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MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Healthy size of JVP?

A

3cm

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2
Q

inspiration makes the JVP rise or fall?

A

Fall - negative intrathoracic pressure

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3
Q

Causes of a raised JVP?

A

Heart failure
Fluid overload
Bradycardia

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4
Q

Kaussmauls SIGN

A

raised JVP with inspiration - due to constriction of the pericardium

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5
Q

Raised JVP with no pulsations?

A

SVC obstruction

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6
Q

JVP a wave

A

atrial contraction

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7
Q

JVP c wave

A

closure of tricuspid valve

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8
Q

JVP x descent

A

downward movement of the heart

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9
Q

JVP v wave

A

passive filling of blood in thr atriaum against closedf tricuspid valve

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10
Q

JVP y descent

A

Opening of tricuspid valve

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11
Q

JVP a waves ==absent==

A

AF

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12
Q

JVP a waves ==Large==

A

tricuspid stenosis

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13
Q

JVP cannon a waves

A

AV dissasociation -
Atrial flutter/tachy ,
complete heart block,
VT and ventricular ectopics

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14
Q

JVP V waves - giant

A

tricuspid regurge

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15
Q

JVP x descent - steep

A

tamponade

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16
Q

JVP y descent - steep

A

Cardiac constriction

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17
Q

JVP y descent - slow

A

Tricuspid stenosis

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18
Q

Absent radial pulse, cause?

A 
Iatrogenic - A-lines
Tetralogy of Fallot
Aortic dissection
Trauma
Takayasu Arteritis
Peripheral arterial embolus
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19
Q

Central pulse is for assessing?

A

character of pulse

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20
Q

peripheral pulse is for assessing?

A

rate and rythym

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21
Q

Collapsing pulse?

A

Aortic regurge
AV fistula
PDA

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22
Q

Slow rising pulse?

A

Aortic stenosis

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23
Q

Bisferiens pulse?

A

“double shudder” mixed Aortic valve disease with significant regurgitation

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24
Q

Jerky pulse?

A

HOCM

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25
Q

Alternans pulse?

A

occurs in LV distortion - reduced EJ % which due to frank-sterling physiology improves the EF of the next beat

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26
Q

Paradoxical pulse?

A

Reduction in the pulse with inspiration - LV compression ie. tamponadde pericarditis and severe asthma

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27
Q

Loud first heart sound cause?

A 
Mobile Mitral stenosis
hyperdynamic states
tachycardia
left to right shunt
short PR interval
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28
Q

Soft first heart sound cause?

A 
immobile mitral stenosis 
Hypodynamic states
Mitral regurge
Poor ventricular function
Long PR interval
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29
Q

Split first heart sound cause?

A 
LBBB
RBBB
VT
Inspiration
Ebsteins anomoly
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30
Q

Variable first heart sound cause?

A 
AF
heart block (complete)
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31
Q

What causes the first heart sound?

A

closure of mitral and tricuspid valve

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32
Q

What causes the second heart sound?

A

closure of the aortic and pulmonary valves

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33
Q

Loud second heart sound cause?

A

Hypertension
Tachycardia
ASD

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34
Q

Soft or absent second heart sound cause?

A

Severe aortic stenosis

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35
Q

Fixed splitting of the second heart sound cause?

A

ASD

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36
Q

Widely split second heart sound cause?

A

RBBB
Pulmonory stenosis
Deep inspiration
Mitral regurge

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37
Q

Single S2 sound cause?

A

Pulmonary stenosis/aortic stenosis
hypertension
elderly
ToF

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38
Q

Reversed split S2 cause?

A

LBBB
Right ventricular pacing
PDA
AS

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39
Q

Third heart sound cause?

A

audible in children - pathalogical in rapid left ventricular filling - eg mitral regurge

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40
Q

Fourth hearth sound cause?

A

LVH

amyloid

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41
Q

causes of valvular clicks?

A

AS
bicuspid aortic valve
valve replacement

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42
Q

causes of opening snap?

A

Mitral stenosis

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43
Q

ECG tall R waves in V1

A

QRS is usually negative in V1
caused by right ventricular hypertrophy
RBBB
posterior infarction

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44
Q

Causes of LBBB

A

ischemia
hypertension
aortic valve disease

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45
Q

Causes of RBBB

A

Normal variant in young
PE
ASD
Ischemic heart disease

46
Q

Causes of St elevation

A

early repolarisation
Acute MI
pericarditis
coronary artery spasm

47
Q

ECG changes in ischaemia? (other than ST-e)

A

St depression

t inversion and peaking

48
Q

ECG changes on Digoxin?

A

downsloping

st depression

49
Q

ECG changes in hypertrophy?

A

St depression

T inversion

50
Q

ecg changes in hyperventilation?

A

ST depression

T inversion and peaking

51
Q

ecg changes in oesophogeal irritation

A

ST depression

T inversion

52
Q

ECG changes in mitral valve prolapse?

A

T wave inversion

53
Q

ecg chnages in strokes?

A

St depression

T wave inversion

54
Q

ECG changes in hyperkalemia

A

Tall T waves
Prolonger PR interval
Absent P waves

55
Q

ECG changes in severe hyperkalemia

A

Wide QRS
sine wave pattern
VT

56
Q

ECG changes in hypokalemia

A

Flat T waves/inverted T waves
Prolonged PR interval
St depression
U waves

57
Q

Mid- late systolic murmur cause?

A 
innocent?
AS
Coarctation
HCM
ASD
Mitral valve prolapse
58
Q

mid-diastolic murmurs cause?

A

Mitral stenosis - austin flint murmur
Rhematic fever
mitral/tricuspid regurge
Atrial tumour

59
Q

Symptoms of severe Mitral Stenosis?

A

Dyspneoa
heamoptysis
dysphagia due to left atrial enlargement
palpitations

60
Q

CXR findings of Mitral Stenosis?

A

Left atrial or right ventricular enlargement

splaying of the subcarinal angle >90 degrees

61
Q

Signs of mitral stenosis

A

low pulse pressure
soft first heart sound
Long diastolic murmur

62
Q

Causes of mitral regurge?

A 
Ventricular dilatation
Mitral valve prolapse
ischaemic papillary rupture
collagen disorders
endocarditis
63
Q

indicators of severe Mitral regurge?

A 
small volume pulse
LV enlargement
S3 sound
AF
Cardiac failure
64
Q

Conditions associated with Mitral valve prolapse?

A 
Coronary artery disease
polycystic kidney disease
HCM
PDA
Marfans
SLE
65
Q

Causes of aortic regurge?

A 
infective endocarditis
RA/SLE
Syphillis/ankspond
Aortic dissection
hypertension
Collagen disorders
66
Q

Causes of Aortic Stenosis

A

congenital bicuspid valve
calcification in elderly
HCM
IHD

67
Q

LVOT velocity of 1?

A

Normal

68
Q

LVOT velocity of 0.25?

A

Severe

69
Q

Indicators of severe AS

A

syncope
LV failure
Valve area greater than 0.5cm on echo

70
Q

Causes of Tricuspid regurge

A

functional due to right ventricular dilatation - ie with MR
Infection - ie venous cannula
Carcinoid
Ebstein’s anomoly - pt have cynanosis and commonly ASD

71
Q

Types of valve replacement?

A

Mechanical - ball and cage, single tilling disc, bileaflet

Tissue - allograft - porcine. Or cadaveric homograft.

72
Q

Infection of prosthetic valve features?

A 
High mortality rate - 60%
Within six months of implant
usually staph epidermis
septal abcess 
heamolysis - increased urobilligin
73
Q

Signs of infective endocarditis

A 
Fever
arthropathy
splinter haemorrhages and painful oslers nodes
hepatosplenomegaly
stroke/digital ischaemia
vasculitis rash

(ONLY TEN PERCENT are IVDU - 40% no previous valve disease)

74
Q

Re-entry tachy

A

usually anatomical

75
Q

atomaticity in tachy

A

secondary arrythmia due to electrolyte imbalance or sepsis

76
Q

triggered activity in tachy

A

Seen in both primary and drug toxicity

77
Q

SVT two main groups?

A

AV nodal re-entry tachycardia

AV reentry tachycardia - accessory pathway between atria and ventricles at distance from AV node.

78
Q

AF - to anticoagulate or not?

A

Chadsvasc score

hasbled score

79
Q

Hs and Ts

A

hypoxia
hypovolemia
hypo/er kalemia
hypothermia

Tensioning PTX
Tamponade
Toxins
Thrombus

80
Q

Angina variants?

A

Decubitus - on lying down - dreaming
Prinzmetals’ - unpredictable and at rest due to coronary artery spasm
Syndrome X - very small vessel diseases - normal coronary arteries on testing but positive exercise test

81
Q

other causes of troponin rises other than MI

A 
sepsis
hypotension
pre-eclampsia
IECOPD
AAA
chemo
82
Q

Absolute contraindication to thrombolysis

A 
active internal bleeding
aortic dissection suspected
head truma in last two weeks
intracranial cancer
heamoraggic stroke <2/12
pregnancy
83
Q

Relative contraindications to thrombolysis

A 
CPR
bleeding disorders
recent surgery
active diabetic heamorage
intracardiac thrombus
INR > 1.8
84
Q

Length of time on ticagralor after MI and study

A

1 year

PLATO study

85
Q

Length of time on beta blockers post MI and study

A

life

ISIS

86
Q

Length of time on ACEi after MI

A

life

SAVE study

87
Q

length of time on aldosterone antaganoists post mi

A

life

ephesus study

88
Q

common aldoserone antagonists

A

spironolactone

Epleronone

89
Q

Length of time on statin after MI

A

life

MIRACL study

90
Q

Cant drive after TLOC ?

A

6/12 after last episode - NB: vasovegal while erect does not preclude driving

91
Q

Cant drive after PCI?

A

1 week

92
Q

Cant drive after MI?

A

1 month

93
Q

HF-PEF?

A

Diastolic heart failure - preserved ejection fraction

pt is breathless but no signs of fluid overload

94
Q

classification of heart failure

A

new york heart association

95
Q

NYHA Class 1 heart failure

A

asytomatic - 5% mortality at one year

96
Q

NYHA Class 2 heart failure

A

slight limitation of DAL - 15% oym

97
Q

NYHA Class 3 HF

A

marked limitation of DAL - 30% oym

98
Q

NYHA Class 4 HF

A

dyspneoa at rest - 50-60 one year mortality rate

99
Q

heart failure echo?

A

EF <40%

5 year survival at 40% is 60% compared with 95% in EF>50%.

100
Q

DCM?

A

Dilated cardiomyopathy

101
Q

Causes of DCM

A 
Etoh
hypertension
auto immune
thiamine deficiancy
HIV
Drugs
sarcoidosis
AF/tachy states uncontrolled
Diabetes
102
Q

Restrictive cardiomyopathy

A

symptoms similar to pericarditis due to rigid ventricles

103
Q

Causes of restrictive cardiomyopathy

A

scleroderma
amyloid/sarcoid/heamochromatosis
malignancy
radiotherapy

104
Q

Myocarditis signs?

A 
young patient
acute hx
viral prodrome
neutrophilia
ECG changes 
elevated troponin

HIGH MORBIDITY AND MORTALITY

105
Q

Common cause of acute paroxysmal AF in young patient?

A

Etoh

if not totally abstaining 50% will die within 5 years

106
Q

Constrictive pericarditis? signs/causes

A

similar to restrictive myocarditis but also bright pericardium on echo/soft heart sounds/pulsus paradoxus rarely - diastolic knock.

Caused by 
TB
radiotherapy
post viral or bacterial pericarditis
trauma
connective tissue disease
107
Q

Signs of pericardial effusion?

A

pulsus alternans or paradoxus

electrical alternans on ecg

108
Q

signs/symptoms of restrictive cardiomyopathy /constrictive pericarditis?

A

Raised JVP
AF
non pulsatile hepatomegaly

109
Q

Hypertension - single episode - greater than 190/x or y/110 ?

A

Treat

110
Q

BP 140-159/90-99 - multiple episodes - no comorbidities -

A

annual assessment

111
Q

First line treatment for hypertension aged >55 or BLack

A

Calcium blocker or thiazide

112
Q

First line treatment for hypertension aged <55

A

ACEi or ARB

MRCP (7 decks)

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