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GCUH FRACP Writtens 2020 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

In AF, for what duration is anticoagulation required prior to DCCV if it had lasted for >48 hours?

A

3 weeks

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2
Q

Which are the two proteins implicated in cardiac amyloidosis?

A

AL

Transthyretin

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3
Q

What clinical features would you expect to see with cardiac amyloidosis? Name 6.

A

HFpEF

Restrictive

AF

Increased wall thickness

Voltage criteria negative

GLS apical sparing

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4
Q

What is E/e’, and what are the reference ranges?

A

Ratio between early mitral inflow velocity and mitral annular early diastolic velocity. Reflects LA pressure.

E = flow from LA to LV during active relaxation
e' = active myocardial relaxation (velocity of descent away from apex)

E/e’ <8 is normal (grade 1)
E/e’&raquo_space; 14 abnormal (grade 3 - restrictive)
e’ 15-20mm - watch

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5
Q

What is tafamidis helpful treatment for?

A

Transthyretin amyloid cardiomyopathy

Decreased mortality and increases quality of life

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6
Q

What are the 5 groups of pulmonary hypertension?

A
  1. Pulmonary arterial hypertension
  2. PH associated with left heart disease
  3. PH with resp disease +/- hypoxia
  4. Chronic venous thromboembolic disease
  5. Misc
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7
Q

With right heart catheterisation, what is the normal reference range for pulmonary capillary wedge pressure?

A

4 to 12 mmHg

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8
Q

With right heart catheterisation, what is the normal reference range for cardiac output?

A

4 to 8 L/min

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9
Q

With right heart catheterisation, what is the trans pulmonary gradient calculation, and what is the normal range?

A

TPG - transpulmonary gradient is mPAP - mean PCWP

Normal < 12 mmHg

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10
Q

With right heart catheterisation, what is the calculation for pulmonary vascular resistance, and what is the normal reference range?

A

PVR = transpulmonary gradient/cardiac output

Normal <3 Wood units

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11
Q

How do you use PCWP to determine group 2 PHT?

A

PCWP < 15 mmHg suggests pre-capillary PHT

PCWP > 15 mmHg suggests post-capillary PHT (i.e. group 2 left-sided)

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12
Q

How is severe high grade aortic stenosis defined? Name 3 parameters.

A

Peak velocity > 4m/sec
Mean gradient > 40mmHg
AVA < 1cm^2

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13
Q

In patients with asymptomatic aortic stenosis who are regularly monitored, what adverse prognostic features would prompt you to refer the patient for intervention besides symptomatology? Name 2.

A

LV dysfunction

Pulmonary hypertension

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14
Q

In patients with asymptomatic mitral valve stenosis, when do you consider intervention? 3 parameters.

A

Mean gradient > 10mmHg

PA systolic pressure > 30mmHg

Valve < 1.5 cm^2

Exercise test may be useful

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15
Q

In patients with asymptomatic mitral valve regurgitation, when do you consider intervention? 5 parameters.

A

Onset of AF

Pulmonary hypertension

LVEF 30-60% and/or LVESD > 40-45mm

LVEF < 30% - high risk

LVEF > 60% and LVESD < 40mm is considered well-compensated

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16
Q

How long can event recorders be used for at a time?

A

7 days

20 minutes pre-event memory

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17
Q

How long can loop recorders be used for at a time?

A

Up to 3 years

Single V2 lead ECG

18
Q

What is the cure rate of ablations for AF?

A

50%

Ablation combined with weight loss has a cure rate of 90%

19
Q

What are the stipulations a patient must meet in order to receive ivabradine?

A

LVEF < 35%

HR > 70

20
Q

What treatments do you give for HFrEF?

A

ACE

B blocker

MRA

If < 35% LVEF, consider ARB, ARNI and/or ivabradine

If persistent HF with LVEF < 40%, change ACEi/ARB to ARNI

21
Q

What is the washout period between ACEi and ARNIs, and why?

A

36 hours

Avoid angioedema due to build up of bradykinin

22
Q

Why do ARNIs need to be given in combination with ARBs?

A

ARNIs inhibit neprolysin

Neprolysin inhibition results in less breakdown of angiotensin receptor 2, hence ARB required

23
Q

In HFrEF, what options can be considered if ACEi/ARB/ARNI aren’t well tolerated?

A

Nitrates +/- hydralazine

Add digoxin if refractory Sx

24
Q

Post MI, how soon after would you consider insertion of an ICD, and with what stipulations? Name 3.

A

40 days post MI

LVEF <35% NYHA I or III

LVEF <30% NYHA I

LVEF <40% NSVT or inducible VT/VF

25
Q

What feature on cardiac MRI would you expect to see with IHD?

A

Subendocardial scarring

26
Q

What do T1 and T2 (in general terms) on a cardiac MRI provide information on?

A

T1 - fibrosis

T2 - oedema, iron

27
Q

What are the benefits of cardiac nuclear stress scanning? Name 3.

A

Helping to guide revascularisation

Risk stratification before non-cardiac surgery

Prognosis

28
Q

When would you consider intervention with asymptomatic aortic regurgitation? Name 3 conditions.

A

LVEF <50%

Previous cardiac surgery

LVEF >50% but LVESD >50mm or LVEDD >70mm

29
Q

With regard to aortic stenosis, what is the dimensionless index, and what does it indicate?

A

Velocity LV outflow (V1) ÷ velocity valve (V2)

0.5 is half of normal area

<0.25 is severe AS

30
Q

What are contraindications for TAVI? Name 6.

A

Endocarditis

Peripheral vascular/thoracic aorta issues

LV apical thrombus

Bicuspid aortic valve

Aortic annulus/ascending aorta size criteria

Life expectancy <1 year

31
Q

When should an ASD be closed? Name 4 stipulations.

A

If HD significant

If symptomatic

RV enlargement

Qp:Qs >1.5

Do not close Eisenmenger’s

32
Q

When should a VSD be closed? Name 3 stipulations.

A

If symptomatic

If LV enlargement

Qp:Qs > 2:1

33
Q

How can Eisenmenger’s be treated?

A

Bosentan

Sildenafil

34
Q

When would you consider an ICD in the setting of HCM? Name 3 considerations.

A

LVH > 30mm

Unexplained syncope

Family history of sudden death

35
Q

Name 3 considerations for a heart transplant.

A

Severe symptomatic HF

Frequent discharges from AICD

Intractable angina

36
Q

Name the principal genes involved in LQT 1, 2 and 3 respectively.

A

LQT1 - gain in K channel KCNQ1 (loss of gene in familial AF and SQTS)

LQT2 - gain in K channel KCNH2 (HERG) (loss of gene in SQTS)

LQT3 - gain in Na channel SCN5A (loss of gene in Brugada and Lenegre’s)

37
Q

What are the common triggers for LQTS 1, 2 and 3?

A

LQT1 - swimming/exertion

LQT2 - post-partum period, auditory triggers

LQT3 - occurs during sleep

38
Q

What drugs are typically given for LQT 1, 2 and 3?

A

LQT1 - beta blockers

LQT2 - beta blockers

LQT3 - beta blockers, mexiletine

39
Q

What receptor is affected in CPVT, and a mutation in which gene is responsible?

A

Ca/ryanodine receptor

Calsequestrin 2 (CASQ2)

40
Q

Name 2 prominent genes implicated in HCM.

A

MYBC3 (cardiac myosin binding protein 3)

MYH7 (beta myosin heavy chain)

There are about 35 genes involved with HCM however

41
Q

Which gene variant in ARVCM results in typically earlier onset of symptoms and VT/VF?

A

PKP2

GCUH FRACP Writtens 2020 (14 decks)

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