MRCP Cardiology Flashcards
Which arrhythmia is most sensitive to cardioversion and therefore requires lower voltage?
Atrial flutter.
Role of adenosine in atrial flutter?
Not curative, but can slow and reveal the sawtooth ECG changes.
Can radiofrequency ablation cure atrial flutter
Yes- 95% of the time :)
MOA in atrial fib
a) Amiodarone
b) Flecianide
a) K+ channel blocker
b) Na+ channel blocker
Rate control AF in HF?
Digoxin
Rhythm control AF in HF?
Amiodarone
Reasons to anti-coagulate in AF? (3)
1) Valvular disease
2) Chadvasc score >1 in men, >2 in women
Anti-coagulation duration in a patient with symptoms >48 hrs, aiming to cardiovert?
3 weeks before and at least 4 weeks after
Is aspirin recommended to reduce stroke risk in AF?
No
1st and 2nd line anti-coag in AF?
1st line= DOAC
2nd line= warfarin.
ECG findings in all wolf parkinson white
Delta waves
PR shortening
ECG findings in type A WPW and which side is accessory path
Right axis deviation due to L sided accessory pathway
ECG findings in type B WPW and which side is accessory path
Left axis deviation due to R sided accessory pathway
1st and 2nd line mx of supraventricular tachycardia
1) Vagal maneuvers
2) Adenosine. Rapid bolus IV, 6mg-12mg-18mg
Prevention of supraventricular tachy?
Beta blockers
Ablation
Definitive mx wolf parkinson white?
Ablation
When is adenosine contra-indicated for SVT? What do you give instead?
Asthmatics
Verapamil
Prophylaxis SVT. What about in pregnancy
for pregnant lady with SVT prophylaxis - Metoprolol
otherwise - flecainide given there is no structural heart disease .
1st line anti-arrhythmic in stable VT?
Amiodarone via central line
Which ECG abnormality are following 2 conditions associated with? How do you differentiate between the two?
Jervelle-lange-neilson
Romano- Ward
Long QT
JLV- deafness.
RW- no deafness.
Long QT syndrome pathophysiology
Defect alpha subunit of K+ channel
3 subtypes of long QT and how they present
LQT1- exertional syncope
LQT2- emotional syncope
LGQT3- happens with sleep
3 electrolyte abnormalities associated with long QT
Hypocalcaemia
Hypokalaemia
Hypomagnaemia
Name some drugs causing long QT
Soltalol
Amiodarone
SSRIs, tricyclics
Erythomycin
Terfenadine (antihistamine)
Haloperidol
Ondasetron
Methadone
When to check LFTs in patients on statins? When to stop statins?
Check LFTs at baseline, 3 months and 12 months.
Stop statin if AST/ALT>3 times upper range of normal.
What types of patients are more at risk of statin induced myopathy
Female, diabetics, advanced age, low BMI
MOA of statins?
Inhibit action of HMG-CoA which is the rate limiting action in cholesterol synthesis
What causes S4 heart sounds?
Atria contracting forcefully against stiff/ hypertrophic ventricle, eg in aortic stenosis.
