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Cardiology Flashcards

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1
Q

Antiplatelets and DOAC for AF and post ACS

A

AF
- 1st month - Triple
- 1-12 months - DOAC and antiplatelets
- > 12 months - DOAC only

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2
Q

Post ACS antiplatelets based on ischaemic risk or bleeding risk

A

High ischaemic risl
- >12 months - DAPT or aspirin + low dose riva

High bleeding risk
- 1-12 months, single antiplatelt

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3
Q

Stroke < 60, no cause
- Check for?
- If found

A

PFO

Should be closed if found

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4
Q

Treatment of Tuberous sclerosis
- Seizures
-pLAM

A

mTOR inhibitors
- Sirolimus first line

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5
Q

Antiepileptic causing weight loss

A

Topiramate

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6
Q

A/E of leviteracetam

A

Psychiatric
- Irritability, mood swings, suicidality

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7
Q

MoA of leviteracetam

A

Synaptic vesicle protein 2A inhibition -> inhibits Ca2+ currents

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8
Q

HLA-5701

A

Abacavir and hypersensitivity

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9
Q

HLA-5801

A

Allopurinol and DRESS

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10
Q

HLA*1502

A

CBZ and SJS
- Check in Han Chinese

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11
Q

Pyrodixine
- implication in GABA
- Deficiency - symptoms and cause

A

Required for GABA synthesis

Deficiency can cause seizures, peripheral neuropathy

Common cause isoniazid use - Give concomittant B6

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12
Q

Mechanism of cardiac contraction

A

Intracellular Ca - binds troponin C, changes shape to reveal actin

Actin binds myosin–> conformational change, cross bridge cycle and contraction

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13
Q

Cardiac relaxation mechanism

A

Troponin/tropomyosin blocks actin sites, so cannot bind myosin

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14
Q

Cardiac relaxation mechanism

A

Troponin/tropomyosin blocks actin sites

Actin cannot bind myosin

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15
Q

ACute rheumatic fever - which component of cardiac tissue contributes to molecular mimicry

A

Myosin

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16
Q

Pulsus paradoxus
- Definition
- 2 causes

A

> 10mmg Hg drop in SBP during inspiration

Causes
- Tamponade, pericardial effusion
- Severe asthma

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17
Q

U wave

A

Hypokalaemia

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18
Q

Carcinoid syndrome heart disease

A

Valvular

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19
Q

Rheumatic fever major criteria

A

SPACE
subcutaneous nodules, pancarditis, arthritis, chorea, erythema marginum

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20
Q

Rheumatic fever minor criteria

A

IHAT
Inflamm marers, Heart block, arthralgias, Temps

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21
Q

Single vessel revascularisation

A

PCI

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22
Q

Two vessel revascularisation
- scenarios

A

CABG if diabetic, LAD with high myocardium, high Syntax

Otherwise PCI

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23
Q

Triple vessel disease - scenarios

A

Low syntax, no diabetes - can do PCI

Otherwise CABG

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24
Q

Gene for Brugada

A

SCN5A

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25
Genetics of Brugada
Autosomal dominant, variable pentrance
26
Pathophys of Brugada
Na channel - loss of function
27
Importance of ECG changes in Brugada assessment - What are they - Type 1 vs 2/3
RBBB and STE V1-V3 Type 1 - classic coved Type 2/3- equivocal, need fleccanide challenge to unmask
28
Treatment of Brugada?
SCD/VT/syncope - ICD Asymptomatic (ie not meeting criteria) - no treatment
29
Erlenmeyer flask abnormality
Gauchers
30
Rheumatic fever 2nd PPx? - Mild MR or MS - PR prolongation
10 years or until 21
31
Rheumatic fever 2nd PPx? - Mod MR or MS - Combined mild MR/MS
10 years until 35
32
Rheumatic fever 2nd PPx? - Severe MR or MS - Combined mod MR/MS
10 years until 40
33
Rheumatic fever, no cardiac involvement - 2nd PPx?
5 years, until 21
34
Reversible PY12 inhibitor
Ticag
35
Irreversible PY12 inhibitor
Clopidogrel Pasugral
36
Indications for revascularisation of stable coronary artery disease
Medical therapy inadequate: - Refractory symptoms despite max - Intolerant High risk anatomy - LM - LM equivalent - Sev Prox LAD and LCx - Triple vessel disease +/- reduced EF
37
B1 agonism
cardiac only - inotropy, chronotropy
38
B2 agonism
Lung and skeletal muscle Bronchodilation and vasodilation
39
A1 agonism
Smooth muscle - vasoconstriction
40
A2 agonism
CNS depression Smooth muscle dilatation - vasodilatation
41
Pathophys behind Raynauds
Impaired A2 adrenoreceptor antagonism in cold --> causing excess vasoconstriction
42
Avoid in Raynaud's?
B2 blockers - cause vasoconstriction
43
Cardioselective BB
MANB Metoprolol aetenolol Nibevilol Bisoprolol
44
Most common cardiac manifestation Igg4 disease
Non-infectious aortitis
45
MoA of adenosine
AV node block (near arrest) --> breaks micro-re-entry circuits
46
CI to adenosine
Severe asthma Severe IHD
47
WPW + asymptomatic - Rx?
Observe?
48
Management of AF and WPW
Fleccanide (Na channel blocker) - avoid AV node blockade
49
Management of WPW and AVRT
Depends on direction - Orthodromic - forward through AV node, use AV node blocking Anti-dromic - forward through accessory pathway, use Na channel blockers
50
WPW and symptomatic
Catheter ablation
51
Indications for EP study
Supraventricular - Symptomatic - Aflutter, AVRT, AVNRT - Refractory - AF Ventricular - Refractory - ectopics - Idiopathic VT/VF
52
Most common site of idiopathic VT
RVOT
53
Differentiate between anterior and posterior fascicular block
Both have RBBB LARP If LAD --> anterior fascicle blocked If RAD --> Posterior fascicle blocked
54
If both sinus node and AV node slowing?
Unlikely to have native both disease Usually extrinsic --> parasympathetics, adenosine
55
CRT indication
LVEF < 35% Sinus LBBB QRS > 150 Maximal medical therapy
56
Mode to prevent atrial tracking in pacing
DDI
57
1st line for Congenital Long QT
Beta blocker (asym or symp)
58
2nd line for Long QT
Stellate sympathetic ganglionectomy Mexelitine
59
ICD in Long QT
Any cardiac arrest
60
Brugada management asymptomatic
Nothing
61
Brugada - when for ICD?
Previous SCA or syncope
62
ARVT - treatment?
ICD - pretty much everyone
63
HCM - ICD indications
Previous cardiac arrest High risk - FHx SCD, syncope, structural changes
64
Okay to excercise in which arrythmia syndromes?
Congenital Long QT 2 and 3 Brugada
65
Reduced GLS with apical sparing
Cardiac amyloid
66
Intepret GLS measurements
Measures EF Should be negative - more negative, more normal
67
Important uses of cMRI
Look for scar Infiltrative/metabolic disease
68
Measures of diastolic function TTE
A wave (atrial contraction) - dominant A wave, or low E/A indicates diastolic dysfunction (reliant on atrial contraction) E measures passive LV filling. Rises with diastolic function. High E/e' indicates elevated filling pressures
69
Management of ATTR cardiac amyloid
tamafadis
70
Treatment of polyneuropathy associated with hATTR
inotersen Nonsense signal Prevents hepatic ttr production
71
2nd line ATTR cardiac amyloid
Patisiran
72
When to do surgical AVR
Young (<75) and low EUROscore
73
MS repair (do if mod and above with/without symptoms)
Percutaneous
74
When to do mitral clip
Functional MR, failing medical Rx
75
Indications sMVR in MR
Severe + symptomatic Asymptomatic but LV dysfunction
76
MoA of digoxin
Inhibits Na/K ATPase - indirectly increases Ca influx Increased vagal tone to heart - slows HR
77
Does ivabradine help mortality?
No - improves hospitalisations/LV function
78
Largest reduction in HF mortality - which drug?
Beta blockers
79
SGLT's in cardiac disease - Reduce?
Reduce HF hospitalisation and CV mortality
80
SiRNA that is nonsense signa to prevent PCSK9 production
Inclisiran
81
PCSK-9 inhibitor
evolocumab
82
Indications for PSCK9 inhibitor
Homozygous Fam hyperchol Heterozygous fam hyperchol High risk, High LDL despite max statin and ezetimibe
83
Sequalae of high TG's
pancreatitis
84
Agents that can lower TG's
Omega-3 Fibrates
85
Management of hyperTG
Lifestyle LDL lowering
86
Sharp Y descent JVP
Constrictie pericarditis
87
JVP goes up with inspiration?
Kussmaul sign, pericardial disease
88
Fixed split S2
ASD
89
Wide split S2
Delayed conduction down R bundle (delays P2) A2 --> P2
90
Paradoxical splitting S2
Delayed L bundle
91
Single S2
Severe A or P disease
92
S3
3 horses overload Gallop --> DCM, HfPEF
93
S4 - when won't hear?
Requires atrial contraction - won't hear in AF
94
Most specific site of beta adrenergic receptors
B3 -lipolysis
95
Medication with strongest likelihood of maintaining SR after DC cardioversion
Amiodarone
96
Most common cause of sudden cardiac death
IHD
97
Missed STEMI? - can't do PCI after what timeframe?
24 hours
98
IE prophylaxis? - High risk conditions - High risk procedures
Cardiac - Prosthetic valve or VAD -Previous IE - Congenita heart disease Procedure - invasive oral/dental
99
R ventricular lift
RVH = pulmonary hypertension
100
Use of cardiac CT
To exclude significant coronary artery disease Classify medium risk to low risk
101
Where does R bundle run after leaving IV septum?
Moderator band
102
Thoracic aortic aneurysm diameter - when to operate?
> 5.5cm
103
Thoracic aortic aneurysm diameter in congenital aortic disease - when to operate?
Marfan - > 5cm Loey Dietz - > 4.5cm
104
Cardiac componenet most important in active cardiac relaxation and recoil of sarcomere
Titin
105
Mild Hyper TG
Treat with statins
106
Mod hyper TG (4-10)
Treat with statin and fenofibrate
107
High TG > 10
Treated with fibrate and fish oil
108
1st line stress test
Excercise ECG
109
CI to excercise ECG
Cannot excercise Baseline LBBB, LVH or pacing
110
If excercise stress cannot be performed, perform what test?
Stress imaging - SPECT or TTE
111
CI to stress TTE
Extensive previous IHD and likely RWMA
112
CI to vasodilator stress test
Severe asthma Hypotension Sinus node disease Neeed to w/h caffeine/theophylline prior
113
CI to inotropes stress test
DObutamine LVOT Recent MI Frequent AF/ventricular arrythmia
114
Major TTE criteria for HFpEF
Functional - E/e' > 15 - PASP > 35 VOlume - LA > 40 - Elevated mass index

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