
Q

Which murmur is associated with Aortic Stenosis?

A

Ejection systolic murmur radiating to the carotids

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36
Q

What is the MoA of Ticagrelor/Clopidogrel/Prasugrel?

A

ADP receptor inhibitor - prevents platelets from binding

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37
Q

Why does Ticagrelor cause dyspnoea?

A

Due to impaired clearance of adenosine

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38
Q

How would you manage heart failure patients with a LVEF < 35% who are still symptomatic on ACE-inhibitors & beta-blockers

A

Sarcubitril - Valsartan
Following washout period of ACEi/ARB

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39
Q

What causes Transposition of the Great Vessels?

A

Failure of the aorticopulmonary septum to spiral

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40
Q

What are the anatomical changes in TGA?

A
  • Aorta leaves the right ventricle
  • Pulmonary trunk leaves the left ventricle
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41
Q

What are the CXR findings in TGA?

A

‘egg on side’

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42
Q

What are the clinical features of TGA?

A
  • cyanosis
  • loud S2
  • Prominent right ventricular impulse
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43
Q

What are the causes of eruptive xanthoma?

A
  • Familial hypertriglyceridaemia
  • Lipoprotein lipase deficiency
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44
Q

What causes tendon xanthoma and xanthelesma?

A
  • Familial hypercholesterolaemia
  • Remnant hyperlipidaemia
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45
Q

Which drugs should be avoided in WPW syndrome?

A
  • Adenosine - AV blockade –> fall in CO
  • Verapamil –> VT/VF
  • Digoxin –> VT/VF
46
Q

What is the management of WPW?

A
  • DC cardioversion
  • Ablation of accesory pathway
  • Sotalol
  • Amiodarone
  • Flecainide
47
Q

What are the ECG features of WPW?

A
  • short PR
  • Delta wave - wide QRS with slurred upstroke
  • RAD - left sided pathway
  • LAD - right sided pathway
48
Q

What is the management of SVT in asthmatics?

49
Q

What is the management of SVT?

A
  • Vagal manouevre
  • Adenosine - contractindicated in asthmatics
  • DC cardioversion
50
Q

Which organism is associated with I.E in IVDU?

51
Q

Which organism is associated with prosthetic valve I.E?

A

S. epidermidis

52
Q

Which organism is associated with dental I. E?

A

Strep sanguinus (s. viridans)

53
Q

What is the cause of I.E >2months post valve replacement?

54
Q

What is the cause of I.E <2 months post valve replacement?

A

S. epidermidis

55
Q

What is the management of HOCM?

A
  • Amiodarone
  • Beta-blockers or verapamil for symptoms
  • Cardioverter defibrillator
  • Dual chamber pacemaker
  • Endocarditis prophylaxis
56
Q

What is persistent A. fib?

A

<12 months and has potential to be terminated by cardioversion

57
Q

What are the ECG findings in ARVC?

A

TWI in V1-V3
Notch at the end of the QRS - episilon

58
Q

What are the potential risks of asystole in bradycardia?

A
  • Recent asystole
  • Complete heart block with broad QRS
  • Mobitz Type II
  • Ventricular pause >3secs
59
Q

What is the MoA of Statins?

A

Inhibition of HMG - CoA reductase

60
Q

What does the vasalva maneouvre do to ejection systolic murmurs?

A

Decreases the murmur

61
Q

What are the features of severe AS?

A
  • narrow pulse pressure
  • slow rising pulse
  • delayed ESM
  • soft/absent S2
  • S4
  • Thrill
62
Q

When should surgery be considered for asymptomatic aortic stenosis?

A
  • Valvular gradient >40mmHg
  • features of left ventricular systolic dysfunction
63
Q

What is the MoA of Amiodarone?

A

Class III antiarrhythmic agent
Blocks K channels
Inhibits repolarisation –> prolongs action potential

64
Q

What are the side effects of Amiodarone?

A
  • Thyroid dysfunction
  • Corneal deposit
  • Pulmonary fibrosis
  • Liver fibrosis
  • Peripheral neuropathy
  • Photosensitivity
  • Slate grey appearance
  • Long QT interval
65
Q

Which valve replacements require higher than normal INR?

A

Mechanical mitral valve

66
Q

What factors cause falsely elevated BNP levels?

A

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

67
Q

What factors cause reduced BNP levels?

A

Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists

68
Q

What combination of drugs are used post MI?

A
  • Beta blocker
  • Statin
  • ACE-i
  • DAPT (aspirin +ticagrelor)
69
Q

What is the MoA Nicorandil?

A

K channel activator –> activation of guanylyl cyclase which results in increase cGMP

70
Q

What causes regular cannon a waves on the JVP?

71
Q

What is the renoprotection mechanism of ACE-i?

A

Dilatation of the glomerular efferent arteriole

72
Q

What murmur is associated with PDA?

A

Continous machinery murmur

73
Q

What are the ECG changes in Brugada Syndrome?

A

Convex ST elevation
Partial RBBB

74
Q

Which drugs cause long QT?

A

THE MASCOTS:
* Terfenadine
* Haloperidol
* Erythromycin
* Methadone
* Amiodarone
* Sotalol
* Chloroquine
* Ondansetron
* TCAs
* SSRIs

75
Q

What are the causes of S4?

A
  • HOCM
  • HTN
  • Aortic Stenosis
76
Q

What causes S4 sound?

A
  • Atrial contractions against a stiff ventricle
  • Coincides with the P wave
77
Q

What causes S3?

A

Diastolic filling of the ventricle

78
Q

What are the causes of S3?

A
  • Left ventricular failure
  • Constrictive pericarditis
  • Mitral regurgitation
79
Q

What causes S1?

A

Closure of mitral and tricuspid valves

80
Q

What causes S2?

A

Closure of aortic and pulmonic valves

81
Q

What causes soft S1?

A

Long PR
Mitral Regurgitation

82
Q

What causes loud S1?

A

Mitral stenosis

83
Q

Which electrolyte imbalances causes long QT?

A
  • Hypocalcaemia
  • Hypomagnesaemia
  • Hypokalaemia
84
Q

What is the MoA dipyridamole?

A

Phosphodiesterase inhibitor –> elevates cAMP
Reduces uptake of adenosine

85
Q

What features suggest a VT rather than SVT?

A
  • AV dissociaiton
  • Fusion/capture beats
  • LAD
  • IHD hx
  • Positive QRS concordance in chest leads
  • QRS >160
  • No response to valsalva / adenosine
86
Q

Why does Amiodarone have a long half life?

A
  • Highly lipophillic
  • Absorbed by tissues –> low serum bioavailability
87
Q

What causes reversed split S2?

A
  • LBBB
  • Severe aortic stenosis
  • Patent Ductus Arteriosus
  • Right ventricular pacing
88
Q

What causes a widely split S2?

A
  • RBBB
  • Deep inspiration
  • Pulmonary stenosis
  • Severe mitral regurgitation
89
Q

What are the features of Patent Ductus Arteriosus?

A
  • Continous machine like murmur
  • Subclavicular thrill
  • Wide pulse pressure
  • Bounding collapsing pulse
  • heaving apex beat
90
Q

What is the management of PDA?

A

NSAIDs - Prostaglandin, Ibuprofen or paracetamol
Inhibits prostaglandin synthesis

91
Q

What is the management of PAH (negative vasodilator response)?

A
  • Prostacyclin analogues - Iloprost, Treprostinil
  • Endothelin receptor antagonists - Bosentan, Ambrisentan
  • Phosphodiesterase inhibitors
92
Q

What is the MoA of Amiodarone?

A

Blocks voltage gated K+ channels

93
Q

What is the MoA of Hydralazine?

A

Increase cGMP levels –> smooth muscle relaxation in arterioles than veins

94
Q

What is the anticoagulation of choice for patients with severe Mitral stenosis?

95
Q

What are the ECG findings in hypothermia?

A
  • bradycardia
  • J waves
  • Long QT
  • First degree heart block
  • Ventricular/ atrial arrhythmias
96
Q

What pulse is associated with mixed aortic valve disease?

A

Bisferens pulse - two distinct systolic peaks separated by a mid-systolic dip

97
Q

What causes a soft S2?

A

Severe aortic stenosis

98
Q

What causes a fixed split S2?

99
Q

Which cardiac enzyme is the first to rise following an MI?

100
Q

Which cardiac enzyme is useful to check for reinfarction?

A

CK - MB (continues to rise 4-10 days)

101
Q

What are the indications for cardiac resynchronisation therapy in heart failure?

A

Widened QRS - LBBB

102
Q

What the are the indications for Sacubitril - Valsartan in heart failure?

A
  • EF <35%
  • Symptomatic on ACE - i
103
Q

Which condition presents with chest pain, ECG changes but normal angiogram?

A

Syndrome X

104
Q

Which organism causes I.E post dental work?

A

Strep. mitis

105
Q

What heart sound is heard in heart block?

A

Variable intensity of S1

106
Q

What are the actions of BNP?

A
  • Diuretic
  • Natruietic
  • Decreases sympathetic tone
  • Suppresses RAAS
  • Decreases afterload
107
Q

Which CCB is used in angina for dual therapy w/ beta blocker?

A

longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)

108
Q

Which CCB is used as monotherapy in Angina?

109
Q

What murmur is associated with Aortic Regurgitation?

A

Early diastolic murmur

MRCP PART 1 (4 decks)

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