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1
Q

Complications of pulmonary vein ablation for AF

A 
1-2 percent
Aorto-oesophageal fistula
Valve damage
Femoral vascular complications 
Thromboembolic events
Tamponade
Phrenic or gastric nerve injury 
Pulmonary vein stenosis
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2
Q

What is actually abated in AF? In flutter?

A

Complete electrical isolation of the pulmonary veins in AF

In flutter need to ablate the cavotricuspid isthmus also

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3
Q

What is the best indication for AF ablation? Other indications accepted?

A

Symptomatic AF that is resistant to at least one class 1 or 3 antiarrhythmic
Best patients are young with paroxysmal AF, small atria and no underlying heart disease
Discontinuation of warfarin is not a good sole indicator
After procedure, anticoaguate for 1-3 months. Don’t discontinue if CHADS2 is 2 or more

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4
Q

12 causes of pericarditis

A 
Idiopathic 
Infective- coxsackie, hep, adeno/ histoplasma, aspergillus, candida/tb/ strep, staph, pneumo,haemoph
Uraemia
Autoimmune- rheumatic (sle sarcoid ra) and non rheum (uc, pan, gca)
Traumatic
Aortic disease related 
MI related
Radio frequency AF ablation
Neoplastic
Radiation
Recovery phase takotsubo 
Medications- amiodarone, penicillin, hydralazine

If effusion - all of the above plus hypothyroidism plus cirrhosis

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5
Q

4 Hs

A

Hypo/hyperthermia
Hypo/hyperkalaemia
Hypovolaemia
Hypoxia

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6
Q

4Ts

A

Toxins
Tamponade
Thrombosis
Tension pneumothorax

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7
Q

Causes of short QT

A

digoxin and hypercalcaemia

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8
Q

Causes of long QT

A 
hypokalaemia
hypomagnesaemia
hypocalcaemia
hypothermia
myocarditis
myocardial ischaemia
Drugs including class one and three antiarrhythmics
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9
Q

SURGERIES where dual antiplatelet risk of bleeding is unacceptable- even aspiring alone might be bad

A 
Intracranial
Spinal
TURP
extra-ocular
Plastic reconstructive
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10
Q

Asthmatic person with SVT?

A

Give verapamil

Not adenosine

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11
Q

Most common cardiac issue in Turners syndrome

A

Bicuspid AV

Also coarctation of aorta

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12
Q

Name three indications for temporary pacemaker insertion

A
  1. symptomatic/haemodynamically unstable bradycardia, not responding to atropine
  2. post-ANTERIOR MI: type 2 or complete heart block*
  3. trifascicular block prior to surgery

*post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and haemodynamically stable

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13
Q

Poor prognostic markers in HOCM (6)

A 
Syncope
FH sudden cardiac death
Young age at presentation
NSVT on holter
Fall in SBP on exercise
Increase in septal thickness
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14
Q

Five groups of pulmonary hypertension

A

Group 1: Pulmonary arterial hypertension (PAH)

  • idiopathic*
  • familial
  • associated conditions: collagen vascular disease, congenital heart disease with systemic to pulmonary shunts, HIV**, drugs and toxins, sickle cell disease
  • persistent pulmonary hypertension of the newborn

Group 2: Pulmonary hypertension with left heart disease
- left-sided atrial, ventricular or valvular disease such as left ventricular systolic and diastolic dysfunction, mitral stenosis and mitral regurgitation

Group 3: Pulmonary hypertension secondary to lung disease/hypoxia

  • COPD
  • interstitial lung disease
  • sleep apnoea
  • high altitude

Group 4: Pulmonary hypertension due to thromboembolic disease

Group 5: Miscellaneous conditions
- lymphangiomatosis e.g. secondary to carcinomatosis or sarcoidosis

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15
Q

Components of TIMI risk score

A

Each of the following criteria constitutes one point for TIMI scoring :

Age ≥65 years
Three or more risk factors for coronary artery disease (CAD) (family history of CAD, hypertension, hypercholesterolemia, diabetes mellitus, tobacco use)
Known CAD (stenosis >50%)
Aspirin use in the past 7 days
Severe angina (≥2 episodes in 24 hours)
ST deviation ≥0.5 mm
Elevated cardiac marker level

Score Risk of Death/MI/Urgent revascularization by Day 14

0-1	5%
2	8%
3	13%
4	20%
5	26%
6-7	41%
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16
Q

TIMI risk score- what is the use?

A

The Thrombolysis in Myocardial Infarction (TIMI) Score is used to determine the likelihood of ischemic events or mortality in patients with unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI)

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17
Q

Causes of hypertriglyceridaemia? (You can think of at least 10!)

A

Obesity (often with increase cholesterol too)
Diabetes mellitus with poor glycaemic control
Alcohol excess
Nephrotic syndrome
Hypothyroidism
High oestrogen states (except transdermal HRT)
Beta blockers except carvedilol
Thiazides and frusemide
Immunosupressives (steroid, cyclosp, sirolimus)
HIV antiretrov
Retinoids
Bile acid sequestrants
Second gen antipsychotics

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18
Q

How does BNP break down?

A

ventricle releases pro-BNP which is cleaved to BNP and NT-proBNP

In normal people, fractions will be about the same.
In heart failure, proBNP goes up more than BNP
900 of NT-pro is about the same as the 100 for BNP

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19
Q

What increases and decreases your BNP?

A 
old
women
renal failure
PE
cor pulmonale

Reduce in obese, duretics, ACE

20
Q

Cut offs for BNP in normal renal function and in AF

A

over 100 in normal PPV 83%
If AF use 200 as cutoff as lower specificity

NTproBNP under 300 has NPV 98%

21
Q

What do you do about SVT in asthmatics?

A

DONT give adenosine

Give verapamil

22
Q

Tako stubo want to diagnose?

A

GREAT! But need a normal angio

Also GET OFF INOTROPES- makes worse

23
Q

What is the earliest sign of anthracycline induced cardiac dysfunction?

A

Lack of significant increase in EF during stress echo
Diastolic dysfunction

before systolic dysfunction

24
Q

Which chemo gives you heart failure>

A

Anthracyclines (doxorubicin, danorubicin, epirubicin)
Mitoxantrone
Alkylating agents (cyclophosphamide, cisplatin)
5-FU can give you MI during treatment
Trastuzumab
IL-2 or IFN gamma- HF during treatment

25
Q

What are the time cut offs for PCI vs thrombolysis?

A

Less than an hour of chest pain
PCI within 60 mins–>do that
Not –>thrombolyse

pain 1-3 hours duration
PCI within 90 mins–> do that
Not–>thrombolyse

Pain 3-12 hours
PCI within 90 mins or 2 hours including transport if off site–>PCI
If not–>thrombolyse

26
Q

Contraindications absolute to thrombolysis

A 
ICH ever
known AVM ie in brain
ischemic stroke three months
bleeding
signif head trauma three months
suspect dissection
cancer in brain
Relative: 
major surgery last three weeks
INR high
non compressible vascular puncture
CPR more than 10 mins or traumatic
bad hypertension
dementia
pregnancy
27
Q

Components of TIMI risk?

Estimates mortality for pts with unstable angina and NSTEMI

A

Age over 65 ***** strongest risk of death
Known CAD with stenosis over half
Aspirin last 7 days
severe angina with more than 2 eps last 24 hours
3 or more RF CAD
biomarkers up
ST seg changes over 0.5mm

28
Q

Most common myocarditis symptom?

A

Chest pan

29
Q

Strongest RF for CVD?

A

Age

30
Q

What is in MACCE?

A

Cardiovascular event
Non fatal MI
stroke
Need for revascularisation

31
Q

Most effective after AF cardioversion to maintain sinus

A

Amiodarone

better than sotalol and flecanide (probably almost as good)

32
Q

SPRINT trial and BP targets?

A

Aim under 120 in non diabetics reduces cardiac events

33
Q

If put in a stent and then later present with ACS… where is the lesion?

A

Half restenosis half new position

34
Q

Mangement bradycardia post inferior MI

A 
Fluids
then 
atropine
then
Isoprenaline
35
Q

Indications for BMS over DES?

A

unlikely compliant
technical eg large vessel
scheduled surgery next year and need to come off
high bleeding risk including on anticoag

36
Q

Most common event? errosion or rupture of plaque

A

rupture- associated with hypercholesterolaemia

errosion associated with smoking, not cholesterol, and is the primary mechanism in premenopausal women

37
Q

Most common valve lesion over age 75?

A

AS

38
Q

What do you see in HOCM with the Brockenbrough-Braunwald sign?

A

After a PVC, the LV pressure increases but because of dynamic outflow obstruction, the aortic pressure decreases.

This is in contrast to in AS where the outflow obstruction is fixed, so following beat post PVC is all high (both LV and aortic trace)

39
Q

Worst symtom in AS for mortality?

A

failure (worse than syncope)

40
Q

Ischaemic CM what is worst prgnostic factor

A

age

worse than EF significantly

41
Q

Does it make a difference is ACE or beta blockers is started first in heart failure?

A

no

CBIS 3 study

42
Q

Poor neuro prognosis post arrest?

A 
Myoclonus generalised and repeditive
motor response under 3 at day 3
day 3 pupil and corneal not reactive
absent bilat SSEP - somatosens evoked potentials 
Neuron specific enolase
43
Q

Should you do a rhythm check post shock?

A

No. continue CPR

44
Q

AFter airway is in during CPR, ventilate at …

A

6-10 breaths per min

45
Q

After resus what should be avoided?

A

Hyperoxaemia - aim 94-96%

Cards (16 decks)

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