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BPT annoying facts > Cardiology 3 > Flashcards

Cardiology 3 Flashcards

1
Q

Long QT - not amendable to ICD or medical therapy - what treatment?

A

Left cardiac sympathetic denervation (LCSD) - high thoracic left sympathectomy and ablation of lower half of ganglion T2- T4

-reduces noradrenaline release at ventricles and increase threshold of VF

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2
Q

Takotsubu cardiomyopathy - what is characteristic of its finding?

Treatment to increase survival at one year

A

Left ventricular apex ballooning
Apical type is most common!

ACEI

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3
Q

TAVI when compared to SAVR - TAVI higher in what complications?

A

Vascular complications
Heart block needing PPM
Stroke somewhat similar to SAVR

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4
Q

What meds block SA and AV node?

A

B-blockers
Digoxin
Non-dihydropyridine CCB - verapamil

-blocking AV node increases pre-excitation and leads to increase Ventricular rate and VF

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5
Q

Adenosine mechanism of action?

A

bind to A1 receptor - open K channel and hyperpolarise the cell

Inhibit L channel - prevent Calcium entry into cell ( like verapamil)

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6
Q

Minoxidil mechanism of action?

Must coadminister with diuretics - why?

A

Blocks ATP on K channel + Deactivate Calcium channel so smooth muscle relaxation

Blocks K channel - so high hypokalaemia, hyperaldosterone = fluid retention

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7
Q

Moxonidine/clonidine mechanism of action?

A

a2/I2- imidazoline ( moxonidine) AGONIST! - reduces catecholamine synthesis

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8
Q

Glyceryl trinitrate mechanism of action?

A

Increase guanylyl cyclase - causing vasodilatation

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9
Q

Hydralazine mechanism of action?

A

interferes with inositol triphosphate action on Sarcoplasmic reticulum = smooth muscle relaxation ( no Ca)

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10
Q

Pacemaker indications? (4Bs)

A

Because of-AV block - 3rd degree, Mobitz Type II
Bifascular block - with PR prolongation
Bradycardia-induced tachyarrhythmias
Bradycardia - symptomatic - any aetiology provided !!Hypotensive and non-responsive to atropine!!

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11
Q

When give Magnesium sulfate in resuscitation of cardiac arrest?

A

VF/VT (pulseless) arrest due to drug-induced prolonged QT interval + Torsades

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12
Q

Why B-blockers and Non-dihydropyridine is a no-no?

A

negative inotropy so reduce heart contractility

AV node blockade

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13
Q

Best anti-HTN meds to prevent stroke?

Best anti-HTN meds to prevent Heart failure?

A

CCB - stroke

Thiazides - Heart failure
Chlorthalidone and indapamide - longer half life
But stop when eGFR < 25 ml/min

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14
Q

What anti-HTN precipitate diabetes?

A

B-blockers ( EXCEPT NEBIVOLOL)

Thiazide

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15
Q

What best medications for postural orthostatic tachycardia syndrome?

A

Ivabradine - but not strong evidence

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16
Q

Medications for pHTN with proven mortality benefit ?

A

Endothelin receptor antagonist - MACITENTAN

Prostacyclin - Epoprostenol ( severe cases)

17
Q

When you can’t use Guanylate cyclase drug (Riociguat)?

A

When have syncope and using PDE inhibitors ( sildenafil)

18
Q

Anticoagulant in which group of pHTN and what drug?

A

Group I and IV - warfarin

19
Q

Exercise based rehabilitation show benefit in what?

A

Reduction all-cause hospitalisation ( including Heart failure)

20
Q

What side effect more prominent in Entresto ( Valsartan/Sacubitril) compared with Enalapril?

A

Hypotension

21
Q

Empagliflozin and Dapagliflozin effective in reducing heart failure what?

Empagliflozin in PRESERVED ejection fraction - what benefit?

A

Reduced EF NYHA II - III category ( with or without DM)
Reduces CV death and hospitalisation for decompensated HF

In preserved ejection fraction - only reduce hospitalisation

22
Q

In chronic regurgitant lesions - what should be done surgically?

A

MR/AR = Dilate LV

TR/PR = Dilate RV

Acute - don’t do it because can decompensate

23
Q

When consider MR and AR severe?

A

Regurgitant fraction > 50%

Regurgitant volume > 60 mls

24
Q

Surrogate marker for EF?

A

Fractional shortening (LVEDD - LVESD)/ LVED-Diameter

25
Q

HOCM - what you expect?

Commonest morphology in HOCM?

Invx in HOC?

When do treatment - surgery for HOCM

A

Asymmetric + septal hypertrophy > 1.5 cm

Commonest morphology = Sigmoid septum enlarged

ECHO + ECG annually till 18 years old then 5 yearly = LVH develops during teenage years

surgical - only if symptomatic after medical therapy
Surgery doesn’t improve mortality!

26
Q

HOCM mutation - what gene?

A

Myosin-binding protein = affects sarcomere

Variable penetrance

27
Q

Fabry’s disease - what it shows on ECG?
(glycolipid storage disease)

Pathogenesis of Fabry’s disease

Best imaging for Fabry?

Treatment for Fabry?

A

LVH pattern ( concentric)

Defect in GLA gene - alpha-galactosidase A deficiency
Without it - GB3 accumulates in heart and causes issue

Invx - Cardiac MRI

Tx - Enzyme replacement - Agal beta

28
Q

Fabry’s disease mnemonic

A

F - Fever
A - Alpha galactosidase enzyme deficiency/ Angiokeratomas

B - Brain stroke ( cryptogenic) , Burning sensation - neuropathy
R - Renal cysts and failure
Y - Young but can be old age manifestation

S - Short PR interval and LVH on ECG

29
Q

Difference between AL and ATTR amyloidosis?

A

AL - light chains produced by Plasma cells in bone marrow - misfolded to b-sheets. Deposit in cardiac tissue and cause issue

ATTR - Protein produced by LIVER - acts as transporter for thyroxine and retinol
-MONOMERIC form is the one prone to be misfolded into b-sheets

30
Q

Difference between Wild type ATTR and mutant type ATTR?

A

Wild type - senile amyloidosis - normal aging process -deposit in HEART = restrictive cardiomyopathy

Mutant - familial/inheritable amyloidosis
-Deposit in nerves and heart = peripheral neuropathy

31
Q

What key findings suggestive of athlete’s heart ( fit) rather than HOCM?

A

Dilated left ventricular size ( volume driven)

32
Q

ARVC - what gene affected?

A

Plakophilin 2 (PKP2) - affects sarcomeres

33
Q

Myocarditis on Cardiac MRI?

A

Non-ischemic distribution - so perfusion defect in NON-ENDOCARDIAL region

34
Q

What type of pHTN has best prognosis?

A

Congenital

BPT annoying facts (62 decks)

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