Cardiology Flashcards
(119 cards)
1
Q
What should you monitor when giving MgSO4?
A
Reflexes, respiratory rate
2
Q
What mechanism causes QT prolongation?
A
blockage of potassium channels
3
Q
What drug is best to give in a patient with WPW who is found to be in AF?
A
Flecainide - doesn’t block the AV node
4
Q
What part of the ECG does an S4 sound coincide with
A
P wave
5
Q
What causes an S3 sound
A
Diastolic filling of the ventricle (heard in LVF - e.g. dilated CM, constrictive pericarditis, MR)
6
Q
What is the A wave on JVP
A
Contraction of right atrium
7
Q
What causes the X descent (part 1) on JVP
A
Relaxation of right atrium
8
Q
What causes the C wave on JVP
A
Contraction of right ventricle forcing tricuspid valve upwards into right atrium
9
Q
What causes the X wave (part 2) on JVP
A
Final stage of ventricular contraction causing extra space in the pericardium
10
Q
What causes the V wave on JVP
A
Relaxation of right atrium with a closed tricuspid valve
11
Q
What causes the Y descent in JVP
A
Tricuspid valve opens
12
Q
What causes U waves on ECG
A
Hypokalaemia
13
Q
What causes J waves on ECG
A
Hypothermia
14
Q
What is the MOA of hydralazine
A
increases cGMP leading to smooth muscle relaxation in the arterioles
15
Q
What causes ST elevation >2 weeks post-STEMI with breathlessness but no chest pain
A
left ventricular aneurysm
16
Q
What is the management of type A aortic dissection
A
IV labetolol + surgery
17
Q
What is the management of type B aortic dissection
A
IV labetolol
18
Q
What is the treatment for uraemic pericarditis
A
haemodialysis
19
Q
What is the target INR for a mechanical aortic valve
A
3.0
20
Q
What is the target INR for a mechanical mitral valve
A
3.5
21
Q
Which drug is contraindicated in VT
A
Verapamil
22
Q
What causes an S4 sound
A
Atrial contraction against a stiff ventricle (aortic stenosis, HOCM, hypertension)
23
Q
Where is BNP produced
A
Mainly the LV in response to strain
24
Q
What factors increase BNP levels
A
LVH, ischaemia, tachycardia, RV overload, hypoxaemia, eGFR <60, sepsis, COPD, diabetes, age >70, liver cirrhosis
25
What decreases BNP levels
Obesity, diuretics, ACEis, beta-blockers, ARB blockers, MRAs
26
What is initial blind therapy of IE in a native valve
Amoxicillin
27
What is initial blind therapy of IE in a native valve if penicillin allergic
Vancomycin + gentamicin
28
What is initial blind therapy of IE in a prosthetic valve
Vancomycin + rifampicin + gentamycin
29
What is the treatment of IE caused by fully sensitive streptococci
Benzylpenicillin
30
What gene is mutated in Brugada syndrome
SCN5A
31
What abnormality causes a bisferiens pulse
Mixed aortic valve disease
32
Which abnormality causes a jerky pulse
HOCM
33
How long should you anti-coagulate a patient following electrical cardioversion
At least 4 weeks
34
What drug should not be used in asthmatics presenting with SVT
Adenosine (use verapamil or flecainide instead)
35
What is kussmaul’s sign in constrictive pericarditis
Rise in JVP on inspiration
36
What are the 5 causes of restrictive cardiomyopathy
Amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Loffler’s syndrome
37
Which defect causes an ESM louder on inspiration
ASD
38
Which syndrome describes microcytic anaemia secondary to calcified AS
Heyde’s syndrome
39
What is the most specific finding of pericarditis on ECG
PR depression
40
What is the MOA of ivabradine
Reduces HR by acting on the funny current in the SA node
41
What is the treatment of Prinzmetal angina
Dihydropyridine CCB e.g. felodipine
42
What causes esoinophilia after arterial manipulation
Cholesterol embolisation
43
What is the most common side of atrial myxoma
Left atrium
44
Which deficiency leads to congenital adrenal hyperplasia and secondary hypertension
11-beta hydroxylase deficiency
45
What test is performed to aid management of pulmonary hypertension
Acute vasodilator testing
46
Where does furosemide act
Thick ascending loop of henle
47
What condition is associated with Aschoff bodies
Rheumatic fever
48
What does troponin C bind to
Calcium ions
49
What does troponin T bind to
Tropomyosin
50
What does troponin I bind to
Actin
51
What % of people have SA nodes supplied by the RCA
60%
52
Where does the coronary sinus drain into
Right atrium
53
Where does the circumflex artery branch from
LCA
54
Name 3 GPIIB/IIIa inhibitors
Eptifibatide, tirofiban, abciximab
55
Which condition will have a normal angiogram but ECG changes on stress testing due to microvascular angina
Cardiac syndrome X
56
What aortic gradient would surgery be considered at
>40
57
What inhibits endothelin production
NO, prostaglandin
58
What promotes endothelin release
Angiotensin II, ADH, hypoxia, mechanical shearing forces
59
When should patients with T1DM be started on a statin
Diagnosed over 10 years ago or age >40 or established neuropathy
60
What is the mechanism of LQTS
defects in slow delayed rectifier potassium channel
61
Which drugs cause long QT syndrome
Amiodarone, sotalol, TCAs, SSRIs, methadone, chloroquine, terfenadine, erythromycin, haloperidol, ondansetron
62
What would indicate cardiac tamponade over constrictive pericarditis
No Y descent on JVP
63
What are the most common causes of viral myocarditis
Parvovirus B-19 and HHV6
64
What are the causes of aortic root disease that result in AR
Hypertension, Syphillis, Marfan’s, EDS, Aortic dissection, Ankylosing Spondylitis
65
What causes a loud S2 sound
Hypertension
66
What causes a reversed split S2 sound
LBBB, severe AS
67
What causes a widely split S2 sound
RBBB, deep inspiration
68
What causes a soft S2 sound
Aortic stenosis
69
What congenital heart defect is associated with WPW syndrome
Ebstein’s abnormality
70
What are the clinical features of Ebstein’s abnormality
Low insertion of TV - cyanosis, prominent ‘a’ waves, hepatomegaly, TR, RBBB
71
What is 1st line treatment of idiopathic pulmonary hypertension with negative response to acute vasodilator testing
Endothelin receptor antagonist, prostacyclin analogues, phosphodiesterase inhibitors
72
When is indomethacin given to treat PDA
Given to newborn if echo shows PDA one week after delivery
73
When is staphylococcus epidermidis the most common organism in IE
<2 months post valve surgery
74
Which organisms cause IE associated with poor dental hygiene
Strep viridans (mitis and sanguinis)
75
Which organism causes IE associated with colorectal cancer
Strep bovis (gallolyticus)
76
What are the culture negative causes of IE
prior ABx therapy, coxiella, bartonella, brucella, HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
77
Which drugs are direct thrombin inhibitors
Bivalirudin, dabigatran
78
What is the MOA of fondaparinux
Activates antithrombin III
79
What is the treatment of prosthetic valve IE caused by staph aureus
Flucloxacillin + rifampicin + low-dose gentamycin
80
What ECG changes are seen in hypokalaemia
U waves, small/absent T waves, prolonged PR interval, ST depression, long QT
81
What happens to BP in normal pregnancy
Falls in the first trimester until 20-24 weeks, then increases back to pre-pregnancy levels by term
82
What drugs are centrally acting antihypertensives
Methyldopa, monoxidine, clonidine
83
What is the MOA of sodium nitroprusside
Potent short acting vasodilator that increases cGMP
84
What is maternal lithium use during pregnancy associated with
Ebstein’s abnormality
85
Which drugs affect the effect of adenosine
Dipyramidole - enhances effect, aminophylline - reduces effect
86
What are the indications for urgent valvular replacement in IE
Severe heart failure, overwhelming sepsis despite ABx, recurrent embolic episodes, pregnancy
87
What are the RFs for myopathy in statin treatment
Age, female, low BMI, multisystem disease
88
What causes irregular cannon ‘a’ waves
Ventricular tachycardia, AVNRT
89
What is the mechanism of VSD causing aortic regurgitation
Poorly supported right coronary cusp leading to cusp prolapse
90
Which congenital cause of Long QT syndrome also causes deafness
Jervell-Lange-Nielsen Syndrome
91
What condition is associated with pulsus alternans
Severe LVF
92
Which valvular abnormality is most associated with takayasu’s arteritis
Aortic regurgitation
93
Which anti-arrhythmic is safest for treating SVT in pregnancy
Metoprolol
94
Which structural cardiac abnormality is most associated with duchenne muscular dystrophy
Dilated cardiomyopathy
95
What is the investigation of choice for aortic dissection
CT angiography TAP, TOE if unstable
96
What ECG changes are characteristically seen in ARVC
TWI in V1-V3, epsilon wave
97
What is Naxos disease
Autosomal recessive variant of ARVC - associated with palmoplantar keratosis and woolly hair
98
Which electrolyte abnormalities cause long QT syndrome
Hypokalaemia, hypomagnesaemia, hypocalcaemia
99
Which statins are most associated with myopathy
Lipophilic statins (simvastatin, atorvastatin)
100
What is the MOA of nicorandil
Potassium-channel activator - increases cGMP
101
What causes cannon ‘a’ waves
Atrial contractions against a closed tricuspid valve (CHB, VT, nodal rhythm, single chamber ventricular pacing)
102
What can cause acute mitral regurgitation, hypotension and pulmonary oedema suddenly after an MI
Rupture of papillary muscle
103
How long after an MI does Dressler’s syndrome tend to appear
2-6 weeks
104
What is the treatment of a left ventricular aneurysm after MI
Anticoagulation (thrombus can form within aneurysm)
105
What can occur 1-2 weeks after MI with raised JVP and pulsus paradoxus
Left ventricular free wall rupture
106
What can cause an overestimation of BP when measuring incorrectly
Cuff too small, arm below heart level, unsupported arm (raises diastolic BP)
107
What is transposition of the great arteries due to
Failure of the aorticopulmonary septum to spiral
108
What is the MOA of adenosine
Agonist of the A1 receptor, causing transient heart block in the AV node
109
Which drug reduces the action of adenosine
Aminophylline reduces
| DEAR
110
Which drug enhances the action of adenosine
Dipyridamole enhances
| DEAR
111
What is the initial treatment of hypertension caused by phaeochromocytoma
Blockage of alpha adrenoreceptors with phenoxybenzamine
112
What is the risk of maternal ASD in pregnancy
No increased risk compared to general population
113
What is p mitrale associated with
Left atrial enlargement (MS, MR, hypertension)
114
What is p pulmonale associated with
Right atrial enlargement (PS, increased PASP)
115
Palmar xanthomas are pathognomic of which condition
Remnant hyperlipidaemia (mixed hyperlipidaemia aka dysbetalipoproteinaemia, type III hyperlipidaemia)
116
What is lutembacher syndrome
Mitral stenosis + ASD
117
Which muscular dystrophy typically presents with heart failure secondary to DCM at 5-15 years
Becker’s muscular dystrophy
118
What are the typical cardiac manifestations of myotonic dystrophy
Conduction disorders (AF, heart block, ventricular arrhythmias)
119
What is the LDL goal for a patient at very high CV risk
<1.8, or 50% reduction if baseline is between 1.8 - 3.5
