Cardiology Flashcards
What medication can increase HDL levels
nicotinic acid
what are side effects of nicotininc acid
flushing: mediated by prostaglandins
impaired glucose tolerance
myositis
give causes of restricted cardiomyopathy
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
what features would suggest a restrictive cardiomyopathy rather than constrictive pericarditis
prominent apical pulse
absence of pericardial calcification on CXR
the heart may be enlarged
ECG abnormalities e.g. bundle branch block, Q waves
what is coartication of the aorta
congenital narrowing of the descending aorta
give conditions associated with coartication of the aorta
Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis
what is the strongest preditor of mortality and morbidity affter a STEMI
excercise capacity
what are the contraindications to excercise tolerance test
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
what would be your maximum predicted heart rate
220-patient age
what is the mechanism of action of ticagrelor
Ticagrelor is a P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependent platelet activation and aggregation
what actually causes patients to feel breathless on ticagrelor
adenosine accumulation
how does aspirin work
blocking prostaglandin synthesis. It is non-selective for COX-1 and COX-2 enzymes.
what medication can reduce the antiplatelet effect of clopidogrel
PPIs
what SPECIFIC ECG feature is present in pericarditis
PR depression
give causes of pericarditits
viral infections (Coxsackie) tuberculosis uraemia (causes 'fibrinous' pericarditis) trauma post-myocardial infarction, Dressler's syndrome connective tissue disease hypothyroidism malignancy
what investigation must be done for all pericarditis patients
echo
clinical features of aortic stenosis
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
examination features of aortic stenosis
narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure
what is the management of aortic stenosis
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
what are the causes of aortic stenosis
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
what is the mechanism of long QTc
caused by defects in the alpha subunit of the slow delayed rectifier potassium channel.
what is a normal Qtc
430 in males
450 in females
name congenital causes of long qt syndrome
Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)
Romano-Ward syndrome (no deafness)
name drugs that prolong QT
amiodarone, sotalol, class 1a antiarrhythmic drugs tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram) methadone chloroquine terfenadine** erythromycin haloperidol ondanestron
give other causes of long QT (not drugs or congenital)
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia acute myocardial infarction myocarditis hypothermia subarachnoid haemorrhage
How do statins work
by inhibiting HMG-CoA reductase (the rate limiting enzyme in hepatic cholesterol synthesis)
what are the containdications of statins
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
who should get a statin
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
what type of statin should the person get
atorvastiain 20mg for primary prevention (increase the dose if non-HDL has not reduced for >= 40%)
atorvastatin 80mg for secondary prevention
how is pericarditis treated
NSAID +/- colchicine
all patients get an echo
how does amioderone work
blocks voltage gated calcium channels
how does dypyridamole work
phosphodiesterase inhibitor - reduces intercelular calcium and decreases cellular uptake of adensine
outline the two types of aortic dissection
type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases
what territory of MI is seen in aortic dissection
often inferior MI due to involvment of the right coronary artery
what murmur can you get with aortic dissection
aortic regurgitation
what is the half life of amioderone
20-100 days
what is streptococcus bovis associated with
bowel cancer
what medications can reduce the effect of adenosisne
aminophyline
where does furosemide act
the triple cotransporter on the ascending loop of henle
what causes eruptive xanthoma
familial hypertriglyceridaemia
where is the most common site for an atrial myxoma
left
what gene mutation is associated with brugada syndrome
SCN5A
what is eisenmengers syndrome
reversal of a left to right shunt due to congential hear defects - causes pulmonary hypertension
what drugs should you avoid in HOCM
ACE inhibitors
ionotrpes
nitrates
what can cause a falsely low BNP
obesity
what can be used for reversal of dabigatran
Idarucizumab
what would be the indications for surgical intervention in endocarditis
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
what should not be given in an inferior MI causing right ventricular dysfunction
nitrates - cause peripheral venodilation and therefor reduce preload to the heart
what are irregular cannon a waves associaeed with
complete heart block
pulsus paradoxus
greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration
severe asthma, cardiac tamponade
slow rising pulse
aortic stenosis
collapsing pulse
aortic regurgpatent ductus arteriosus hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
pulsus alternans
severe LVF
bisferiens pulse
‘double pulse’ - two systolic peaks
mixed aortic valve disease
jerky pulse
HOCM
what is cardiac x syndrome
also called microvascular angina. Patients have a normal ECG at rest and normal coronary arteries but develop ST depression on exercise stress testing.
what is the mechanism of action of aspirin
inhibits the production of thromboxane A2
what is the functions of bnp
vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and the renin-angiotensin-aldosterone system
give the indications for an implantable cardiac defibrillato
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
what are u waves associated with
hypokalaemia
in what condition do u see delta waves
WPW
‘slurred upstroke’ in QRS
what is Catecholaminergic polymorphic ventricular tachycardia
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.
how is catecholaminergic polymorphic VT treated
beta blocker
ICD
what causes CPVT
the most common cause is a defect in the ryanodine receptor (RYR2) which is found in the myocardial sarcoplasmic reticulum
what drug can precipaitate VF if used in VT
verapamil
what other factors can increase BNP levels
Ischaemia Tachycardia Right ventricular overload Hypoxaemia (including pulmonary embolism) GFR < 60 ml/min Sepsis COPD Diabetes Age > 70 Liver cirrhosis
what can cause decreased BNP levels
Obesity Diuretics ACE inhibitors Beta-blockers Angiotensin 2 receptor blockers Aldosterone antagonists
what marker is useful to look for reinfarction after an MI
CK-MB
as this returns to normal within 3 or 4 days
how do u treat torsades de pointes
magnesium
what rises first in an MI
myoglobin
epsilon waves are seen in what
ARVC
what is the first line treatment of congenital prolonged QT
beta blockers
what drug should be avoid in WPW
verapamil and digoxin
