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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What medication can increase HDL levels

A

nicotinic acid

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2
Q

what are side effects of nicotininc acid

A

flushing: mediated by prostaglandins
impaired glucose tolerance
myositis

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3
Q

give causes of restricted cardiomyopathy

A

amyloidosis (e.g. secondary to myeloma) - most common cause in UK
haemochromatosis
post-radiation fibrosis
Loffler’s syndrome: endomyocardial fibrosis with a prominent eosinophilic infiltrate
endocardial fibroelastosis: thick fibroelastic tissue forms in the endocardium; most commonly seen in young children
sarcoidosis
scleroderma

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4
Q

what features would suggest a restrictive cardiomyopathy rather than constrictive pericarditis

A

prominent apical pulse
absence of pericardial calcification on CXR
the heart may be enlarged
ECG abnormalities e.g. bundle branch block, Q waves

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5
Q

what is coartication of the aorta

A

congenital narrowing of the descending aorta

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6
Q

give conditions associated with coartication of the aorta

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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7
Q

what is the strongest preditor of mortality and morbidity affter a STEMI

A

excercise capacity

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8
Q

what are the contraindications to excercise tolerance test

A

myocardial infarction less than 7 days ago
unstable angina
uncontrolled hypertension (systolic BP > 180 mmHg) or hypotension (systolic BP < 90 mmHg)
aortic stenosis
left bundle branch block: this would make the ECG very difficult to interpret

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9
Q

what would be your maximum predicted heart rate

A

220-patient age

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10
Q

what is the mechanism of action of ticagrelor

A

Ticagrelor is a P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependent platelet activation and aggregation

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11
Q

what actually causes patients to feel breathless on ticagrelor

A

adenosine accumulation

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12
Q

how does aspirin work

A

blocking prostaglandin synthesis. It is non-selective for COX-1 and COX-2 enzymes.

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13
Q

what medication can reduce the antiplatelet effect of clopidogrel

A

PPIs

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14
Q

what SPECIFIC ECG feature is present in pericarditis

A

PR depression

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15
Q

give causes of pericarditits

A 
viral infections (Coxsackie)
tuberculosis
uraemia (causes 'fibrinous' pericarditis)
trauma
post-myocardial infarction, Dressler's syndrome
connective tissue disease
hypothyroidism
malignancy
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16
Q

what investigation must be done for all pericarditis patients

A

echo

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17
Q

clinical features of aortic stenosis

A

chest pain
dyspnoea
syncope
murmur
an ejection systolic murmur (ESM) is classically seen in aortic stenosis
classically radiates to the carotids
this is decreased following the Valsalva manoeuvre

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18
Q

examination features of aortic stenosis

A 
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure
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19
Q

what is the management of aortic stenosis

A

if asymptomatic then observe the patient is general rule
if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
cardiovascular disease may coexist. For this reason an angiogram is often done prior to surgery so that the procedures can be combined
balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacemen

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20
Q

what are the causes of aortic stenosis

A

degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

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21
Q

what is the mechanism of long QTc

A

caused by defects in the alpha subunit of the slow delayed rectifier potassium channel.

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22
Q

what is a normal Qtc

A

430 in males

450 in females

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23
Q

name congenital causes of long qt syndrome

A

Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)
Romano-Ward syndrome (no deafness)

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24
Q

name drugs that prolong QT

A 
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
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25
Q

give other causes of long QT (not drugs or congenital)

A 
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
acute myocardial infarction
myocarditis
hypothermia
subarachnoid haemorrhage
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26
Q

How do statins work

A

by inhibiting HMG-CoA reductase (the rate limiting enzyme in hepatic cholesterol synthesis)

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27
Q

what are the containdications of statins

A

macrolides - clarithromycin, erythromycin
pregnancy
avoid if previous cerebral haemorrhage
can cause myopathies
discontinue if treatment has resulted in persistance of liver enzymes at 3 times the upper limit of normal

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28
Q

who should get a statin

A

all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

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29
Q

what type of statin should the person get

A

atorvastiain 20mg for primary prevention (increase the dose if non-HDL has not reduced for >= 40%)
atorvastatin 80mg for secondary prevention

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30
Q

how is pericarditis treated

A

NSAID +/- colchicine

all patients get an echo

31
Q

how does amioderone work

A

blocks voltage gated calcium channels

32
Q

how does dypyridamole work

A

phosphodiesterase inhibitor - reduces intercelular calcium and decreases cellular uptake of adensine

33
Q

outline the two types of aortic dissection

A

type A - ascending aorta, 2/3 of cases

type B - descending aorta, distal to left subclavian origin, 1/3 of cases

34
Q

what territory of MI is seen in aortic dissection

A

often inferior MI due to involvment of the right coronary artery

35
Q

what murmur can you get with aortic dissection

A

aortic regurgitation

36
Q

what is the half life of amioderone

A

20-100 days

37
Q

what is streptococcus bovis associated with

A

bowel cancer

38
Q

what medications can reduce the effect of adenosisne

A

aminophyline

39
Q

where does furosemide act

A

the triple cotransporter on the ascending loop of henle

40
Q

what causes eruptive xanthoma

A

familial hypertriglyceridaemia

41
Q

where is the most common site for an atrial myxoma

A

left

42
Q

what gene mutation is associated with brugada syndrome

A

SCN5A

43
Q

what is eisenmengers syndrome

A

reversal of a left to right shunt due to congential hear defects - causes pulmonary hypertension

44
Q

what drugs should you avoid in HOCM

A

ACE inhibitors
ionotrpes
nitrates

45
Q

what can cause a falsely low BNP

A

obesity

46
Q

what can be used for reversal of dabigatran

A

Idarucizumab

47
Q

what would be the indications for surgical intervention in endocarditis

A

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

48
Q

what should not be given in an inferior MI causing right ventricular dysfunction

A

nitrates - cause peripheral venodilation and therefor reduce preload to the heart

49
Q

what are irregular cannon a waves associaeed with

A

complete heart block

50
Q

pulsus paradoxus

A

greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration
severe asthma, cardiac tamponade

51
Q

slow rising pulse

A

aortic stenosis

52
Q

collapsing pulse

A 
aortic regurgpatent ductus arteriosus
hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
53
Q

pulsus alternans

A

severe LVF

54
Q

bisferiens pulse

A

‘double pulse’ - two systolic peaks

mixed aortic valve disease

55
Q

jerky pulse

A

HOCM

56
Q

what is cardiac x syndrome

A

also called microvascular angina. Patients have a normal ECG at rest and normal coronary arteries but develop ST depression on exercise stress testing.

57
Q

what is the mechanism of action of aspirin

A

inhibits the production of thromboxane A2

58
Q

what is the functions of bnp

A

vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and the renin-angiotensin-aldosterone system

59
Q

give the indications for an implantable cardiac defibrillato

A 
long QT syndrome
hypertrophic obstructive cardiomyopathy
previous cardiac arrest due to VT/VF
previous myocardial infarction with non-sustained VT on 24 hr monitoring, inducible VT on electrophysiology testing and ejection fraction < 35%
Brugada syndrome
60
Q

what are u waves associated with

A

hypokalaemia

61
Q

in what condition do u see delta waves

A

WPW

‘slurred upstroke’ in QRS

62
Q

what is Catecholaminergic polymorphic ventricular tachycardia

A

a form of inherited cardiac disease associated with sudden cardiac death. It is inherited in an autosomal dominant fashion and has a prevalence of around 1:10,000.

63
Q

how is catecholaminergic polymorphic VT treated

A

beta blocker

ICD

64
Q

what causes CPVT

A

the most common cause is a defect in the ryanodine receptor (RYR2) which is found in the myocardial sarcoplasmic reticulum

65
Q

what drug can precipaitate VF if used in VT

A

verapamil

66
Q

what other factors can increase BNP levels

A 
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
67
Q

what can cause decreased BNP levels

A 
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
68
Q

what marker is useful to look for reinfarction after an MI

A

CK-MB

as this returns to normal within 3 or 4 days

69
Q

how do u treat torsades de pointes

A

magnesium

70
Q

what rises first in an MI

A

myoglobin

71
Q

epsilon waves are seen in what

A

ARVC

72
Q

what is the first line treatment of congenital prolonged QT

A

beta blockers

73
Q

what drug should be avoid in WPW

A

verapamil and digoxin

MRCP Part 1 (12 decks)

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