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UKMLA Cardiology Flashcards

1
Q

What is the 2 week referral indication for a patient with a systolic murmur?

A

Systolic murmur AND exertional syncope

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2
Q

What is the target INR for a mechanical aortic valve?

A

3.0

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3
Q

What is the target INR for a mechanical mitral valve?

A

3.5

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4
Q

What is the mean pressure gradient value for severe aortic stenosis?

A

> 40 mmHg

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5
Q

What is the valve area value for severe aortic stenosis?

A
  • Valve area of <1.0 cm2
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6
Q

What is the peak velocity across the aortic valve that is consistent for severe aortic stenosis?

A
  • Peak velocity >4 m/sec
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7
Q

What is the most common cause of aortic stenosis?

A

Senile age-related calcification

Rheumatic heart disease

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8
Q

What type of cardiac hypertrophy is associated with aortic stenosis?

A

Concentric hypertrophy

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9
Q

What type of murmur is associated with aortic stenosis?

A

Ejection systolic crescendo-decrescendo murmur - radiating to the carotid arteries

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10
Q

On examination what pulse pressure presentation is observed in aortic stenosis?

A

Narrow pulse pressure
Slow-rising pulse

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11
Q

What happens to the S2 sound in aortic stenosis?

A

Soft S2

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12
Q

What murmur examination finding is associated with severe disease?

A

Murmur progression then regression

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13
Q

What is the first line investigation for suspected aortic stenosis?

A

Echocardiography

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14
Q

Which type of aortic valve replacement is recommended in younger patients?

A

Metallic valve

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15
Q

What type of hypertrophic remodelling is associated with aortic regurgitation?

A

Eccentric hypertrophy

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16
Q

Which antihypertensive medication increases uric acid and increases the risk of gout?

A

Thiazide e.g., indapamide

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17
Q

What type of murmur is associated with aortic regurgitation?

A

Early diastolic murmur

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18
Q

A water hammer pulse is associated with which valvular pathology?

A

Aortic regurgitation

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19
Q

What is the mot common cause of aortic regurgitation?

A

Congenital valve abnormalities e.g., bicuspid aortic valve

Rheumatic heart disease

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20
Q

Which sign describes head nodding in time with the pulse in AR?

A

De Musset’s sign

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21
Q

Which sign describes visible pulsations in the nailbed in AR?

A

Quincke’s sign

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22
Q

Which sign describes visible pulsations in the neck in AR?

A

Corrigan’s sign

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23
Q

Which specific coronary artery supplies the atrioventricular node?

A

Posterior interventricular artery branching off from the RCA

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24
Q

Fixed splitting of the second heart sound suggests which septal defect?

A

Atrial septal defect

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25
Q

Which drug is the most effective to reduce triglyceride concentration?

A

Fibrates

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26
Q

What are the first line prophylactic anti-anginal medication indicated in a patient with asthma?

A

Rate limiting CCB e.g., diltiazem/verapamil

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27
Q

What test is used for confirming the diagnosis of rheumatic fever?

A

Antistreptolysin O test

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28
Q

What is the first line management for an aortic dissection?

A

Intravenous labetalol

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29
Q

What is the gold-standard investigation in a patient who is clinically stable?

A

CT angiography of the chest, abdomen and pelvis

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30
Q

What is the first line management of Kawasaki disease?

A

Intravenous immunoglobulin

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31
Q

Which serum blood test is recommended for the diagnosis of heart failure?

A

Plasma NT-pro-BNP

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32
Q

Prior to starting ACE inhibitors, what disorder should be excluded first?

A

Renal artery stenosis

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33
Q

What is the first line management for patients with heart failure without pulmonary oedema?

A

ACE inhibitors

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34
Q

What is the first line of investigation to confirm acute anaphylaxis?

A

Serum tryptase

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35
Q

What is the most common risk factor for aortic dissection?

A

Hypertension

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36
Q

What type of aortic dissection is proximal to the brachiocephalic artery?

A

Type A

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37
Q

What classification system is used for aortic dissection?

A

DeBakey/Stanford

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38
Q

Which genetic syndromes are associated with aortic dissection?

A

Marfan Syndrome, Ehlers–Danlos Syndrome, Turner syndrome and bicuspid aortic valve.

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39
Q

What is the characteristic presentation of an aortic dissection?

A

Sudden onset tearing chest pain

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40
Q

Where does the pain radiate to in a descending aortic dissection?

A

Interscapular and lower back pain

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41
Q

What happens to the pulse in an aortic dissection?

A

Pulse deficit (>20 mmHg)

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42
Q

Which type of aortic dissection is associated with a diastolic? murmur?

A

Type A (Ascending)

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43
Q

What ECG changes are associated with an aortic dissection?

A

ST-segment depression

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44
Q

What chest radiograph sign is observed in an aortic dissection?

A

Widening of the mediastinum
Aortic knob

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45
Q

What is the definitive investigation for an aortic dissection (stable patients)?

A

CT angiography

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46
Q

What is the definitive investigation for unstable patients with an aortic dissection?

A

Transoesophageal echocardiography

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47
Q

What is the first line management for a confirmed type A aortic dissection?

A

Labetalol and immediate surgical repair (open aortic arch replacement/total endovascular repair)

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48
Q

What is the management for a confirmed type B aortic dissection?

A

Labetalol

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49
Q

What is the main complication associated with a type A aortic dissection?

A

Aortic regurgitation

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50
Q

An aortic aneurysm is characterised by a diameter of ?

A

> 3.0cm (x 1.5 normal diameter(

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51
Q

When does the AAA screening programme begin in the UK?

A

65 and over

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52
Q

What is the investigation of choice for an AAA?

A

Abdominal ultrasound scan

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53
Q

What is the frequency of investigation for a small AAA (3 - 4.4 cm)?

A

Repeat scan every 12 months

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54
Q

What is the frequency of investigation for a medium AAA (4.5 - 5.4 cm)?

A

Repeat scan every 3 months

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55
Q

What is the cut-off for an urgent AAA (referral for a vascular surgeon within 2 weeks)?

A

> 5.5 cm

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56
Q

What are the referral criteria for an AAA?

A
  • Symptomatic
  • Asymptomatic, >4.0 cm AND has grown by more >1.0 cm in 1 year (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound).
  • Asymptomatic and >5.5 cm.
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57
Q

Definition of persistent AF?

A

> 7 days

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58
Q

Definition of paroxysmal AF?

A

Episodes that last >30s that terminate spontaneously or with intervention within 7 days of onset

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59
Q

What ECG findings are observed in patients with AF?

A

Absence of distinct repeating P waves, irregular atrial activations, irregularly irregular R-R intervals + narrow QRS complex.
* Consider a 24-hour ambulatory ECG monitor if suspected and not detected on standard ECG.

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60
Q

What is the first line management for AF >48 hours of presentation)?

A

Rate control with a beta-blocker or a rate-limiting calcium channel blocker

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61
Q

Provide examples of a rate-limiting calcium channel blocker:

A

diltiazem
verapamil

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62
Q

If the maximum tolerated dose of rate limiting drugs are ineffective what is recommended for AF?

A

Digoxin

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63
Q

What is the management for stable onset AF <48 hours?

A

Admission for cardioversion

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64
Q

What is the management of AF >48 hours with no reversible causes?

A

CHA2DS2-VASc score: Start DOAC and beta-blocker or rate limiting CCB

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65
Q

What scoring system is used to assess stroke risk in patient with AF?

A

CHA2DS2-VASc score

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66
Q

When should a review be scheduled in a patient with AF treated with rate control?

A

Within 1 week

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67
Q

What are the parameters and score of the CHA2DS2—VASc score?

A
  • Congestive heart failure/left ventricular dysfunction = 1
  • Hypertension (>140 mmHg systolic/>90 mmHg diastolic) = 1
  • Age (>75 year) = 2
  • Diabetes mellitus (fasting plasma glucose >7.0 mmol/L) = 1
  • Stroke/transient ischaemic attack = 2
  • Vascular disease (prior to myocardial infarction, peripheral arterial disease or aortic plaque) = 1
  • Age 65-74 years = 1
  • Sex category (female) = 1
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68
Q

What is the cut off for starting a DOAC in a man and woman with AF?

A

2 or above - woman
1 - man

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69
Q

What is the preferred anticoagulation in patients with AF?

A

Apixaban, dabigatran, edoxavban and rivaroxaban

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70
Q

When is anticoagulation contraindicated in patients with AF?

A

Left atrial appendage occlusion

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71
Q

What is the absolute contraindication for apixaban in the management of AF?

A

Antiphospholipid syndrome and positive lupus anticoagulant

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72
Q

What anticoagulant should be prescribed in patients with AF (with antiphospholipid syndrome)?

A

Warfarin

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73
Q

What score is used to assess the risk of bleeding in AF?

A

ORBIT bleeding score

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74
Q

When should electrical cardioversion be performed in patients with AF?

A

AF <48 hours of onset
Haemodynamic instability

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75
Q

How long should anticoagulation be initiated until cardioversion in persistent AF?

A

3 weeks

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76
Q

Which AF drug is contraindicated in structural heart disease?

A

Flecainide

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77
Q

What is the anticoagulation of choice for patients with valvular AF?

A

Warfarin

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78
Q

QRS duration for narrow complex tachycardia?

A

QRS <120 ms

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79
Q

What is the first line investigation for SVT?

A

ECG followed by a Holter monitor and EPS

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80
Q

What is the first line management for SVT?

A

Vagal manoeuvres

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81
Q

Following Vagal manoeuvres , what is the next step of management for SVT?

A

Adenosine 6 mg

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82
Q

What is the drug of choice for SVT in a patient with asthma?

A

verapamil

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83
Q

If drug management is ineffective in SVT, what is the next step in management?

A

Synchronised DC cardioversion

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84
Q

What are the adverse effects associated with adenosine?

A

Chest pain
Bronchospasm
Transient flushing

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85
Q

What is the definitive management for SVT?

A

Radiofrequency catheter ablation

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86
Q

Which structure is implicated in Wolff–Parkinson–White Syndrome?

A

Bundle of Kent

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87
Q

What characteristic ECG findings are associated with Wolff–Parkinson–White Syndrome?

A

Delate wave - short PR interval and pre-excitation

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88
Q

What is the management of unstable Wolff–Parkinson–White Syndrome?

A

Synchronised DC shock

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89
Q

What is the management of stable Wolff–Parkinson–White Syndrome?

A

Sotalol, amiodarone, flecainide

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90
Q

What is the most common risk factor for ventricular tachycardia?

A

Ischaemic heart diseae

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91
Q

Congenital cause of prolonged QT interval (2)?

A
  • Jervell–Lange–Nielsen Syndrome (includes deafness – abnormal potassium channel).
  • Romano–Ward
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92
Q

Which drugs are associated with prolonged QT?

A
  • Amiodarone, sotalol, class 1a antiarrhythmic drugs
  • Tricyclic antidepressants, fluoxetine
  • Chloroquine
  • Terfenadine
  • Erythromycin, clarithromycin
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93
Q

What is the management for pulseless VT?

A

Immediate unsynchronised cardioversion

CPR 30:2 and 300 mg amiodarone

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94
Q

What is the management for VT (unstable)?

A

Synchronised shock (up to 3) + amiodarone

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95
Q

What is an alternative to amiodarone in the management of VT?

A

Procainamide 50 mg/min, lignocaine

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96
Q

What is the first line management for stable VT?

A

300 mg amiodarone

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97
Q

Which drug is contraindicated for VT?

A

Verapamil

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98
Q

What is the ICD criteria for VT?

A
  • Sustained VT causing syncope
  • Sustained VT with EF <35%
  • Previous cardiac arrest due to VT/VF
  • MI complicated by non-sustained VT
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99
Q

QTc threshold in men?

A

450 ms

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100
Q

QTc threshold in women?

A

460 ms

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101
Q

What is the management for Torsades des pointes?

A

IV Magnesium Sulphate

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102
Q

QRS duration for wide-complex tachycardia?

A

> 120 ms

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103
Q

What is the first line management for VF?

A

Urgent defibrillation and CPR (30:2) – continue for 2 minutes then pause briefly to check the monitor (non-synchronised DC shock).

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104
Q

Maximum number of shocks for VF?

A

3

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105
Q

What drug should be prescribed following the third shock in VF?

A

1 mg adrenaline and 300 mg amiodarone

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106
Q

How frequently should 1 mg of IV adrenaline be prescribed in VF?

A

every 3-5 minutes

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107
Q

What are the two non-shockable rhytmns?

A

Pulseless electrical activity

Asystole

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108
Q

What are the 4H’s and 4 T’s?

A
  1. Hypovolaemia
  2. Hypoxia
  3. Hypokalaemia/hyperkalaemia
  4. Hypothermia

4 Ts:
1. Tension pneumothorax
2. Trauma
3. Tamponade
4. Thrombosis

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109
Q

What is the first step in managing PEA/Asystole?

A

CPR with a 30:2 ratio AND 1 mg IV adrenaline

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110
Q

Which artery is responsible for supplying the AV node?

A

Right coronary artery

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111
Q

What is the normal PR interval?

A

120-200 ms

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112
Q

Which type of AV block is characterised by a constant prolonged PR interval?

A

Type 1

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113
Q

What is the management for Type 1 AV block?

A

Reassurance - normal physiological variant

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114
Q

Which type of AV block is characterised by a progressive prolongation of the PR interval?

A

2nd degree - Mobitz type I

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115
Q

What is the management for symptomatic Mobitz type 1 heart block?

A

Transcutaneous pacing

116
Q

Which type of heart block is characterised by a constant PR interval with intermittent dropped QRS complexes?

A

Mobitz type 2

117
Q

What is the management for unstable Mobitz type 2 heart block?

A

Beta-adrenergic agonist e.g., isoproterenol, dopamine, dobutamine or adrenaline + temporary pacing.

118
Q

What is the management for unstable Complete heart block?

A

Atropine and temporary cardiac pacing

119
Q

What is the management for stable complete heart block?

A

Permanent pacemaker insertion

120
Q

What is the most common viral cause of acute pericarditis?

A

Coxsackie virus A and B, echovirus, adenovirus

121
Q

Which connective tissue disorders are associated with acute pericarditis?

A

Sarcoidosis, SLE, scleroderma

122
Q

Which drugs can cause acute pericarditis?

A

Hydralazine, isoniazid

123
Q

How is acute pericarditis relieved?

A

Sitting forward

124
Q

Which specific ECG finding is associated with acute pericarditis?

A

PR depression followed by T-wave flattening and inversion

125
Q

What is the characteristic ECG presentation observed in acute pericarditis?

A

Widespread saddle-shaped (Concave) ST-elevation

126
Q

Which investigation is indicated in acute pericarditis to assess for pericardial effusion?

A

Echocardiogran

127
Q

What is the first-line management for acute pericarditis?

A

NSAIDs or aspirin or colchicine

128
Q

What is the management for cardiac tamponade?

A

Emergency pericardiocentesis

129
Q

What is Beck’s triad?

A

Raised JVP, hypotension, muffled heart sounds

130
Q

Which pulse waveform is characteristic of cardiac tamponade?

A

pulsus paradoxus

131
Q

Define pulsus paradoxus?

A

large decrease in SBP >10 mmHg during inspiration

132
Q

What i the most common cause of constrictive pericarditis?

A

Tuberculosis

133
Q

What characteristic sign is associated with constrictive pericarditis?

A

Kussmaul’s sign

134
Q

What is Kussmaul’s sign?

A

Paradoxical increase in JVP that occurs during inspiration

135
Q

What is the management of constrictive pericarditis?

A

Pericardiectomy

136
Q

What is the time-frame for acute limb ischaemia?

A

<2 weeks of symptoms

137
Q

Which artery is most affected in acute limb ischaemia?

A

Superficial femoral artery

138
Q

What is the classic presentation of Acute limb ischaemia?

A
  • Pallor
  • Pain
  • Present and persistent
  • Paraesthesia
  • Reduced sensation or numbness
  • Paralysis
  • Pulselessness
  • Absent ankle pulses
139
Q

What investigation is first line for acute limb ischaemia?

A

Measure ankle-branchial pressure index

140
Q

What ABPI measurement indicates chronic limb-threatening ischaemia?

A

<0.5

141
Q

What ABPI measurement indicates peripheral arterial disease?

A

<0.9

142
Q

Which ABPI measurement indicates arterial calcification secondary to diabetes?

A

Diabetes

143
Q

What is the confirmatory testing for acute limb ischaemia?

A

CT angiogram

144
Q

What is the first line of management for ALI?

A

IV unfractionated heparin and urgent vascular assessment

145
Q

What is the definitive management for ALI?

A
  • Endovascular therapies – percutaneous catheter-directed thrombolytic therapy | percutaneous mechanical thrombus extraction.
146
Q

What is the characteristic presentation of chronic limb ischaemia?

A

Chronic rest pain - worst at night (decrease in BP due to loss of gravitational effects on lower limb circulation)

147
Q

What is the definitive management of CLI?

A

Definitive management: revascularisation

148
Q

What three conditions fall under ACS?

A
  1. Unstable angina (no cardiac injury)
  2. Non-ST-elevation myocardial infarction (NSTEMI)
  3. ST-elevation MI
149
Q

Which biomarker is measured to evaluate for recurrent MI?

A

CK-MB

150
Q

Which biomarker is initially measured for acute MI?

A

Troponin-T

151
Q

Which early ECG changes should suspect MI?

A

New-onset LBB

152
Q

ST elevation in leads: I, aVL, V5, V6 is associated with what coronary artery?

A

Left circumflex

153
Q

ST elevation in leads: II, III, AvF associated with what coronary artery?

A

Right coronary artery

154
Q

ST-elevation in which leads is associated with an MI in the LAD?

A

V1, V2, V3, V4

155
Q

What is the definitive gold-standard investigation for ACS?

A

Coronary angiography

156
Q

What is the first line drug for unstable angina/NSTEMI?

A

300 mg aspirin AND fondaparinux

157
Q

When should oxygen be delivered in ACS?

A

If oxygen is <94%

158
Q

Which risk assessment tool is used for assessing the 6-month mortality in patients with NSTEMI?

A

Global Registry of Acute Cardiac Events (GRACE)

159
Q

A GRACE score >3%, warrants what next immediate management?

A

PCI within 72 hours

160
Q

What is the management for NSTEMI with a GRACE score <3%?

A

Ticagrelor

161
Q

What is the first line management for a STEMI?

A

300 mg aspirin

162
Q

What is the definitive intervention for STEMI?

A

Coronary reperfusion therapy (primary PCI or fibrinolysis) – radial artery is preferred.

163
Q

What is the preferred artery for PCI?

A

Radial artery

164
Q

What is the indications for primary PCI in STEMI?

A

Within 12 hours of symptom onset

If PPCI can be performed within 120 minutes

165
Q

What additional anticoagulant is prescribed for patients with PCI?

A

Prasugrel

166
Q

What is the alternative intervention for patients whereby PCI cannot be performed in STEMI?

A
  • Fibrinolysis (Tissue plasminogen activators e.g., streptokinase, and urokinase)
167
Q

What is administered alongside fibrinolytic therapy in the management of STEMI?

A

Antithrombin - e.g., fondaparinux

168
Q

What is the next line in management if there is residual ST-elevation after 60-90 minutes?

A

Immediately coronary angiography with follow-on pCI

169
Q

What is the dual antiplatelet therapy for PCI?

A

Aspirin and prasugrel (if not on DOAC, maintenance dose 75 mg for one year minimum)

170
Q

If a patient is on a DOAC, what is the DAPT of choice?

A

Aspirin and clopidogrel

171
Q

What antithrombin therapy is delivered during primary PCI?

A

Unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (e.g., tirofiban, eptifibatide) – if radial PCI.

172
Q

If femoral access is used for primary PCI, what is the antithrombin therapy of choice?

A

Bivalirudin with bailout GPI

173
Q

What dose of statin is indicated post MI?

A

Atorvastatin 80 mg

174
Q

What secondary prevention drugs are prescribed post-MI?

A
  • Angiotensin-converting enzyme inhibitor
  • Dual antiplatelet therapy (as aspirin + second antiplatelet) – continue for up to 12 months, and aspirin indefinitely.
  • Beta-blocker – Continue for 12 months (assess for left ventricular ejection fraction).
  • Atorvastatin – 80 mg OD
175
Q

What investigation and frequently, should be performed once a statin is initiated?

A

Liver function tests at baseline, 3 months and 12 months

176
Q

For long is driving not advised post MI?

A

1 month

177
Q

What is Killip Class IV?

A

Cardiogenic shock

178
Q

Most common cause of death post-MI?

A

Ventricular fibrillation

179
Q

When does Dressler’s syndrome typically arise post-MI?

A

2-6 weeks

180
Q

Which post-MI complication is associated with persistent ST-elevation and left ventricular failure?

A

Left ventricular aneurysm

181
Q

Which post-MI complication is associated with cardiac tamponade?

A

Left ventricular free wall rupture

182
Q

What is the complication associated with a papillary muscle rupture?

A

Acute mitral regurgitation

183
Q

Coved ST-segment elevation of V1-V3 followed by a negative T wave is associated with what?

A

Brugada syndrome

184
Q

Brugada syndrome is associated with which gene?

A

SCN5A

185
Q

Which electrolyte derangement is associated with digoxin toxicity?

A

Hypokalaemia

186
Q

At what concentration does digoxin toxicity arise?

A

1.5 to 3 mcg/L

187
Q

What ocular manifestation is associated with digoxin toxicity?

A

Yellow-green discolouration in vision

188
Q

What is the 1st line management for digoxin toxicity?

A

Digoxin-specific antibody antigen-binding fragments (DSFab) – ‘digibind’

189
Q

What ejection fraction is associated with HF with reduced EF?

A

<40%

190
Q

HFrEF is associated with which type of HF?

A

Systolic failure

191
Q

Which classification system is used to assess for symptomatic severity of HFrEF?

A

New York Heart Association (NYHA) classification

192
Q

What is Class 2 NYHA?

A

Slight limitation of physical activity – comfortable at rest, however, ordinary physical activity manifests as undue breathlessness, fatigue or palpitations.

193
Q

What is Class 3 NYHA?

A

: Marked limitation of physical activity – comfortable at rest, but less than ordinary physical activity results in symptoms.

194
Q

Which NYHA class is associated with symptoms at rest?

A

Class 4

195
Q

What is the most specific auscultation finding in heart failure?

A

S3 - ventricular gallop

196
Q

Which imaging investigation is indicated for HFrEF?

A

Echocardiography

197
Q

Which serum marker is used to investigate HFrEf?

A

NT-pro-BNP

198
Q

What NT-pro-BNP cut off is used for diagnosis of HF?

A

> 125 pg/mL

199
Q

What is the first line management for chronic HFrEF?

A

ACE inhibitor AND beta-blocker

200
Q

When is a beta-blocker contraindicated in chronic HFrEF?

A

Hx of diabetes mellitus or signs of fluid overload

201
Q

What is the second line medical management for chronic HFrEF?

A

Mineralocorticoid receptor antagonist e.g., spironolactone.

202
Q

Which drug should replace an ACE inhibitor if EF <35%?

A

sacubitril valsartan

203
Q

What fourth drug should be added to medical management in patients with chronic HFrEF?

A

SGLT-2 inhibitor

204
Q

What are the adverse effects associated with the use of SGLT-2 inhibitors?

A

Fournier’s gangrene, necrotising fasciitis, increased UTIs, euglycemic diabetic ketoacidosis.

205
Q

Which medical drugs are recommended in patients of African-Carribbean descent in chronic HFrEF?

A
  • Hydralazine and nitrate
206
Q

Name the two criteria for ICD insertion in chronic heart failure?

A

LVEF <35%
QRS <130 ms

207
Q

What are the indications for CRT in chronic heart failure?

A
  • Symptomatic patients with HF with a QRS duration >150 ms and LBB QRS morphology and with LVEF <35%
208
Q

What is the 1st line medical management for acute heart failure?

A

loop diuretics e.g., furosemide or bumetanide

209
Q

What is the EF threshold for HFpEF?

A

LVEF >50%

210
Q

Diastolic heart failure is associated with which type of HF?

A

HFpEF?

211
Q

What is the medical management for HFpEF?

A

SGLT-2 inhibitor

212
Q

Which two vaccinations are indicated for chronic heart failure?

A

once only pneumococcal vaccination

Annual influenza vaccine

213
Q

What are the contraindications for nitrates in HF?

A

in SBP <90 mmHg or in aortic stenosis

214
Q

What is the 1st medical management for cardiogenic shock in HF?

A

inotropes/vasopressors e.g., dobutamine, and noradrenaline.

215
Q

Which circulatory support devices are indicated in cardiogenic shock?

A

Intra-aortic balloon pump

216
Q

What is the first line medical management for peri-arrest bradycardia?

A

Atropine (500 mcg IV) – up to a maximum of 3 mg.

217
Q

Following atropine in bradycardia management, what is the next intervention?

A

Transcutaneous pacing

218
Q

What are the ECG changes associated with LBBB?

A
  • QRS duration > 120 ms
  • Dominant S wave in V1 (W in V1)
  • Broad monophasic R wave in lateral leads (I, aVL, V5-6)
  • Prolonged R wave peak time >60 ms in leads V5-6 (M in V6)
219
Q

What ECG pattern is associated with RBBB?

A
  • QRS duration >120 ms
  • V1: RSR’ pattern in V1-3 (M-shaped QRS complex)
  • V6: Wide, slurred S wave in lateral leads
220
Q

Which classification system is used for typical angina diagnosis?

A

Diamond classification

221
Q

What i the gold standard investigation for typical angina?

A

CT coronary angiography

222
Q

What is the first line symptomatic relief for angina?

A

Sublingual glyceryl trinitrate

223
Q

What is the first line long-term management for angina?

A

Beta-blocker or calcium-channel blocker (Rate-limiting is indicated for monotherapy e.g., verapamil or diltiazem – class IV antiarrhythmics).

224
Q

What are the adverse effects associated with beta-blockers?

A

Tiredness, postural hypotension (in elderly patients), loss of sympathetic response to hypoglycaemia, nightmares (use a fat-soluble agent e.g., atenolol), male impotence.

225
Q

What is the second line management for angina?

A

Combination dual-therapy – long-acting dihydropyridine CCB (e.g., amlodipine, modified-release nifedipine)

226
Q

What is the consequence of Verapamil + beta-blocker ?

A

Complete heart block

227
Q

If monotherapy or initial CCB/BB therapy is ineffective in managing angina, what is next?

A

Long-acting nitrate (e.g., isosorbide mononitrate); nicorandil; ivabradine; ranolazine

228
Q

Where do loop diuretics act?

A

Na-K-Cl cotransport in the thick ascending limb of the loop of Henle

229
Q

How do loop diuretics affect calcium?

A
  • Hypocalcaemia
230
Q

What electrolyte derangement is associated w/loop diuretics?

A
  • Hyponatraemia
  • Hypokalaemia, hypomagnesaemia
  • Hypocalcaemia
231
Q

What is the diagnostic investigation for Buerger’s disease?

A
  • Contrast angiography
232
Q

What finding is observed in Buerger’s disease?

A

Segmental arterial occlusions with corkscrew appearance

233
Q

Which bacteria is associated with underlying colon cancer (infective endocarditis)?

A

streptococcus bovis

234
Q

What is the most common cause of infective endocarditis?

A

Staph. Aureus

235
Q

What are the HACEK organisms?

A

Haemophilus, Aggregatibacter, Cardiobacterum, Eikenella, and Kingella.

236
Q

Which valve is most affected in IVDU?

A

Tricuspid

237
Q

What is the most common cause of infective endocarditis following a valve replacement (within the first 2 months)?

A

streptococcus viridans

238
Q

Where do Janeway lesions typically affect?

A

Painless flat macules on the palms and soles

239
Q

What are Osler’s nodes?

A

Tender red/purple nodules on the pads of the fingers and toes

240
Q

What ocular manifestation of infective endocarditis is observed?

A

Roth spots

241
Q

What are the two major Duke’s criteria?

A
  • Positive blood cultures growing typical IE organisms or 3 positive cultures>12 hours, taken from 3 different sites at 3 different times.
  • Evidence of vegetation on TTE or new regurgitant murmur
242
Q

What are the five minor Duke’s criteria?

A
  • Risk factors (e.g., prosthetic valve, IVDU, congenital valve abnormalities).
  • Fever >38
  • Thromboembolic phenomena
  • Immune phenomena – glomerulonephritis, Osler’s nodes, Roth spots
  • Positive blood cultures not meeting major criteria.
243
Q

What is the antibiotic of choice for prosthetic valve IE?

A

Vancomycin + rifampicin + gentamicin.

244
Q

What investigation is required prior to antibiotics in IE?

A

Blood cultures

245
Q

What is the antibiotic of choice for confirmed staphylococcus aureus IE?

A

Flucloxacillin

246
Q

What is the most common viral cause of myocarditis?

A

Coxsackie B virus

247
Q

What is the gold-standard investigation to confirm myocarditis?

A

Endomyocardial biopsy

248
Q

What is the clinic range for stage 1 hypertension?

A

140/90 mmHg to 159/99 mmHg

249
Q

What is the daytime or HBPM average for stage 1 hypertension?

A

135/85 to 149/94 mmHg

250
Q

What is the clinic BP range for stage 2 hypertension?

A

160/100 to 180/120 mmHg

251
Q

What is the ABPM daytime average for stage 2 hypertension?

A

> 150/95 mmHg

252
Q

Define stage 3 (severe) hypertension?

A

Clinic blood pressure >180 mmHg or clinic diastolic blood pressure >120 mmHg.

253
Q

What is malignant hypertension?

A

Malignant hypertension is defined as a blood pressure >180/120 mmHg accompanied by signs of retinal haemorrhage, papilloedema and new or progressive target organ damage.

254
Q

What are the BP target ranges for ‘normal’ patients (<80 years)?

A

<140/90

255
Q

What are the BP target ranges for a patient with T1DM/CKD (<80 years)?

A

<130/90

256
Q

What is the BP target range for patients aged >80 years?

A

<150/90

257
Q

What is the first line drug for hypertension <55 years non-AC origin?

A

ACE inhibitors e.g., ramipril

258
Q

What is the first line management for hypertension >55 years or AC origin?

A

Calcium channel blocker e.g., amlodipine, nifedipine

259
Q

What is the second line medical management for hypertension?

A
  • ACEi/ARB + CCB or thiazide-like diuretic.
  • CCB + ACEi/ARB or thiazide-like diuretic (For those on CCB as first-line).
260
Q

What is the third line medical management for hypertension?

A
  • ACEi/ARB + CCB + thiazide-like diuretic.
261
Q

What potassium level indicates low-dose spironolactone for step 4 hypertension management?

A

<4.5 mmol/L

262
Q

What is the medical management for refractory hypertension and potassium >4.5 mmol/L?

A

alpha-blocker or beta-blocker.

263
Q

What are the contraindications for alpha-blockers?

A

Postural hypotension, and micturition syncope

264
Q

What are the adverse effects associated with alpha-blockers?

A

vertigo, dizziness, arrhythmias, chest pain, constipation and diarrhoea, depression, drowsiness, dry mouth, dyspnoea, first-dose hypotension, headache, oedema, palpitations, syncope, sexual dysfunction, and tinnitus

265
Q

What is the main adverse effect associated with ACE inhibitors?

A

Dry non-productive cough and angioedema

266
Q

What are the contraindications to ACE inhibitors?

A

history of recurrent or family angioedema; reduced eGFR <60 mL/minute/1.73m2 and in combination with aliskiren; pregnancy and breastfeeding women

267
Q

Wells score >4, what is the next investigation?

A

CTPA and interim anticoagulation

268
Q

What is the first line anticoagulation indicated for PE?

A

DOAC e.g., apixaban

269
Q

If the Wells score is <4, what is the next test?

A

D-dimer within 4 hours

270
Q

A positive D-dimer in a patient with Well’s score <4, indicates what?

A

CTPA

271
Q

What is the most common ECG finding observed in PE?

A

Sinus tachycardia

272
Q

What specific rare ECG pattern is associated with PE?

A
  • S1Q3T3
273
Q

What is the management of massive PE or those that are haemodynamically unstable?

A

Thrombolytic therapy e.g., IV alteplase

274
Q

What is the first line management of orthostatic hypotension?

A

Fludrocortisone

275
Q

A pansystolic murmur radiating to the axilla, is consistent with what?

A

Mitral regurgitation

276
Q

Which ECG feature is associated with mitral regurgitation?

A

P mitrale

277
Q

What is the definitive diagnosis of MR?

A

Echocardiography

278
Q

Which murmur is heard in mitral stenosis?

A

Mid-diastolic low-pitched murmur

279
Q

A malar flush is associated with what?

A

Mitral stenosis

280
Q

Why is there a loud S1 in mitral stenosis?

A

– thick valves requiring a large systolic force to shut.

281
Q

Which investigation is indicated following a vasovagal syncope?

A

12-lead ECG

282
Q

Which murmur is heard in hypertrophic cardiomyopathy?

A
  • Crescendo-decrescendo ejection systolic murmur

best auscultated at the apex and lower left sternal border) – increases with Valsalva manoeuvre and decreases on squatting.

283
Q

Which investigation confirms hypertrophic cardiomyopathy?

A

2D transthoracic echocardiography or cardiovascular magnetic resonance imaging demonstrating a maximal end-diastolic left ventricular wall thickness of ≥15 mm

284
Q

What prophylactic intervention is recommended in HCM?

A

prophylactic ICD therapy

285
Q

Which drugs are indicated for symptomatic control in HCM?

A

non-vasodilating beta-blockers or non-dihydropyridine calcium channel blockers

286
Q

Critical stenosis of the LAD is associated with what disorder?

A

Wellen’s Syndrome

MLA Flashcards (19 decks)

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