Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nimna's Flash Cards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Ticagrelor MOA

A
  1. Direct acting (non-pro-drug)
  2. reversible
  3. Inhibitor of P2Y12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cause of ARVD and ECG changes

A

fibro-fatty infiltration of the myocardium. Mutation in desmosome genes and intercalated discs.
V1- V5 T wave inversion and epsilon waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Catecholaminergic Polymorphic VT gene mutation

A

RYR2 gene - defect in calcium channels - VT triggered by catecholamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Wolf-Parkinson white

ECG findings and defect

A

short PR interval and delta wave

due to accessory pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

HOCM - genetic defect and effect

A

Defect in sarcomere genes (beta myosin, troponin T)
multiple gene causes
autosomal dominant
LVH and asymmetrical septal hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Brugada ECG changes and gene mutation

A

SCN5A

Brugada wave - coved ST segment or saddle shaped.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Long QT 1 gene mutation and trigger

A

K+ channels - KCNQ1 mutation

Exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Long QT 2 gene mutation and trigger

A

K+ channels - HERG mutation

Noise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Long QT 3 gene mutation and trigger

A

Na+ channel - SCN5A

Sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In what phase of the cardiac action potential is the heart not refractory to a new action potential

A

phase 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Class 1 antiarrhythmics

A

Na+ blockers - work on phase zero

- Flecanide, Lignocaine, Procanamide, Phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Class 2 antiarrhythmics

A

K+ equilibrium blockers - Beta blockers - work on phase 4

- propanolol, metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Class 3 antiarrhythmics

A

K+ channel blockers - work on phase 3

- Sotalol, Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Class 4 antiarrhythmics

A

Ca2+ channel blockers - work on phase 2

- Verapamil, Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biggest RF for CVD

A

AGE

up to 15 points on Framingham risk calculator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patient cohorts that would need infective endocarditis prophylaxis peri-procedure

A
  • prosthetic valves/ cardiac structures
  • PMHx IE
  • congenital heart disease with ongoing defects
  • transplanted heart with leaky valves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Procedures needing ABx prophylaxis for infective endocarditis for high risk patient cohorts.

A
  • respiratory biopsy
  • dental procedures breaking the mucosa
  • surgical procedure for infected skin
  • cardiac surgery with prosthetic material.

ABx NOT required for GI procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cause of hyponatremia in heart failure

A

Increased ADH.

Although oedematous patients with heart failure have increased plasma and extracellular fluid volumes, the body perceives volume depletion (reduced effective arterial blood volume) since the low cardiac output decreases the pressure perfusing the baroreceptors in the carotid sinus and the renal afferent arteriole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Pulsus paradoxus

A

Is the exaggerated drop in systemic blood pressure on inspiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Kussmaul’s sign

A

JVP not decreasing on inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of TAVI vs SAVR

A

SAVR - major bleeding and atrial fibrillation

TAVI - short-term aortic valve reintervention, pacemaker implantation, and aortic regurgitation compared with SAVR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Features of Acute rheumatic heart disease

A

Major criteria - JONES
Joint involvement - migratory polyarthritis
O – “O” looks like a heart shape – carditis and valvulitis
N – nodules that are subcutaneous
E – Erythema marginatum which is a rash of ring-like lesions that can start in the trunk or arms. When joined with other rings, it can create a snake-like appearance
S – Sydenham chorea is a late feature which is characterized by jerky, uncontrollable, and purposeless movements resembling twitches

Minor criteria – CAFÉ P
C – CRP Increased
A – Arthralgia
F – Fever
E – Elevated ESR
P – Prolonged PR Interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Muscle contraction inhibitors

A

Tropomyosin - controlled by troponin.

Tropomyosin/Troponin is inactivated by high levels of Ca2+, allowing muscle contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Worst arrhythmia for prognosis in OOHCA

A

Asystole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common cardiac abnormality occuring with coarctation of the aorta

A

bicuspid aortic valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

NSAID with highest risk of AMI

A

Voltaren (Diclofenac)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Another name for P2Y12 drugs

A

Adenosine diphosphate (ADP) receptor inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cause of death in cardiac transplant at 30 days, 1 year and 5 years

A
  1. Graft failure: Primary graft failure accounts for the majority of mortality within the first 30 days after transplantation.
  2. Infections are the leading single cause of death between six months to one year post-transplant.
  3. Malignancy is the most frequent cause of death beginning at five years post-cardiac transplantation. malignancies (both lymphoma and solid tumors) are more common in heart compared with renal transplant recipients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Biggest risk factor for mortality (1 yr mortality) after cardiac transplant

A
  1. use of a total artificial heart as a bridge to transplant,
  2. end-organ support with mechanical ventilation or dialysis,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Drug that should be avoided when using clopidogrel

A

PPI’s - both clopidogrel and PPIs use the same CYP2C19 pathway. Clopidogrel is a prodrug so this reduces efficacy and increases MACE.
Best PPI if required is pantoprazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Criteria for severe aortic stenosis

A

aortic jet velocity over ≥4.0 m/s
or mean transvalvular pressure gradient ≥40 mmHg
+/ -an aortic valve area ≤1.0 cm

may be symptomatic OR asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Criteria for aortic valve replacement in ASYMPTOMATIC severe aortic stenosis

A
  1. Symptoms on exercise testing
  2. EF <50%
  3. If undergoing another cardiac surgery
  4. Very severe (velocity gradient > 4.5) and low procedure risk
  5. If hypotensive with exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Myocardial infarction types

A
  1. Spontaneous AMI - usually due to plaque
  2. Ischaemia/ demand related
  3. Assumed to be AMI - usually in the case of sudden death
    4a. Post PCI
    4b. post stent thrombosis
  4. Post CABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Branches of the Aorta

A

Brachiocephalic
L common carotid
L Subclavian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Commonest site of coarctation of the aorta

A

Just distal to the L Subclavian at the site of the ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Cardiac SE of 5FU

A

coronary vasospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Cardio selective beta blockers

A

Atenolol, Metoprolol, Bisoprolol, Nebivolol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Non-selective Beta blockers

A

Propanolol, Sotalol, Timolol, Labetalol, Carvidelol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Beta blockers with alpha blocker activity

A

Labetalol, Carvidelol

40
Q

Which beta blocker also blocks potassium channels?

A

Sotalol

41
Q

Effect of B1 inhibition

A

Decrease HR and contractility
Decrease AV node conduction
Block juxtaglomerular cells to reduce renin release, therefore increases water excretion to reduce BP.

42
Q

Effect of B2 inhibition

A

Vasoconstriction and bronchoconstriction
Decrease intra-ocular pressure
Decrease insulin release - Increase diabetes.
Decrease liver glycogenolysis - increase hypo’s
Inhibits lipase - increases hyperlipidaemia

43
Q

Effect of B3 inhibition

A

Decreases lypolysis - increased weight gain.

44
Q

When are beta blockers contra-indicated?

A
  1. Decompensated heart failure
  2. Phaeochromocytoma - need alpha blocker first
  3. Sick sinus syndrome
  4. cardiogenic shock
45
Q

Function of Titin

A

To recoil the muscle fibres and prevent overstretching.

46
Q

Indications for surgery in infective endocarditis

A
  • valve dysfunction causing heart failure
  • L sided IE from fungal/ highly resistant bug.
  • heart block
  • abscess (cardiac)
  • destructive lesions
  • persistant bacteremia/fevers 1 week after starting treatment.
47
Q

Management in stable angina

A

Medical Mx.
Stenting is for symptomatic Mx only if medical Mx does not work, no mortality benefit.
(exception is if they have L main disease)

48
Q

Management of stable angina with L main disease

A

CABG - has survival benefit.

CABG would be the answer over PCI in L main disease.

49
Q

Electrical alternans is seen in which condition

A

large pericardial effusion

50
Q

ECG finding for cardiac amyloid

A

low voltage QRS

51
Q

ECG in Takasubo

A

deep anterior T wave
ST elevation
Long QT
Long PR

52
Q

Ebsteins abnormality is associated with which other cardiac condition

A

wolf parkinson white

53
Q

Carcinoid syndrome causes which cardiac condition

A

heart failure caused by R sided valve dysfunction (hormone secreted from tumour into R heart causes valve abnormalities)

54
Q

Treatment of RV infarct

A
  1. IV fluids ++++
  2. Dobutamine

to improve LV preload

55
Q

Causes of falsely low BNP in heart failure

A

obesity
pericardial constriction
flash APO

56
Q

When is PCI/stenting harmful?

A

In patients with CKD and stable angina. Causes INCREASED morbidity and mortality.

57
Q

What is the calcium score used for?

A

Risk stratification. Improves mortality by accurate primary prevention interventions (aspirin + statin).
0 = no risk
1-100 = moderate risk, consider aspirin/statin
>100 = high risk - aspirin and statin for primary prevention.

58
Q

What should be done if a patient comes in with a STEMI and has severe stenosis in a NON-culprit vessel also.

A

Should stent that vessel. Although this is technically a non-symptomatic occlusion, this patient has proven to be a plaque rupturer. Therefore there is benefit in stenting over medical management.

59
Q

How urgently do OOHCA patients need to go to Cath lab?

A
  • If ST elevation is present after defibrillation - need urgent cath lab
  • If ST elevation not present - non urgent cath lab - up to 1 week.
60
Q

Does aspirin have a benefit for patients above age 70 without specific cardiac risk factors.

A

No benefit

61
Q

What is the benefit of Colchicine after AMI?

A

Reduced stroke risk

Reduced recurrent angina

62
Q

What cardiac outcome does Empagliflozin improve?

A 
Heart failure (particularly HEFrEF)
All cause mortality
63
Q

For a patient with an indication for anticoagulation (PE/AF/prosthetic valve), what should the medication regime be if the have a stent inserted?

A

Clopidogrel + anticoagulation for 12m then anticoagulation alone ongoing.

If very high risk AMI - can also add aspirin for triple therapy for the first month only.

64
Q

When does AF ablation have a MORTALITY benefit?

A

If EF is <35%

65
Q

Lifestyle factor which has significant affect on AF burden

A

Alcohol intake.

Alcohol abstinence has a significant effect on reducing AF in heavy drinkers.

66
Q

In which patients with HEFREF does ICD implantation have a mortality benefit?

A

Those with ischaemic cause of HEFREF

67
Q

When is the best time for antihypertensives to be taken?

A

At night BEFORE bed. Has a mortality benefit.

This is because the biggest cortisol surge occurs in the morning.

68
Q

Emery-Dreifuss muscular dystrophy is associated with what type of cardiomyopathy and gene mutation

A

Dilated cardiomyopathy and Lamin A/C genes

69
Q

Management of Long QT

A

Without cardiac arrest - Beta blockers. Can consider ICD only if ongoing symptoms.
Cardiac arrest - ICD

70
Q

Management of ARVD

A
  • Avoid high intensity exercise
  • beta blocker if symptomatic
  • ICD if high risk features or secondary prevention post SCA.
71
Q

First line drug for chest pain in HOCM

A

Verapamil

72
Q

Cause of stable raised troponins (no incrementation)

A

Chronic myocardial injury. If it is acute, then troponin will increment (up or down depending on if it is before or after the peak)

73
Q

Stent thrombosis definitions of definite, probable and possible.

A
  • Definite – Angiographic confirmation of a thrombus that originates in the stent or in the segment 5 mm proximal or distal to the stent, with or without vessel occlusion, which is associated with acute onset of ischemic symptoms at rest or ECG signs of acute ischemia or typical rise and fall of in cardiac biomarkers within 48 hours of angiography OR pathologic confirmation of stent thrombosis determined at autopsy or from tissue obtained following thrombectomy.
  • Probable – Unexplained death occurring within 30 days after the index procedure, or an MI occurring at any time after the index procedure that was documented by ECG or imaging to occur in an area supplied by the stented vessel in the absence of angiographic confirmation of stent thrombosis or other culprit lesion.
  • Possible – Unexplained death occurring more than 30 days after the index procedure.
74
Q

Benefit of the new generation drug eluting stents

A

Reduced “very late” stent thrombosis

75
Q

Biggest RF for in stent thrombosis

A

improper use of antiplatelets

76
Q

Difference between stent types for stent thrombosis

A

BMS - more late stent thrombosis (1 m-12 m)
1st Gen DES - more very late stent thrombosis
2nd Gen DES - no data

77
Q

Stent thrombosis categories (by time frame)

A

Acute - 24hrs
Sub acute - 24hrs - 30 days
Late - 30days - 1yr
Very late - >1yr

78
Q

which layer of the coronary artery does artherosclerosis affect?

A

intima and media

79
Q

Management of antiplatelets with stents and surgery

A

If within 1 year:

  • postpone elective surgeries
  • emergency surgeries - complete on DAPT if able.
  • If unable, complete on aspirin alone then recommence 2nd agent immediately after

If after 1 year
- complete on aspirin alone if able.

80
Q

Cardiac side effect of Propofol

A

decreased contractility

81
Q

LDL aims based on risk score

A

very high CV risk - LDL <1.8 mmol/L
high risk <2.5 mmol/L
moderate risk,<3 mmol/L

82
Q

How much does lowering the LDL by 1 improve outcomes

A

reduces mortality by 21%

83
Q

Features of vulnerable plaques (3)

A
  1. positive remodelling
  2. low-attenuation plaque (soft plaque)
  3. spotty calcification
84
Q

Heart failure drugs to avoid in HEFREF

A

diltiazem, verapamil and moxonidine

85
Q

Indications for angiogram prior to mitral valve surgery

A
  • Patients with angina, objective evidence of ischemia, decreased left ventricular systolic function, or a history of coronary disease.
  • In patients at risk for coronary disease, including men >40 years old and postmenopausal women with high pretest likelihood of cardiovascular disease.
86
Q

Indications for Mitral valve surgery over percutaneous mitral balloon valvotomy.

A
  • Suboptimal valve anatomy for PMBV such as severe valve leaflet thickening/calcification/immobility with subvalvular fibrosis
  • Left atrial thrombus that persists despite anticoagulation
  • Concomitant moderate to severe mitral regurgitation
  • Concomitant severe tricuspid regurgitation
87
Q

Drugs for heart failure

A 
ACEi, ARB, ARNI 
Beta blockers 
Diuretics 
Ivabradine 
Hydralazine
88
Q

Drugs for angina

A 
Beta blockers 
Ca channel blockers 
Nitrates
Nicorandil- potassium channel activator
Perhexiline - high hepatotoxicity
Ivabradine - in co-existing heart failure only
89
Q

MOA Hydralazine and SE

A

MOA: Direct vasodilation of arterioles with decreased systemic resistance. occur via inhibition of calcium release from the sarcoplasmic reticulum and inhibition of myosin phosphorylation in arterial smooth muscle cells.

SE: rebound tachycardia, rebound hypertension

90
Q

When to do a flecanide challenge

A

When Brugada is suspected - unmasks type 1 ECG findings (saddle back), if only type 2 findings can be seen at rest

91
Q

Most common ASD

A

Ostium secundum

92
Q

Takasubo features (3)

A
  1. New ECG changes (ST elevation or T wave inversion) or moderate troponin rise.
  2. Transient akinesis / dyskinesis of left ventricle (apical and mid-ventricular segments) with regional wall abnormalities extending beyond a single vascular territory.
  3. Absence of coronary artery stenosis >50% or culprit lesion.
93
Q

Biggest RF for stroke in AF

A
  1. Valvular AF
  2. Age >65
  3. Prior stroke/ TIA
94
Q

Can heart/lung transplants be done in HCV positive donors?

A

Yes - antiviral treatment for 4 weeks prevents HCV infection

95
Q

Benefit of early cardioversion in new symptomatic AF

A

No benefit - was found that delayed cardioversion was non-inferior to early cardioversion in terms of percentage in sinus rhythm at 4 weeks.

96
Q

MOA of inclisiran

A

Works on PCSK9 to reduce LDL - however unlike evolucumab which works directly on the protein, inclisiran works as a small interfering RNA to prevent translation of the protein.

97
Q

Difference between rate control and rhythm control for early AF

A

rhythm control has lower AF related adverse outcomes.

Nimna's Flash Cards (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions