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mrcp part 1 > cardiology > Flashcards

cardiology Flashcards

1
Q

Congenital heart disease

cyanotic: most common at birth, Fallot’s most common overall

A

TGA

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2
Q

Congenital heart disease

cyanotic: most common overall

A

most common at birth, Fallot’s

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3
Q

acyanotic: most common cause

A

VSD

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4
Q 
HOCM
mitral valve prolapse
Ebstein's anomaly
thyrotoxicosis
secundum ASD
A

Associations of WPW

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5
Q

Management WPW

definitive treatment:

A

radiofrequency ablation of the accessory pathway

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6
Q

in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with ?deviation

A

left axis

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7
Q

Management WPW medical therapy:

A

sotalol**, amiodarone, flecainide

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8
Q

sotalol should be avoided in WPW if there is coexistent

A

atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

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9
Q

WPW ECG

A

short PR interval

wide QRS complexes with a slurred upstroke - ‘delta wave’

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10
Q

Hypertension - NICE now recommend ?monitoring to aid diagnosis

A

ambulatory blood pressure

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11
Q

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

A

Stage 1 hypertension

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12
Q

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

A

Stage 2 hypertension

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13
Q

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

A

Severe hypertension

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14
Q

Patients with established CVD should take atorvastatin ? dose

A

80mg on

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15
Q

treatment indicated for: ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
and??

A

treat if

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16
Q

treatment indicated? ABPM/HBPM >= 150/95 mmHg (i.e. stage 2 hypertension)

A

offer drug treatment regardless of age

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17
Q

hypertension Step 1 treatment

A

patients 55-years-old or of Afro-Caribbean origin: calcium channel blocker

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18
Q

NICE recommend that all heart failure patients should take.

A

both an ACE-inhibitor and a beta-blocker

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19
Q

mgt Aortic dissection

type A - ascending aorta -

A

control BP(IV labetalol) + surgery

20
Q

mgt Aortic dissection type B - descending aorta -

A

control BP(IV labetalol)

21
Q

Atrial fibrillation: rate control

A
  • beta blockers preferable to digoxin
22
Q

Factors favouring rate control

A

Older than 65 years

History of ischaemic heart disease

23
Q

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation

A

sotalol
amiodarone
flecainide

24
Q

HOCM most common defects involve a mutation in the gene encoding

A

β-myosin heavy chain protein or myosin binding protein C.

25
Q

Step 2 treatment hypertension

A

ACE inhibitor + calcium channel blocker (A + C)

26
Q

Step 3 treatment hypertension

A

add a thiazide diuretic (D, i.e. A + C + D)
NICE now advocate using either chlorthalidone (12.5-25.0 mg once daily) or indapamide (1.5 mg modified-release once daily or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide

27
Q

Aortic stenosis management:

A

AVR if symptomatic, otherwise cut-off is gradient of 50 mmHg

28
Q

acute pericarditis ECG changes

A

widespread ‘saddle-shaped’ ST elevation

PR depression: most specific ECG marker for pericarditis

29
Q

management of patients following a myocardial infarction (MI)

A

dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

30
Q

An ECG should be performed 90 minutes following thrombolysis to assess whether there has been a greater than 50% resolution in the ST elevation
if there has not been adequate resolution then

A

rescue PCI is superior to repeat thrombolysis

31
Q

ST-elevation myocardial infarction (STEMI)

In the absence of contraindications, all patients should be given

A

aspirin
clopidogrel: the two major studies (CLARITY and COMMIT) both confirmed benefit but used different loading doses (300mg and 75mg respectively)
low molecular weight heparin

32
Q

ST-elevation myocardial infarction (STEMI). Only offer supplemental oxygen to:

A

people with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94-98%
people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88-92% until blood gas analysis is available.

33
Q

ST-elevation myocardial infarction (STEMI) Glycaemic control in patients with diabetes mellitus
i

A

regular monitoring of blood glucose levels to glucose below 11.0 mmol/l

34
Q

ECG II, III, aVF

A

Inferior Right coronary

35
Q

V1-V4

A

Anteroseptal Left anterior descending

36
Q

V4-6, I, aVL

A

Anterolateral Left anterior descending or left circumflex

37
Q

aVL +/- V5-6

A

Lateral Left circumflex

38
Q

Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys →

A

renal artery stenosis - do MR angiography

39
Q

Turner’s syndrome - most common cardiac defect is

A

bicuspid aortic valve

40
Q

Prevention of SVT Episodes

A

Prevention of episodes
beta-blockers
radio-frequency ablation

41
Q

Isolated systolic hypertension

A

calcium channel blockers would be first-line.

42
Q

Complete heart block following an inferior MI ? pacing

A

is NOT an indication for pacing, unlike with an anterior MI

43
Q

*post-INFERIOR MI complete heart block

A

is common and can be managed conservatively if asymptomatic and haemodynamically stable

44
Q

A number of drugs have been shown to improve mortality in patients with chronic heart failure:

A

ACE inhibitors (SAVE, SOLVD, CONSENSUS)
spironolactone (RALES)
beta-blockers (CIBIS)
hydralazine with nitrates (VHEFT-1)

45
Q

*digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties. Digoxin is strongly indicated if there is coexistent

A

atrial fibrillation

46
Q

sawtooth’ appearance
as the underlying atrial rate is often around 300/min the ventricular or heart rate is dependent on the degree of AV block. For example if there is 2:1 block the ventricular rate will be 150/min
flutter waves may be visible following carotid sinus massage or adenosine

A

Tachycardia with a rate of 150/min ?atrial flutter

47
Q

atrial flutter curative for most patients

A

radiofrequency ablation of the tricuspid valve isthmus

mrcp part 1 (2 decks)

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