Cardiology 3 Flashcards
Long QT - not amendable to ICD or medical therapy - what treatment?
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
Takotsubu cardiomyopathy - what is characteristic of its finding?
Treatment to increase survival at one year
Left ventricular apex ballooning
Apical type is most common!
ACEI
TAVI when compared to SAVR - TAVI higher in what complications?
Vascular complications
Heart block needing PPM
Stroke somewhat similar to SAVR
What meds block SA and AV node?
B-blockers
Digoxin
Non-dihydropyridine CCB - verapamil
-blocking AV node increases pre-excitation and leads to increase Ventricular rate and VF
Adenosine mechanism of action?
bind to A1 receptor - open K channel and hyperpolarise the cell
Inhibit L channel - prevent Calcium entry into cell ( like verapamil)
Minoxidil mechanism of action?
Must coadminister with diuretics - why?
Blocks ATP on K channel + Deactivate Calcium channel so smooth muscle relaxation
Blocks K channel - so high hypokalaemia, hyperaldosterone = fluid retention
Moxonidine/clonidine mechanism of action?
a2/I2- imidazoline ( moxonidine) AGONIST! - reduces catecholamine synthesis
Glyceryl trinitrate mechanism of action?
Increase guanylyl cyclase - causing vasodilatation
Hydralazine mechanism of action?
interferes with inositol triphosphate action on Sarcoplasmic reticulum = smooth muscle relaxation ( no Ca)
Pacemaker indications? (4Bs)
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!!
When give Magnesium sulfate in resuscitation of cardiac arrest?
VF/VT (pulseless) arrest due to drug-induced prolonged QT interval + Torsades
Why B-blockers and Non-dihydropyridine is a no-no?
negative inotropy so reduce heart contractility
AV node blockade
Best anti-HTN meds to prevent stroke?
Best anti-HTN meds to prevent Heart failure?
CCB - stroke
Thiazides - Heart failure
Chlorthalidone and indapamide - longer half life
But stop when eGFR < 25 ml/min
What anti-HTN precipitate diabetes?
B-blockers ( EXCEPT NEBIVOLOL)
Thiazide
What best medications for postural orthostatic tachycardia syndrome?
Ivabradine - but not strong evidence
Medications for pHTN with proven mortality benefit ?
Endothelin receptor antagonist - MACITENTAN
Prostacyclin - Epoprostenol ( severe cases)
When you can’t use Guanylate cyclase drug (Riociguat)?
When have syncope and using PDE inhibitors ( sildenafil)
Anticoagulant in which group of pHTN and what drug?
Group I and IV - warfarin
Exercise based rehabilitation show benefit in what?
Reduction all-cause hospitalisation ( including Heart failure)
What side effect more prominent in Entresto ( Valsartan/Sacubitril) compared with Enalapril?
Hypotension
Empagliflozin and Dapagliflozin effective in reducing heart failure what?
Empagliflozin in PRESERVED ejection fraction - what benefit?
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
In chronic regurgitant lesions - what should be done surgically?
MR/AR = Dilate LV
TR/PR = Dilate RV
Acute - don’t do it because can decompensate
When consider MR and AR severe?
Regurgitant fraction > 50%
Regurgitant volume > 60 mls
Surrogate marker for EF?
Fractional shortening (LVEDD - LVESD)/ LVED-Diameter
HOCM - what you expect?
Commonest morphology in HOCM?
Invx in HOC?
When do treatment - surgery for HOCM
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!
HOCM mutation - what gene?
Myosin-binding protein = affects sarcomere
Variable penetrance
Fabry’s disease - what it shows on ECG?
(glycolipid storage disease)
Pathogenesis of Fabry’s disease
Best imaging for Fabry?
Treatment for Fabry?
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
Fabry’s disease mnemonic
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
Difference between AL and ATTR amyloidosis?
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
Difference between Wild type ATTR and mutant type ATTR?
Wild type - senile amyloidosis - normal aging process -deposit in HEART = restrictive cardiomyopathy
Mutant - familial/inheritable amyloidosis
-Deposit in nerves and heart = peripheral neuropathy
What key findings suggestive of athlete’s heart ( fit) rather than HOCM?
Dilated left ventricular size ( volume driven)
ARVC - what gene affected?
Plakophilin 2 (PKP2) - affects sarcomeres
Myocarditis on Cardiac MRI?
Non-ischemic distribution - so perfusion defect in NON-ENDOCARDIAL region
What type of pHTN has best prognosis?
Congenital
