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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
Mechanism of adenosine ?
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
26
Adverse effect of adenosine?
Chest pain Bronchospasm Transient flushing Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
27
Name of ADP inhibitors?
Clopidogrel Prasugrel Ticagrelor Ticlopidine
28
Mechanism of clopidogrel?
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.
29
Contraindications in prasugrel?
prior stroke or transient ischaemic attack, high risk of bleeding
30
Contraindications of ticagrelor?
High risk of bleeding, those with a history of intracranial haemorrhage Severe hepatic dysfunction Acute asthma or COPD,
31
Noteable side effect of ticagrelor?
Cause dyspnoea
32
What pan systolic murmur occurs commonly post myocardial infarction - and why?
Papillary muscle tear Mitral regurgitation
33
Pansystolic murmur + Loudest at lower left sternal edge + Parasternal thrill ? How may this occur?
Ventricular septal defect May occur post myocardial infarction
34
ECG findings of brugada syndrome?
V1-V3 ST elevation + Complete / incomplete RBBB
35
Mutation in brigade syndrome?
SCN5A
36
Calculation for mean arterial blood pressure?
MAP = 2/3 DBP + 1/3 SBP
37
Normal MAP ?
65-110 Minimum is 60 for cerebral perfusion
38
What does cardiac index measure?
Measures cardiac output to body surface area
39
What is the normal for Cardiac index?
2.5 - 4 L/min/m2
40
Normal right atrial pressure?
1-6
41
When do you expect right atrial pressure to be elevated?
Backpressure e.g. pulmonary oedema
42
Normal ejection fracture is ?
50-60% Calculated: Stroke Volume / End diastolic volume
43
Causes of restrictive cardiomyopathy?
Amyloidosis Haemchromatosis Post-radiation fibrosis
44
What is the most common mutation in long QT syndrome?
LQT1 mutation Romano- Ward mutation
45
Features of Jervell-Lange-Nelson syndrome? And mutation?
High incidence in scandinavian Long QT Bilateral sensorineural hearing loss
46
Features of LQT3 mutation?
Tachycardia in sleep (bradycardia --> tachyardia )
47
Features of LQT7 mutation?
Anderson syndrome Long QT Muscle weakness Skeletal abnormalities
48
ECG Left mainstem artery occlusion?
aVR with diffuse ST depression in other leads
49
ECG for posterior descending artery?
Posterior descending is a branch of RCA ST elevation in leads V7-V9
50
Most likely causative organism in IVDU endocarditis?
Staph aureus
51
Which side endocarditis leads to septic emboli to lungs?
Typically right sided (may see abscess formation in lungs)
52
Which side endocarditis leads to embolic phenonema?
Typically left sided
53
Treatment for stable VT?
Amiodarone
54
Treatment for unstable VT?
Synchronised DC cardioversion
55
Electrical alternans?
Cardiac tamponade
56
What increases in-stent thrombosis?
Bare metal stents Diabetes Non-complinance with DAPT
57
How to differentiate between pericarditis and myocarditis?
Troponin Friction rub - pericarditis
58
Features of rheumatic fever?
Strep pyogenes Inflammatory polyarthritis Erythema marginatum Raised inflammatory markers
59
WHat is unstable angina?
Pain ongoing - looks like STEMI / NSTEMI Negative cardiac markers
60
What is stable angina?
Pain on exertion
61
What triptan is associated with chest pain?
Sumatriptan Believed to be from vasospasm
62
Considerations for ICD in patients with previous myocardial infarction?
Non-sustained VT Inducible arrhythmia on electrophysiology testing Left ventricular ejection fraction < 35%
63
Features of pulsus paridoxicus?
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
How quickly should blood pressure be brought down for treatment of hypertensive encephalopathy?
Aim for reduction of 25 % within for 24-48 hours
65
What is left ventricular strain pattern?
ST-segment depression that is bowed upwards and slopes down into an inverted asymmetrical T wave.
66
What is right ventricular strain pattern?
S1Q3T3 pattern RBBB Or Tall T waves
67
Biggesdt rsik factors for stroke?
Review CHADVASC scoring to answer these questions
68
Features of pulmonary stenosis
Prominant a waves on JVP Systolic murmur Heard at left sternal edge
69
What cardiac manifestations are associated with noonan syndrome?
Pulmonary lesions ( pulmonary stenosis) ASD
70
Major and minor criteria for diagnosis of rheumatic fever?
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
Most common cause for feeling of missing a beat in chest?
Ventricular ectopics
72
Orthostatic hypotension?
Tweak meds - try and remove thiazides Compression stockings Oral fludrocortisone
73
Gudielines for intervention for abdominal aortic root dilation?
Dilated root > 50 mm Or > 45 mm in presence of risk factors
74
Gudielines for intervention for abdominal aortic root dilation?
Dilated root > 50 mm Or > 45 mm in presence of risk factors
75
Things that increase long term mortality post MI?
1. Smoking cessation - the best 2. Cardiac rehab 3. Weight loss
76
Complication of central venous catheterisation?
Iatrogenic arteriovenous fistula Likely between iliac vein and artery Leads to increased right heart pressures
77
What is fenofibrae used to treat?
Hypertriglyceridaemia
78
What effect does nicotinic acid have in fats?
Reduces triglycerides
79
Choice of treatment inf familial hyperlipidaemia?
Atrovastatin
80
Hypertensive + radio-radio delay + late systolic murmur?
Coarctation of aorta Other symptoms: Nose bleeds, claudication, cool periperies, headaches

MRCP: Cardiology (2 decks)

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