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MRCP: Cardiology > MRCP2 > Flashcards

MRCP2 Flashcards

1
Q

What is accelerate idioventricular rhythm?

A

Benign rhythm of ventricular origin

Occurs following reperfussion of myocardium

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2
Q

Features of accelerated idioventricular rhythm?

A

50-100 bpm
Occurs following the reperfusion of an ischaemic myocardium.

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3
Q

What does HFrEF stand for?

A

Heart failure reduced ejection fraction

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4
Q

When should a Cardiac resynchronisation therapy device (CRT-D) be considered in heart failure?

A

On maximum medical therapy
+
Evidence of ventricular dyssynchrony

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5
Q

When should you consider ivabradine in HFrEF?

A

HR > 70 bpm despite maximal doses of beta blocker

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6
Q

What is suggestive of cardiac dyssynchony in heart failure?

A

LBBB

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7
Q

What is often a precursor to torsade de pointe?

A

Prolonged QTc
Hypokalaemia
Hypomagnesaemia

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8
Q

SVT + RBB vs polymorphic VT?

A

If it is regular
Monomorphic ( but pointy)
Positive deflection in V1
Negative deflection in V6

Consider SVT - and manage with adenosine

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9
Q

How does WPW cause an arrthymia?

A

AVRT ( atrioventricular rentry tachycardia)

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10
Q

Features of WPW ECG?

A
  1. short PR interval
  2. wide QRS complexes with a slurred upstroke - ‘delta wave’
  3. left axis deviation if right-sided accessory pathway
    - in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with left axis deviation
  4. right axis deviation if left-sided accessory pathway
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11
Q

Mechanism of ACEi ?

A

Inhibit the conversion angiotensin I to angiotensin II

ACE inhibitors are activated by phase 1 metabolism in the liver

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12
Q

Side effect of ACEi?

A

Cough
Angioedema
Hyperkalaemia

First dose hypotension: most common with diuretics

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13
Q

Contraindications of ACEI?

A

Breast feeding
Pregnancy
Aortic stenosis
Idiopathic angioedema

Potassium > 5.0

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14
Q

What interacts with ACEI in high doses?

A

Hypotension in high dose diuretic therapy

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15
Q

What is an acceptable rise in creatinine?

A

30% rise in creatinine

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16
Q

ACS classifications:

A

STEMI: ST-segment elevation + elevated biomarkers of myocardial damage

NSTEMI: ECG changes but no ST-segment elevation + elevated biomarkers of myocardial damage

Unstable angina: No biochemistry

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17
Q

STEMI criteria?

A

2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years,
or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years

1.5 mm ST elevation in V2-3 in women
1 mm ST elevation in other leads
new LBBB (LBBB should be considered new unless there is evidence otherwise)

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18
Q

Management of STEMI? - When PCI possible

A

STEMI:
1. Aspirin 300mg + PCI within 120 minutes
2. Prasugrel
3. Unfractionated heparin
4. Glycoprotein IIb / IIA

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19
Q

Management of STEMI? - When PCI not possible?

A
  1. Aspirin
  2. Fibrinolysis - give antithrombin
  3. Give ticagrelor post procedure
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20
Q

NSTEMI management?

A

Score with grace score

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21
Q

Aetiology of acute pericarditis?

A

viral infections (Coxsackie)
tuberculosis
uraemia
post-myocardial infarction
- early (1-3 days): fibrinous pericarditis
- late (weeks to months): autoimmune pericarditis (Dressler’s syndrome)
radiotherapy
connective tissue disease
- systemic lupus erythematosus
- rheumatoid arthritis
hypothyroidism
malignancy
- lung cancer
- breast cancer
trauma

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22
Q

Features of pericarditis on ECG?

A

Global ST elevation
Saddle shaped St elevation
PR depression

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23
Q

What investigations should be done in acute pericarditis?

A

Rule out aetiology
Complete troponin - indicates myocardium involvement

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24
Q

Management of acute pericarditis?

A
  1. High risk patients- temperature and troponin
  2. Treat underlying cause
  3. Avoid strenuous activity

Combination of NSAID and colchicine first line

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25
Q

Mechanism of adenosine ?

A
  1. Causes transient heart block in the AV node
  2. Agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux
    adenosine has a very short half-life of about 8-10 seconds
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26
Q

Adverse effect of adenosine?

A

Chest pain
Bronchospasm
Transient flushing

Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)

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27
Q

Name of ADP inhibitors?

A

Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine

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28
Q

Mechanism of clopidogrel?

A

Adenosine diphosphate (ADP) is one of the main platelet activation factors, mediated by G-coupled receptors P2Y1 and P2Y12.

The main target of ADP receptor inhibition is the P2Y12 receptor, as it is the one which leads to sustained platelet aggregation and stabilisation of the platelet plaque.

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29
Q

Contraindications in prasugrel?

A

prior stroke or transient ischaemic attack, high risk of bleeding

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30
Q

Contraindications of ticagrelor?

A

High risk of bleeding, those with a history of intracranial haemorrhage

Severe hepatic dysfunction

Acute asthma or COPD,

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31
Q

Noteable side effect of ticagrelor?

A

Cause dyspnoea

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32
Q

What pan systolic murmur occurs commonly post myocardial infarction - and why?

A

Papillary muscle tear

Mitral regurgitation

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33
Q

Pansystolic murmur + Loudest at lower left sternal edge + Parasternal thrill ?

How may this occur?

A

Ventricular septal defect

May occur post myocardial infarction

34
Q

ECG findings of brugada syndrome?

A

V1-V3 ST elevation
+
Complete / incomplete RBBB

35
Q

Mutation in brigade syndrome?

A

SCN5A

36
Q

Calculation for mean arterial blood pressure?

A

MAP = 2/3 DBP + 1/3 SBP

37
Q

Normal MAP ?

A

65-110

Minimum is 60 for cerebral perfusion

38
Q

What does cardiac index measure?

A

Measures cardiac output to body surface area

39
Q

What is the normal for Cardiac index?

A

2.5 - 4 L/min/m2

40
Q

Normal right atrial pressure?

A

1-6

41
Q

When do you expect right atrial pressure to be elevated?

A

Backpressure

e.g. pulmonary oedema

42
Q

Normal ejection fracture is ?

A

50-60%

Calculated:
Stroke Volume / End diastolic volume

43
Q

Causes of restrictive cardiomyopathy?

A

Amyloidosis
Haemchromatosis
Post-radiation fibrosis

44
Q

What is the most common mutation in long QT syndrome?

A

LQT1 mutation
Romano- Ward mutation

45
Q

Features of Jervell-Lange-Nelson syndrome? And mutation?

A

High incidence in scandinavian
Long QT
Bilateral sensorineural hearing loss

46
Q

Features of LQT3 mutation?

A

Tachycardia in sleep
(bradycardia –> tachyardia )

47
Q

Features of LQT7 mutation?

A

Anderson syndrome
Long QT
Muscle weakness
Skeletal abnormalities

48
Q

ECG Left mainstem artery occlusion?

A

aVR with diffuse ST depression in other leads

49
Q

ECG for posterior descending artery?

A

Posterior descending is a branch of RCA
ST elevation in leads V7-V9

50
Q

Most likely causative organism in IVDU endocarditis?

A

Staph aureus

51
Q

Which side endocarditis leads to septic emboli to lungs?

A

Typically right sided
(may see abscess formation in lungs)

52
Q

Which side endocarditis leads to embolic phenonema?

A

Typically left sided

53
Q

Treatment for stable VT?

A

Amiodarone

54
Q

Treatment for unstable VT?

A

Synchronised DC cardioversion

55
Q

Electrical alternans?

A

Cardiac tamponade

56
Q

What increases in-stent thrombosis?

A

Bare metal stents
Diabetes
Non-complinance with DAPT

57
Q

How to differentiate between pericarditis and myocarditis?

A

Troponin
Friction rub - pericarditis

58
Q

Features of rheumatic fever?

A

Strep pyogenes
Inflammatory polyarthritis
Erythema marginatum
Raised inflammatory markers

59
Q

WHat is unstable angina?

A

Pain ongoing - looks like STEMI / NSTEMI
Negative cardiac markers

60
Q

What is stable angina?

A

Pain on exertion

61
Q

What triptan is associated with chest pain?

A

Sumatriptan
Believed to be from vasospasm

62
Q

Considerations for ICD in patients with previous myocardial infarction?

A

Non-sustained VT
Inducible arrhythmia on electrophysiology testing
Left ventricular ejection fraction < 35%

63
Q

Features of pulsus paridoxicus?

A

Fall in left ventricular pressure >10 mmHg during inspiration
Or fall in systolic pressure > 10 mmHg during inspiration

May be caused by pericardial effusion or tamponade

64
Q

How quickly should blood pressure be brought down for treatment of hypertensive encephalopathy?

A

Aim for reduction of 25 % within for 24-48 hours

65
Q

What is left ventricular strain pattern?

A

ST-segment depression that is bowed upwards and slopes down into an inverted asymmetrical T wave.

66
Q

What is right ventricular strain pattern?

A

S1Q3T3 pattern
RBBB
Or Tall T waves

67
Q

Biggesdt rsik factors for stroke?

A

Review CHADVASC scoring to answer these questions

68
Q

Features of pulmonary stenosis

A

Prominant a waves on JVP
Systolic murmur
Heard at left sternal edge

69
Q

What cardiac manifestations are associated with noonan syndrome?

A

Pulmonary lesions ( pulmonary stenosis)
ASD

70
Q

Major and minor criteria for diagnosis of rheumatic fever?

A

Major:
Migrating polyarthritis
Carditis
Erythema marginatum
Sydenham’s chorea
Subcutaneous nodules

Minor:
Fever
Raised ESR / CRP
Arthralgia
ECG showing heart block
Previous rheumatic fever

71
Q

Most common cause for feeling of missing a beat in chest?

A

Ventricular ectopics

72
Q

Orthostatic hypotension?

A

Tweak meds - try and remove thiazides
Compression stockings
Oral fludrocortisone

73
Q

Gudielines for intervention for abdominal aortic root dilation?

A

Dilated root > 50 mm
Or > 45 mm in presence of risk factors

74
Q

Gudielines for intervention for abdominal aortic root dilation?

A

Dilated root > 50 mm
Or > 45 mm in presence of risk factors

75
Q

Things that increase long term mortality post MI?

A
  1. Smoking cessation - the best
  2. Cardiac rehab
  3. Weight loss
76
Q

Complication of central venous catheterisation?

A

Iatrogenic arteriovenous fistula
Likely between iliac vein and artery
Leads to increased right heart pressures

77
Q

What is fenofibrae used to treat?

A

Hypertriglyceridaemia

78
Q

What effect does nicotinic acid have in fats?

A

Reduces triglycerides

79
Q

Choice of treatment inf familial hyperlipidaemia?

A

Atrovastatin

80
Q

Hypertensive + radio-radio delay + late systolic murmur?

A

Coarctation of aorta

Other symptoms: Nose bleeds, claudication, cool periperies, headaches

MRCP: Cardiology (2 decks)

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