MRCP Cardio Flashcards
In New LBBB: what are the first and second heart sounds like?
First soft
Second- reversed splitting (pulmonary valve closes before aortic valve due to delay in depol)
What is paradoxical embolism (crossed embolism), and what are the consequences?
when venous clot enters arterial side or vice versa. (DVT to stroke)
through patent foramen ovale.
bubble TTE ECHO would diagnose.
What does S4 heart sound indicate?
Non compliant stiff ventricle and pressure overload (HFPEF)
Thiazide side effects?
Exacerbate hyperglycaemia
low sodium and potassium
What are the symptoms and consequences of Trypanosoma cruzi?
Changas disease
spread by blood sucking bugs
acute:
fever, myalgia, hepatosplenomegaly, myocarditis
consequence:
dilated heart, oesophagus and colon -> heart failure
romana sign- periorbital swelling and oedema from bite
Absolute contraindication of thrombolytic treatment
- active bleed
- recent head trauma <2 wks
- known intracranial cancer
- hx of stroke <2months ago
- uncontrolled HTN >200/120
What is the HS like in severe aortic stenosis?
Quieting of second HS = severe due to immobile valve
What are the HS like in aortic stenosis?
soft first HS
reverse splitting of second HS in LVF
What is the pathophysiology of WPW?
atrioventricular re-entry tachycardia (AVRT)
narrow complex with anterograde through AVN and retrograde through accessory pathway
What happens when WPW syndrome develop AF?
VF (broad QRS- SVT with aberrancy)
Patients on life long warfarin requiring dental procedure- what is target INR?
INR<4
What happens to the S2 heart sound in RBBB?
Wide physiological splitting S2
Persistent in both inspiration and expiration
What are 3 indications of temporary pacing?
symptomatic bradycardia (failed atropine)
complete heart block at risk of haemodynamic compromise (and prior to surgery)
suppression of tachyarrhythmia not amenable to drug therapy (enable overdrive pacing)
What 5 indications for permanent pacemaker
CHB
Drug resistant tachyarrhythmia
mobitz type 2
persistent AV block post MI
sick sinus syndrome
sinus pause >3s
trifascicular block
What is the order of NNT for drugs prolonging survival post MI?
ACEi > statin > aspirin > beta blocker
ASAB
What is the auscultation sound you would hear for complete heart block?
variable intensity of first heart sound
Where does atrial myxoma originate from 75% of the time?
left atrium (interatrial septum)
What is the murmur like in atrial myxoma?
Diastolic murmur changing in character with position.
What does S3 heart sound indicate?
Rapid Diastolic filling
Fluid overload
Which coronary artery is blocked in anterior MI?
LAD - left ANTERIOR descending
Which coronary artery is blocked in inferior MI?
right coronary artery
Which coronary artery is blocked in lateral MI?
Left CIRCUMFLEX
How should you take out a person in cold water drowning?
pull out and leave prone position to prevent venous pooling and circulatory collapse.
Why does isometric handgrip exercise accentuates mitral regurgitation?
due to increased BP and afterload hence increased backflow murmur