Cardiology

Question 1

CHA2DS2VASC score?

Answer 1

Question 2

Indications for cardiac resynchronisation therapy?

Answer 2

HFrEF (LVEF <35%)
Sinus rhythm
QRS ≥150ms (LBBB)

Question 3

Indications for ICD?

Answer 3

HFrEF associated with IHD
LVEF ≤35%

May be considered as primary prevention in patients with HHFrEF dilated CM
LVEF ≤35%

Question 4

Predictors for SCD with hypertrophic cardiomyopathy?

Answer 4

Age <30 years
Resuscitated cardiac arrest
Early symptom onset
Family history SCD
Septal hypertrophy >30mm
Outflow obstruction
LA diameter
Non-sustained VT
Syncope
Exertional hypotension/ischaemia
MRI-LGE

Question 5

Who should be investigated for cardiac amyloid?

Answer 5

Heart failure +
Wall thickness >12mm +
Age >65 OR red flags

Red flags:
Polyneuropathy (TTR/AL)
Dysautonomia (TTR/AL)
Skin bruising (AL)
Macroglossia (AL)
Deafness
Bilateral carpal tunnel
Ruptured biceps tendon
Lumbar spinal stenosis
Vitreous deposits
FHx
Renal insufficiency/proteinuria (AL)

Question 6

Examples of p-glycoprotein inhibitors that reduce DOAC metabolism?

Answer 6

Clarithromycin
Ritonavir
Verapamil

Therefore leads to increased DOAC levels

Question 7

Examples of p-glycoprotein inducers that increase DOAC metabolism?

Answer 7

Phenytoin
Rifampicin
St John’s Wort

Therefore leads to decreased DOAC levels

Question 8

Examples of strong CYP3A4 inhibitors leading to increased DOAC levels

Answer 8

Clarithromycin
Ritonavir

Question 9

Examples of strong CYP3A4 inducers leading to lower DOAC levels

Answer 9

Carbamazepine
Phenytoin
Rifampicin

Question 10

When to consider ablation for AF?

Answer 10

Young patients (<75)
Limiting symptoms despite trial of anti-arrhythmics
Success rate 60-70%

Question 11

Diagnostic criteria for Takotsubo CM?

Answer 11

All 4 required (Mayo Clinic diagnostic criteria):
1. Transient LV dysfunction (hypokinesis, akinesis, dyskinesis)
2. Absence of obstructive coronary disease/angiographic evidence of acute plaque rupture
> If found, can still be made if wall motion abnormalities not in distribution of coronary disease
3. New ECG abnormalities/modest elevation in troponin
4. Absence of phaeochromocytoma/myocarditis

Question 12

Takotsubo - demographics?

Answer 12

Post menopausal women

Question 13

Conditions with late gadolinium enhancement on cardiac MR?

Answer 13

Myocarditis
MI

(NOT Takotsubo - absence of this)

Question 14

Mechanism of action - ticagrelor?

Answer 14

Reversibly and noncompetitively binds the adenosine diphosphate (ADP) P2Y12 receptor on the platelet surface which prevents ADP-mediated activation of the GPIIb/IIIa receptor complex thereby reducing platelet aggregation. Due to the reversible antagonism of the P2Y12 receptor, recovery of platelet function is likely to depend on serum concentrations of ticagrelor and its active metabolite.