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RACP 2022 Written > cardiology > Flashcards

cardiology Flashcards

1
Q

ECG features of trifascicular block?

A

1st degree heart block
AND
RBBB
AND
LAFB or LPFB

LAFB: qR complex leads 1 and AVL, RS complex II, III, aVF, LAD

LPFB: rS complex leads 1 and AVL, qR complex leads II, III, aVF, RAD. NO RVH.

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2
Q

Indications for ICD in ischemic HFrEF as primary prevention

A
  • LVEF ≤35% + NYHA II or III
  • LVEF ≤30% + NYHA I*
  • LVEF ≤40% + non-sustained VT assoc. with previous MI + inducible sustained VT/VF on EP*

Can be beneficial if syncopal episodes occurring suspected to be due to ventricular arrythmia

*Must be post acute phase of MI i.e. 40 days post MI AND >3/12 post revascularization + medical therapy

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3
Q

Indications for ICD in ischemic HFrEF as secondart prevention

A

Sustained VT/VF after reversible causes excl;uded (i.e. AMI, electrolyte disturbances, medication effects)

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4
Q

Lipid profile seen with diabetes and CKD

A

High triglycerides and LDL, low HDL

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5
Q

Lipid profile seen with alcohol excess

A

Isolated hypertriglyceridemia

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6
Q

Lipid profile seen with hypothyroidism

A

predominantly high LDL, sometimes high triglycerides

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7
Q

Rates of stroke post coronary angiography? Associated 30 day mortality?

A

1 in 100
30 day mortality = 20%

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8
Q

Normal ECG variants in young athletes?

A

RBBB
Wenchebach phenomena (2nd degree heart block, mobitz 1 i.e. progressive PR prolongation)
Dominant R wave in V1
LVH
Bradycardia
Junctional rhythm
1st degree heart block

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9
Q

Which antihypertensive should be avoided in aortic dissection?

A

Hydralazine

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10
Q

Mechanism of action/class of amiodarone

Which other drug is in this class?

A

Class 3 antiarrythmic - potassium channel blocker, acts on phase 3 of AP
Prolongs refractory period of atrial, nodal and ventricular myocardium by prolonging the the action potential
Decreases sinus node automaticity
Decreases rate of impulse conduction through the AV node

Other class 3 antiarrythmic - sotalol

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11
Q

Mehchanism of action/class of verapamil?

A

Class 4 antiarrhythmic acting on phase 2 of AP

Central (non-dihydropyridine) calcium channel blocker -
Prevents calcium from entering voltage sensitive areas of myocardium/vascular SM cells (via slow channels) during depolarization
Slows automatacity and conduction of AV node

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12
Q

Indications for surgery in type B aortic dissection

A

Recurrent chest pain
Persistent severe HTN
Aneurysm expansion
Dissection propogation
Expanding hematoma
Rupture
Occlusion of a major aorta branch leading to end organ ischemia

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13
Q

What is the murmur in acute aortic dissection? Which type of aortic dissection is it seen in?

A

Type A dissection

Decrescendo diastolic murmur, best heard over the right sternal edge and exentuated on expiration (left sided murmur)

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14
Q

What is the most common cause of aortic regurgitation?

A

Rheumatic heart disease (developing world)
Calcified aortic valve, bicuspid aortic valve, aortic root dilation (developed world)

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15
Q

Indications for pace maker

A

Symptomatic Sinus node dysfunction (SND)
Advanced 2nd degree block (Mobitz Type II) or intermittent 3rd degree block
Symptomatic Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
Persistent inappropriate or symptomatic bradycardia not expected to resolve after cardiac transplantation
Sustained pause dependent VT with or without QT prolongation.

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16
Q

What are the effects of carvedilol?

A

Beta-1, Beta-2 and alpha-1 antagonist
Non selective HOWEVER has evidence in HFREF

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17
Q

What are the effects of metoprolol?

A

Selective beta 1 antagonist

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18
Q

What medications should be avoided in torsades?

A

Class IA agents + 1c (moderate + strong Na channel blockers)
- A: quinidine, procainamide, disopyramide),
- C: (eg,flecainide),

Class III agents potassium channel blockers ( eg, sotalol, amiodarone).

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19
Q

Contraindications to stress ECG (name 10)

A

LBBB
Severe HOCM
Severe AS
Recent AMI (3-4 days)
Unstable angina with recent rest pain or increased symptoms.
Untreated life threatening cardiac arrhythmia
Advanced AV block
Uncontrolled systemic HT (>220/120)
Acute systemic illness ie: PE, aortic dissection
Unable to perform test ie: gait disturbance,severe OA.

20
Q

Which enzyme is required to convert clopidogrel to it’s active form?

A

CYP2C19
Higher rates of loss of function seen in chinese populations –> poor metabolizers
Choose prasugrel or ticagrelor isntead

21
Q

Typical echo and MRI findings of cardiac amyloidosis

A

Echo: relative apical sparing of longitudinal strain

MRI: subendocardial late gadolinium enchancement (early); later transmural late gadolinium enhancement

22
Q

Key investigation for diagnosing transthyretin cardiac amyloid (ATTR)

A

Bone scintigraphy

23
Q

Effects of alpha 1 receptors

A

Peripheral vasoconstriction
Increased heart rate

24
Q

Effects of beta 1 receptors

A

Poisitve chonotropy and inotropy

25
Q

Effects of beta 2 receptors

A

Skeletal muscle relaxation
Bronchodilation
Mast cell stabilization

26
Q

ECG findings of dextrocardia

A

R) axis deviation
Positive QRS in aVR
Lead I → inversion of all complexes
Absent R wave progression in chest leads, dominant S waves

27
Q

ECG findings of ASD

A

R) axis deviation
“Incomplete” RBBB due to RVH
RV strain (TWI/ST depression V1-V4)
Characteristic R wave notching in inferior leads II, III, aVF (Crochetage sign)

28
Q

ECG findings digoxin toxicity

A

Increased automaticity with slow ventricular response
I.e. AF with slow VR

Bidirectional VT

29
Q

ECG findings sodium channel blockage

A

Wide QRS
Terminal R wave in AVR
RAD

30
Q

ECG findings posterior infarct

A

V1-V3 changes → INVERTED ANTERIOR STEMI: ST depression (i.e. elevation), tall R waves (i.e. pathologic Q waves), upright T waves

31
Q

Definition of low flow low gradient aortic stenosis

A

mean gradient <40 mmHg
valve area <1 cm2
LVEF <50%
SVi <35 mL/m2

32
Q

What class of drugs are abciximab, tirofiban and eptifibatide?
When can they be use?
When should they not be used?

A

GIIb/GIIIa receptor inhbitors
Can be used in high risk patients pre PCI or for treating thrombotic complications among patients with ACS

Should not be used in combination with thrombolysis

33
Q

3 beta blockers with proven effiacy in HFREF treatment

A

carvedilol, bisoprolol, metoprolol

carvedilol may have greatest survival benefit

34
Q

Indications for emergency reperfusion in STEMI

A

Sx onset within 12hrs REGARDLESS of if sx have resolved at time of presentation
No advanced age, frailty and significant co-morbidities influencing overall survival

Sx onset >12hrs but ongoing chest pain –> should be considered for salvage PCI (fibrinolysis not recommended, bleeding+++ and lower benefit)

35
Q

Metabolic syndrome criteria

A

Low HDL
High triglycerides
HTN
Central obesity
High fasting glucose (>5.6) or T2DM

36
Q

Genes associated with familial hypercholesterolemia

A

LDLR
APOB (previously apoB100)
PCSK9

37
Q

CXR findings of aortic coarctation

A

Notching of the posterior ⅓ of ribs 3-8
Indentation of the aortic wall - produces a “3” sign

38
Q

Brugada syndrome
Heritabilltiy?
Type of defect?
ECG?
Tx?

A

Autosomal dominant
Sodium channel defect
syncope. arrest and SCD
Tx: ICD implantation
ECG: changes in V1-V6
1. prononounced elevation of J point, coved type ST segment, inverted w wave V1/V2
2. Saddle back ST segments >1mm elevated
3. sloping st elevation V1/V2

39
Q

What kind of Murmmer is best heard at the lower left sternal border/apex harsh systolic murmur holosystolic. begins well after first heart sound.

A

Mitral regurgitation
Classic in obstructive HCM.

40
Q

Meds used in HOCM?

A

Beta block
amiodarone
Non-dihydropyridine Ca blocker (eg verapamil)
disopryramide.

ETOH often poorly tolerated.

41
Q

SOB, syncope and mlid fever
Loud first heart sound, a loud third heart sound and a mid diastolic murmur?

A

Atrial myxoma

42
Q

Acute Aortic Regurgitation

A

Diastolic decrescendo murmur (best heard over right sternal border in acute) - in chronic left sternal border in primary chronic aortic valve disease.

43
Q

Mitral stenosis and Aortic regurgitation in Rheumatic fever heart sounds?

A

MS: malar flush, low volume pusle, tapping and undisplaced apex beat and loud S1 with an opening snap. Murmur is rumbling and mid diastolic at apex.
AR: murmer is early diastolic and increases in duration to holodiastolic in severe AR - left sternal border.

44
Q

Murmur loudest with exp and inspiration?

A

lEft sided loudest on Expiration (Aortic/mitral)
rIght sided loudest on Inspiration (PV, TV)

45
Q

Risk of stroke chadS2 Score 0 vs 4?

A

0 = 2%
4 = 8%

46
Q

CHA2DS2-VASc

A

CHF + 1
HTN +1
Age: 65 - 74 +1, >75 +2
Diabetes +1
Stoke/TIA +2
PVD/IHD +1
Female +1

Once you score twice strongly consider anti-coag stroke risk 3%

47
Q

Action of Bivalirudin?

A

Reversible direct thrombin inhibitor.
Others include argatroban and Hirudin

RACP 2022 Written (21 decks)

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