CARDIOLOGY Flashcards
1
Q
How do Thiazide diurectics cause hypokalaemia?
A
- Increased sodium delivery to collecting ducts –> Na/K exchanger to release more K into urine
- Activation of RAAS 2ndry to hypovolaemia
2
Q
How do Thiazide diurectics work?
A
Inhibit Na reabsorption at the DCT by blocking Na/Cl symporter
3
Q
What drug should be avoided in the management of VT?
A
Verapimil due to risk of hypotension, VF and cardiac arrest
4
Q
Which drugs are used in the management of VT
A
- Amiodarone
- Lidocaine
- Procainamide
5
Q
What is the treatment for magnesium induced respiratory depression?
A
Calcium Gluconate
6
Q
What is the most common cause of cyanotic congenital heart disease in neonates?
A
Transposition of the Great Arteries (TGA)
7
Q
What are the most common causes of cyanotic heart disease?
A
- VSD
- ASD
- PDA
- Coarctation of the aorta
8
Q
What is the anti thrombotic therapy for patients with mechanical valve?
A
Warfarin and aspirin
9
Q
What is the anti thrombotic therapy for patients with prosthetic heart valves?
A
Aspirin
10
Q
What are the poor prognostic factors for HOCM?
A
- Syncope
- FHx of sudden death
- Non - sustained VT on monitoring
- Abnormal BP changes on exercise
- Septal wall thickness >3cm
11
Q
What JVP waveform is associated with VT/heart block?
A
Cannon ‘a’ waves
12
Q
What JVP waveform is seen in tricuspid regurgitation?
A
V wave
13
Q
What is the curative management for A. flutter?
A
Radiofrequency ablation of tricuspid valve isthmus
14
Q
What causes A. flutter?
A
Re-entrant circuit in the right atrium involving tricuspid valve isthmus
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
16
Q
What is the management for ARVC?
A
- Sotalol
- Catheter ablation - prevent VT
- ICD
17
Q
What happens in Ebstein’s anomaly?
A
Low insertion of tricuspid valve –> large atrium and small ventricles
18
Q
What are the clinical features of Ebstein’s anomaly?
A
- cyanosis
- ‘a’ waves
- hepatomegaly
- tricuspid regurgitation - pansystolic murmur
- RBBB
19
Q
Which murmur is associated with VSD?
A
Pansystolic murmur
20
Q
What are the features of VSD?
A
- Failure to thrive
- Feature of heart failure
- Cyanosis - late feature due to Eissenmenger syndrome
21
Q
What is the most common cause of death post MI?
A
Ventricular fibrillation
22
Q
What type of heart block is seen post inferior MI?
A
AV blocks
23
Q
What is the persistent ST-elevation and LVF suggestive of post MI?
A
Left ventricular aneurysm - weaken myocardium due to ischaemic damage
24
Q
Which murmur is associated with mitral regurgitation?
A
Early - to - mid systolic murmur
25
What is the MoA of Fondaparinux?
Activates antithrombin III and potentiates the action of Xa
26
Which murmur is associated with Aortic regurgitation?
Early diastolic murmur
Mid-diastolic Austin flint murmur (severe AR)
27
What are the ECG abnormalities associated with ARVC?
1. TWI in V1-V3
2. Epsilon waves - terminal notch in QRS complex
3.
28
What pulse is associated with Aortic regurgitation?
Collapsing pulse
Wide pulse pressure
29
What is the initial blind therapy for native valve endocarditis?
Amoxicillin +/- gentamicin
Vanc if pen allergic
30
What is the initial blind therapy for prosthetic valve endocarditis?
Vancomycin + Rifampicin + Gentamicin
31
Why does Amiodarone have a long half life?
Highly lipophilic so widely absorbed by tissues
32
What is the MoA Amiodarone?
Class III antiarrhythmic - acts by blocking K channels --> prolongs action potential
33
What is the management of multifocal atrial tachycardia?
Rate limiting CCB - Verapamil
34
What is the MoA of Bivalirudin?
Reversible direct thrombin inhibitor
35
Which murmur is associated with Aortic Stenosis?
Ejection systolic murmur radiating to the carotids
36
What is the MoA of Ticagrelor/Clopidogrel/Prasugrel?
ADP receptor inhibitor - prevents platelets from binding
37
Why does Ticagrelor cause dyspnoea?
Due to impaired clearance of adenosine
38
How would you manage heart failure patients with a LVEF < 35% who are still symptomatic on ACE-inhibitors & beta-blockers
Sarcubitril - Valsartan
Following washout period of ACEi/ARB
39
What causes Transposition of the Great Vessels?
Failure of the aorticopulmonary septum to spiral
40
What are the anatomical changes in TGA?
* Aorta leaves the right ventricle
* Pulmonary trunk leaves the left ventricle
41
What are the CXR findings in TGA?
'egg on side'
42
What are the clinical features of TGA?
* cyanosis
* loud S2
* Prominent right ventricular impulse
43
What are the causes of eruptive xanthoma?
* Familial hypertriglyceridaemia
* Lipoprotein lipase deficiency
44
What causes tendon xanthoma and xanthelesma?
* Familial hypercholesterolaemia
* Remnant hyperlipidaemia
45
Which drugs should be avoided in WPW syndrome?
* Adenosine - AV blockade --> fall in CO
* Verapamil --> VT/VF
* Digoxin --> VT/VF
46
What is the management of WPW?
* DC cardioversion
* Ablation of accesory pathway
* Sotalol
* Amiodarone
* Flecainide
47
What are the ECG features of WPW?
* short PR
* Delta wave - wide QRS with slurred upstroke
* RAD - left sided pathway
* LAD - right sided pathway
48
What is the management of SVT in asthmatics?
Verapamil
49
What is the management of SVT?
* Vagal manouevre
* Adenosine - contractindicated in asthmatics
* DC cardioversion
50
Which organism is associated with I.E in IVDU?
S. aureus
51
Which organism is associated with prosthetic valve I.E?
S. epidermidis
52
Which organism is associated with dental I. E?
Strep sanguinus (s. viridans)
53
What is the cause of I.E >2months post valve replacement?
S.aureus
54
What is the cause of I.E <2 months post valve replacement?
S. epidermidis
55
What is the management of HOCM?
* Amiodarone
* Beta-blockers or verapamil for symptoms
* Cardioverter defibrillator
* Dual chamber pacemaker
* Endocarditis prophylaxis
56
What is persistent A. fib?
<12 months and has potential to be terminated by cardioversion
57
What are the ECG findings in ARVC?
TWI in V1-V3
Notch at the end of the QRS - episilon
58
What are the potential risks of asystole in bradycardia?
* Recent asystole
* Complete heart block with broad QRS
* Mobitz Type II
* Ventricular pause >3secs
59
What is the MoA of Statins?
Inhibition of HMG - CoA reductase
60
What does the vasalva maneouvre do to ejection systolic murmurs?
Decreases the murmur
61
What are the features of severe AS?
* narrow pulse pressure
* slow rising pulse
* delayed ESM
* soft/absent S2
* S4
* Thrill
62
When should surgery be considered for asymptomatic aortic stenosis?
* Valvular gradient >40mmHg
* features of left ventricular systolic dysfunction
63
What is the MoA of Amiodarone?
Class III antiarrhythmic agent
Blocks K channels
Inhibits repolarisation --> prolongs action potential
64
What are the side effects of Amiodarone?
* Thyroid dysfunction
* Corneal deposit
* Pulmonary fibrosis
* Liver fibrosis
* Peripheral neuropathy
* Photosensitivity
* Slate grey appearance
* Long QT interval
65
Which valve replacements require higher than normal INR?
Mechanical mitral valve
66
What factors cause falsely elevated BNP levels?
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
67
What factors cause reduced BNP levels?
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
68
What combination of drugs are used post MI?
* Beta blocker
* Statin
* ACE-i
* DAPT (aspirin +ticagrelor)
69
What is the MoA Nicorandil?
K channel activator --> activation of guanylyl cyclase which results in increase cGMP
70
What causes regular cannon a waves on the JVP?
VT
AVNRT
71
What is the renoprotection mechanism of ACE-i?
Dilatation of the glomerular efferent arteriole
72
What murmur is associated with PDA?
Continous machinery murmur
73
What are the ECG changes in Brugada Syndrome?
Convex ST elevation
Partial RBBB
74
Which drugs cause long QT?
THE MASCOTS:
* Terfenadine
* Haloperidol
* Erythromycin
* Methadone
* Amiodarone
* Sotalol
* Chloroquine
* Ondansetron
* TCAs
* SSRIs
75
What are the causes of S4?
* HOCM
* HTN
* Aortic Stenosis
76
What causes S4 sound?
* Atrial contractions against a stiff ventricle
* Coincides with the P wave
77
What causes S3?
Diastolic filling of the ventricle
78
What are the causes of S3?
* Left ventricular failure
* Constrictive pericarditis
* Mitral regurgitation
79
What causes S1?
Closure of mitral and tricuspid valves
80
What causes S2?
Closure of aortic and pulmonic valves
81
What causes soft S1?
Long PR
Mitral Regurgitation
82
What causes loud S1?
Mitral stenosis
83
Which electrolyte imbalances causes long QT?
* Hypocalcaemia
* Hypomagnesaemia
* Hypokalaemia
84
What is the MoA dipyridamole?
Phosphodiesterase inhibitor --> elevates cAMP
Reduces uptake of adenosine
85
What features suggest a VT rather than SVT?
* AV dissociaiton
* Fusion/capture beats
* LAD
* IHD hx
* Positive QRS concordance in chest leads
* QRS >160
* No response to valsalva / adenosine
86
Why does Amiodarone have a long half life?
* Highly lipophillic
* Absorbed by tissues --> low serum bioavailability
87
What causes reversed split S2?
* LBBB
* Severe aortic stenosis
* Patent Ductus Arteriosus
* Right ventricular pacing
88
What causes a widely split S2?
* RBBB
* Deep inspiration
* Pulmonary stenosis
* Severe mitral regurgitation
89
What are the features of Patent Ductus Arteriosus?
* Continous machine like murmur
* Subclavicular thrill
* Wide pulse pressure
* Bounding collapsing pulse
* heaving apex beat
90
What is the management of PDA?
NSAIDs - Prostaglandin, Ibuprofen or paracetamol
Inhibits prostaglandin synthesis
91
What is the management of PAH (negative vasodilator response)?
* Prostacyclin analogues - Iloprost, Treprostinil
* Endothelin receptor antagonists - Bosentan, Ambrisentan
* Phosphodiesterase inhibitors
92
What is the MoA of Amiodarone?
Blocks voltage gated K+ channels
93
What is the MoA of Hydralazine?
Increase cGMP levels --> smooth muscle relaxation in arterioles than veins
94
What is the anticoagulation of choice for patients with severe Mitral stenosis?
Warfarin
95
What are the ECG findings in hypothermia?
* bradycardia
* J waves
* Long QT
* First degree heart block
* Ventricular/ atrial arrhythmias
96
What pulse is associated with mixed aortic valve disease?
Bisferens pulse - two distinct systolic peaks separated by a mid-systolic dip
97
What causes a soft S2?
Severe aortic stenosis
98
What causes a fixed split S2?
ASD
99
Which cardiac enzyme is the first to rise following an MI?
Myoglobin
100
Which cardiac enzyme is useful to check for reinfarction?
CK - MB (continues to rise 4-10 days)
101
What are the indications for cardiac resynchronisation therapy in heart failure?
Widened QRS - LBBB
102
What the are the indications for Sacubitril - Valsartan in heart failure?
* EF <35%
* Symptomatic on ACE - i
103
Which condition presents with chest pain, ECG changes but normal angiogram?
Syndrome X
104
Which organism causes I.E post dental work?
*Strep. mitis*
105
What heart sound is heard in heart block?
Variable intensity of S1
106
What are the actions of BNP?
* Diuretic
* Natruietic
* Decreases sympathetic tone
* Suppresses RAAS
* Decreases afterload
107
Which CCB is used in angina for dual therapy w/ beta blocker?
longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)
108
Which CCB is used as monotherapy in Angina?
Diltiazem
109
What murmur is associated with Aortic Regurgitation?
Early diastolic murmur
110
