Cardio Flashcards
(176 cards)
1
Q
cardiac Markers?
A
myoglobin»_space; earliest
troponin I»_space; most specific
CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days
2
Q
Fondaparinux mechanism of action?
A
Antithrombin lll activation
Similar to LMWH
3
Q
Driving for Group 2 in heart failure?
A
If LVEF<40% cant drive, even if asymptomatic with treatment.
4
Q
CHD that cause Eisenmenger?
A
VSD
ASD
PDA
5
Q
Hypertension in DM!
A
ACEi/ARBs first line
6
Q
Causes of prolonged PR?
A
Idiopathic
IHD
Digoxin
Hypokalemia
RF
Aortic root pathology
Lyme disease
Sarcoidosis
7
Q
Hypocalemia in ECG?
A
Prolonged QT
Vs hypokalemia» prolonged PR
8
Q
Normal corrected QT interval?
A
<430 ms in males
<450 ms in females
9
Q
Most common underlying mechanism causing prolongation of QT segment?
A
Loss of function/ blockage of k+ channels
10
Q
Pathophysiology of LQTS?
A
Defect in alpha subunit of the slow delayed rectifier potassium channel.
11
Q
Anti-thrombotic for prosthetic heart valves?
A
Bioprosthetic»_space; Aspirin
Mechanical»_space; warfarin + aspirin
12
Q
Left axis deviation?
A
Left anterior hemiblock
LBBB
Inferior MI
Hyperkalemia
WPW
CHD (ostium primum ASD/ Tricusped Atresia)
Obesity
13
Q
Management of HFrEF?
A
Beta blocker + ACEi
BB for HF (bisoprolol/nebivolol/carvedilol)
14
Q
HFrEF , LVEF<35%
Given BB and ACEi
Still asymptomatic, next step?
A
Sacubitril+valsartan
15
Q
Ebstein’s anomaly?
A
Rf: mother taking lithium
Atrialization of Rt ventricule > TR
Associated with wpw and RBBB
16
Q
What reduces and what enhances effect of adenosine?
A
Reduced by Theophylline
Enhanced by Dipyridamole
17
Q
Beta blockers and verapamil together?
A
Not taken together» risk of bradycardia, heart block and arrest.
18
Q
CCBs?
A
DHP» Amlodipine/Nifedipine»_space; Dilator
Non-DHP» diltiazim/verapamil» Reduce HR
19
Q
First line for angina pectoris?
A
BB or CCB
If CCB monotherapy»_space; rate limiting NonDHP (verapamil/diltiazim)
If with BB»_space; DHP (amlodipine/nifedipine)
** never BB with verapamil = Heart block**
20
Q
Common side effect of ticagrelor?
A
Dyspnea (inhibits adenosine deaminase so increase adenosine levels)
21
Q
Drug that makes clopidogrel less effective?
A
Omeprazol
22
Q
Dentistry in warfarinised patients?
A
check INR 72 hours before procedure, proceed if INR < 4.0
23
Q
ICD DVLA rules?
A
For Group 2> permanent bar
For group 1:
6 months if for sustained V tach
1 month if prophylactic
24
Q
Hypercalcemia main ECG finding?
A
Short QT interval
25
MS intervention of choice?
Percutaneous commissurotomy
26
Cholesterol embolization?
Thromboembolic renal disease.
Reduced renal function + livedo reticularis (purpuric rash on the feet) +- eisoniphilia
27
Commonest causes of AS?
<65: bicusped aortic valve
>65: degenerative calcification
28
29
Mx of AS?
No symptoms >> regular review
Symptomatic >> surgery
Gradient > 40 consider surgery
In young with low operative risk: Surgical AVR
In high operative risk: TAVR
30
Cough in ACEI due to?
Increased bradykinin
31
CCB for bp control in Heart failurue?
Nifedipine avoided
Amlodipine is the only CCB licensed in HF
32
Defective ptn in HOCM?
B myosin heavy chain
Myosin binding protein C
33
IE in patients with poor dental hygiene?
Strept Sanguinis
34
Anticoagulation in AF with Mitral valve disease?
Always regardless of CHADsVaSc
35
Old ptn has colorectal cancer and receives chemo. What organism causes IE?
Streptococcus gallolyticus
36
How to diff Ostium primum from secundum?
on ECG:
Primum>> Lt axis deviation
Secundum>> Rt axis deviation
37
MOC of Bivalirudin?
Direct thrombin inhibitor. Given IV
Vs
Dabigatran. Given orally
38
Statins and elevated liver enzymes?
Continue statins if ALT is raised but less than 3 times the upper limit.
39
Gallop S3?
Early sign of LVF
40
Takayasu’s arteritis?
Large vessel vasculitis affects the aorta and leads to absent limb pulses.
41
Takayasu’s arteritis?
Large vessel vasculitis affects the aorta and leads to absent limb pulses.
42
Amiodarone MOA?
Block voltage gates K channels
43
DVLA advice following angioplasty?
Stop driving for 1 week
44
IE with strept gallolyticus?
Do Colonoscopy
45
Furosemide MOA?
Inhibition ot Na/K/Cl co transported in the thick ascending limb of the loop of Henle
46
PCI thrombosis RF?
PCI restenosis RF?
Premature withdrawal of anti platelets
DM
47
Persistent AF?
>7 days, <12 months, terminated by cardioversion.
Vs proxysmal AF, can self terminate
48
Indications of temporary pacemaker?
- Symptomatic or HD unstable bradycardia, not responding to atropine.
- Post-anterior MI with Mobitz ll or CHB
- trifascicular block prior to surgery
49
Prominent V wave?
TR
50
INR >8 on warfarin and no bleeding?
Oral vit K 5mg + stop warfarin + repeat after 24hrs
Restart when INR<5
51
Falsely elevated BNP?
COPD
52
Falsely low BNP?
Obesity
53
ASD murmur?
Ejection systolic increase on inspiration
54
Anti thrombotic with prosthetic valves?
Mechanical valve: warfarin+aspirin
Bio prosthetic valve: aspirin
55
How to reduce the risk of developing preeclampsia again?
Low dose aspirin
56
How to differentiate cardiac tamponade form constructive pericarditis?
No Y descent on JVP
57
CI in VT?
Verapamil
58
Causes of reversed/paradoxical S2 split?
LBBB
Severe AS
Rt ventricular pacing
WPW type B
PDA
59
Defect in Brugada Syndrome?
Mutation in SCN5A gene which encodes the myocardial sodium ion channel protein
60
ECG changes in Brugada?
Convex ST elevation > 2 mm in > 1 of V1-V3 followed by a negative T wave
Partial RBBB
Changes more prominent after fecainide or ajmaline
61
MOA nicroandil?
K channel activator
62
Factors related to poor prognosis of IE?
Staph aureus
Low complement levels
Culture negative endocarditis
Prosthetic valve endocarditis
63
PCWP measure pressure in which chamber of the heart?
Left atrium
64
Most specific ECG finding in acute pericarditis?
PR depression
65
ICD indications?
Long QT syndrome
HOCM
Brugada
Previous arrest due to VT/VF
Previous MI with non-sustained VT on 24hrs monitoring
66
MOA clopidogrel?
Inhibits ADP binding to its platelets receptors.
67
First line for prinzmetal angina?
Dihydropyridine CCB >> Felodipine
68
Target INR for mechanical valves?
Aortic: 3
Mitral 3.5
69
LVOT obstruction murmur?
Harsh mid-diastolic murmur at the left sternal border
Increase with valsalva or standing
70
Dipyridamole MOA?
Non specific Phosphodiesterase inhibitor
71
Endocarditis of the aortic valve, most imp ECG changes to monitor?
Aortic root abscess>> prolonged PR interval
72
What does troponin T binds to?
Tropomyosin
73
Anticoagulation after electrical cardioversion?
At least four weeks after the procedure
74
Electrical cardioversion is synchronized to which wave?
R wave
75
S3 causes?
Diastolic filling of ventricles in:
LVF (dilated cardiomyopathy)
Constrictive pericarditis
Mitral regurgitation
76
S4 causes?
Forceful Atrial contraction:
AS
HTN
HOCM (palpable S4>> double apical impulse)
77
Sotalol?
Torasde de pointes, long QT syndrome
Defect in the alpha subunit of the slow delayed rectifier K channel.
78
Stable angina management?
All patients: Statins and Aspirin
1st line:
Monotherapy with BB or CCB
No response?
Increase to Maximum tolerated dose (atenolol 100)
Still symptomatic?
Add the 2nd drug
NB: never BB with Verapamil
79
IE poor dental hygiene?
Viridans streptococci=
Strept sanguinis / Strept Mitis
80
Management of NSTEMI?
Acc to mortality assessment (GRACE score)
If >3%: glycoprotein inhibitor started prior to angiography within 96 hours
Gpllb/llla inhibitors:
- Tirofiban
- Abciximab
- Eptifibatide
81
82
Hypokalemia ECG changes?
U waves (hypUkalemia)
Prolonged PR
Long QT
Flat or inverted T
ST depression
83
Statins monitoring?
LFTs baseline, 3 months and 12 months
Discontinued if AST > 3 times upper limit
84
Optimum management of STEMI?
Dual anti platelet
IV heparin
Immediate PCI
85
BNP actions?
Diuretic/natriuretic
Vasodilator >> decrease afterload
Suppress sympathetic and RAAS
86
Main ECG finding in hypercalcemia?
Short QT
87
MOA dipyridamole?
Non-specific phosphodiesterase inhibitor> decrease cellular uptake of adenosine
88
MOA hydralazine?
Increases cGMP>> smooth muscle relaxation more in arterioles
89
Patient on warfarin undergoing emergency surgery?
If can wait 6-8 hours >> 5mg IV vitamin K
If cant wait >> 25-50 unit/kg four-factor prothrombin complex
90
Prosthetic valve endocarditis?
Staph aureus
Staph epidermidis if <2 months post valve surgery
91
Ivabradin side effect?
Visual disturbances including phosphenes and green luminescence.
92
Amiodarone regimen >> proplonged loading period to achieve therapeutic levels. Why?
Has a very long half life.
Highly lipophilic and widely absorbed in tissue this reduces bioavailability in serum.
93
Cholesterol emboli?
Livedo reticularis
Esinophilia
Purpura
Renal failure
94
Ticagrelor/Clopidogrel MOA?
Inhibits ADP binding to platelets
95
Radiotracer for PET scan?
FDG (fluorodeoxyglucose)
96
Thiazide MOA?
Blocks Na/Cl symporter in the proximal part of DCT
97
Wellen’s syndrome?
Proximal LAD coronary artery stenosis.
Symmetrical, deep T wave inversion in the anterior leads (v1-v6)
98
HFrEF treatment?
BB and ACEi and Spironolactone (first line)
99
Holiday heart syndrome?
Supravent arrhythmias (like af) 2ry to acute alcohol intake
No treatment needed
100
SVT prophylaxis is pregnancy?
Metoprolol
101
MgSO4 monitoring?
Reflexes and RR
102
Severe MS intervention of choice?
Percutaneous mitral commissurotomy
103
Strongest marker for poor prognosis of HOCM?
Septal wall thickness of > 3 cm
104
Cardiac syndrome X?
Angina like chest pain without significant occlusion or stenosis on angio
With ECG changes of ischemia of exercise>> downsloping ST depression
105
Dipyridamole MOA?
Inhibits phosphodiesterase
And adenoisine deaminase> increase effect of adenosine
106
Naftidrofuryl for PAD MOA?
5-HT2 antagonist
107
Blind therapy for native valve endocarditis?
Amoxicillin+ Low-dose Gentamycin
108
Positive vasodilator test in PAH?
Reduction in mPAP> 10
Absolute value< 40
109
Early and specific sign of LVF?
S3 gallop
110
PDA mx?
Ibuprofen, endomethacin, paracetamol
Inhibit PGs
To infant not the mother
111
Bleeding on dabigatran?
Idarucizumab
112
Why do we give loading dose in Amiodarone?
It has long half life
113
Giant V wave in?
Tricuspid Regurgitation
114
Recommended dose of adrenaline in ALS?
1 mg
115
Not a normal variant in ECG?
LBBB always pathological
116
ECG Normal variants in athletes
Brady
1st degree block
Mobitz 1
Junctional rhythm
117
Angina Mx?
BB or CCB
118
Factors that potentiate warfarin?
Liver disease
Enzyme inhibitors: amiodarone/ ciprofloxacin/ cranberry juice
NSAID
119
ICD DVLA advice?
Group 2>> permanent bar
Group 1>> 6 months if for sustained VT/ 1 month if prophylactic
120
DVLA after permanent pacemaker?
Not drive for 1 week
121
Ticagrelor/Clopidogrel MoA?
P2Y12 receptor antagonist.
Inhibit ADP binding to platelet receptors.
122
VT JVP waveform?
Cannon A
123
Strongest indication for thrombolysis in PE?
Hypotension
Massive PE + Hypotension = thrombolyse
124
VT JVP waveform?
Cannon A
125
Thiazide note:
Inhibit Na reabsorption in the proximal part of DCT
Increases Na delivery to the distal part of DCT >> exchanged for K >> hypokalemia
126
AF pharmacological cardioversion?
Amiodarone + flecainide
127
Hypothetmia ECG finding?
J wave
Brady
1st degree heart block
Long QT
Arrhythmias
128
How to permanently restore sinus rhythm in atrial flutter?
Radio frequency ablation of the tricuspid valve isthmus.
129
Absolute indication to terminate exercise tolerance test?
Blood pressure drop
130
Least associated with wpw?
Coarctation of aorta
131
Warfarin target INR after DVT?
2.5
If recurrent >> 3.5
132
Initial physiological response to valsalva?
Reduce Venous Return
133
Duration of DOAC in PE?
3 months if provoked
6 months if unprovoked
134
IE over prosthetic valves caused by?
Epidermidis if <2 months post valve surgery
Aureus if more
135
CI in VT?
Verapamil
136
Most accurate way to determine left ventricular function?
MUGA scan >> nuclear angio
137
Electerical cardioversion given at which wave?
R wave
138
False negative BNP?
Obesity
139
ECG in ARVC?
ECG abnormalities in V1-3 typically T wave inversion.
Epsilon wave in 50% of cases>> terminal notch in the QRS complex.
140
WPW mx?
Avoid ABCD (adenosine/BB/CCB/Digoxin)
SAFe to give:
Sotalol unless Afib/ Amiodarone/ Flecainide
141
Ticagrelor and clopidogrel binding to P2Y12 ADP receptors:
Reversible
142
ECH changes in hypokalemia?
U waves/ T inversion/ ST depression
Long QT long PR
143
Asymmetrical dosing regimes for?
Isosorbid mononitrate
Nitrate free time for 10-14 hrs
144
Broad QRS is more than?
120 ms
145
Strongest predictor of sudden death risk in HOCM is?
Abnormal bp changes on exercise
146
In LBBB, whats the auscultatory finding?
Reversed split
147
Angioedema with ACE inhibitors?
Rare complication
Can occur at anytime during ttt
148
Not a RF for statin induced myopathy?
Large fall in LDL cholesterol
149
Most important investigation for PH?
Cardiac catheterization
150
Does not occur during exercise?
Increase in diastolic Bp
151
VTE target INR if recurrent?
3.5
152
Inv of choice in PE with renal impairment?
V/Q scan
153
Hypertensive not controlled on ACEi, CCB and thiazide. k>4.5?
Alpha or beta blocker
154
ECG of digoxin use?
ST depression
Inverted or flat T
Short QT
Arrhythmias > AV block/ Bradycardia
155
Normal LVEF ?
55-70%
156
Most likely predictor of poor prognosis after acute MI?
Reduced ejection fraction
157
Associations with aortic dissection?
HTN
Trauma
Bicuspid valve
Marfan
Ehlar danlos
Turner’s
Noonan’s
Syphilis
Pregnancy
158
DVLA advice post MI?
Not drive for 4 weeks
159
Catecholaminergic polymorphic ventricular tachycardia (CPVT)?
AD
Defect in RYR2 (Ryanodine Receptor) found in myocardial sarcoplasmic reticulum
Sudden death
Symptoms before 20
MX >> BB/ ICD
160
after excluding hemorrhage TIA + AF =>
Start anticoagulation immediately
161
After excluding hemorrhage; stroke + AF =>
Aspirin x 2 weeks
Followed by anticoagulation
162
Post MI heart failure and left ventricular systolic dysfunction
Treatment with aldosterone antagonist
Preferably after ACEi
163
Inhibits transmembrane cotransporter protein?
Furosemide & bumetanide (loop diuretics)
164
Management of aortic dissection?
Type A ascending aorta>> IV labetalol+surgery
Type B descending aorta>> IV labetalol
165
Witnessed cardiac arrest while on monitor?
3 successive shocks before CPR
166
Side effect of Nicorandil?
Ulceration anywhere in GIT
167
Complete heart block following MI, which artery?
Right coronary
168
Eruptive xanthoma is associated with?
Familial hypertriglyceridemia
169
MOA:
• abciximab
• eptifibatide
• tirofiban
Glycoprotein llb/llla antagonist
170
Takotsubo cardiomyopathy?
ST elevation without coronary obstruction
Broken heart syndrome
Apical ballooning of left ventricle (octopus pot)
171
Centrally acting anti hypertensives?
• methyldopa: used in the management of hypertension during pregnancy
• moxonidine: used in the management of essential hypertension when conventional antihypertensives have failed to control blood pressure
• clonidine: the antihypertensive effect is mediated through stimulating alpha-2 adrenoceptors in the vasomotor centre
172
New onset AF within 48 hours of presentation?
DC cardioversion
173
MOA of Sacubitril-Valsartan?
Prevents the degradation of natriuretic peptides such as BNP and ANP
174
Indications of surgery in infective endocarditis?
Infective endocarditis - indications for surgery:
• severe valvular incompetence
• aortic abscess (often indicated by a lengthening PR interval)
• infections resistant to antibiotics/fungal infections
• cardiac failure refractory to standard medical treatment
• recurrent emboli after antibiotic therapy
175
Dilated cardiomyopathy caused by deficiency of ?
Selenium >>keshan Disease
176
Avoided in Rt Ventricular MI?
Nitrates>> reduces preload>> deterioration
