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MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

In a hypertensive emergency, by how much should you aim to reduce BP?

A

MAP by 25% or diastolic BP by a third

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2
Q

Right side murmurs do not increase with inspiration - correct or incorrect?

A

RHS murmurs DO INCREASE with respiration, LHS murmurs do not.

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3
Q

What valvular abnormalities cause LVH?

A

AS and MR

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4
Q

What valvular abnormality causes RVH?

A

TR

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5
Q

What defect causes biventricular hypertrophy?

A

VSD

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6
Q

What congential heart defect is associated with Down’s syndrome?

A

ASD - ostium primum

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7
Q

Murmur associated with ASD?

A

Splitting S2 and systolic murmur

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8
Q

What is normal percentage oxygenation of R heart and pulmonary artery?

A

75%

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9
Q

How does ADS (ostium primum) present?

A

Congestive heart failure

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10
Q

Clinical signs of VSD?

A

Parasternal heave and displaced apex beat

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11
Q

Mechanism of action of adenosine

A

CCB as a consequence of alpha 1 receptor activation

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12
Q

Amiodarone mechanism of action

A

K+ channel blocker

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13
Q

What are the potential effects of cardiac catheterisation on hyperthyroidism?

A

Uses iodine containing contrast - toxic MNG will therefore worsen due to presence of autonomous thyroid nodules whereas in Graves disease it may improve due to transient inhibition of TPO with rising intrathyroidal iodine

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14
Q

What is the treatment for AF if Bbockers, rate limiting CCBs and digoxin are ineffective?

A

Cardioversion then pulmonary vein radiofrequency ablation if unsuccessful

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15
Q

Most anterior valve in heart and therefore most likely to be affected in stabbing of rpecordium

A

Pulmonary valve

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16
Q

What coronary artery supplies the AV node and subsequently causes complete heart block if blocked?

A

RCA. Also causes inferior lead changes

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17
Q

What does the LCA supply

A

50% of LV - anteriolateral, apex and intraventricular septum

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18
Q

What supplies the left apex

A

Left marginal artery

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19
Q

What artery is implicated in a posterior MI

A

Left circumflex artery. Also supplies lateral left ventricle

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20
Q

How much does diastolic BP fall by in pregnancy during second trimester?

A

10% due to 50% increase in cardiac output leading to increased PVR

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21
Q

What rhythm abnormality can sotalol cause?

A

Torsades de point
It is a class III agent (K blockade)

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22
Q

How does WPW appear on ecg

A

short pr interval, positive R wave in V1 and delta wave

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23
Q

What channel defect most likely causes long QT syndrome

A

K+ channel defect caused by LQT1 and 2 mutations

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24
Q

What is the mutation seen in HOCM?

A

Beta myosin heavy chain mutation

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25
Q

What drugs should be avoided in fast AF with WPW

A

Adenosine, flecanide and digoxin - slow conduction outside accessory pathway but having no effect outside conduction system

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26
Q

Why do atrial myoxomas cause a diastolic ‘flop’?

A

Because they aren’t fixed to the atrial wall - will hence change sound when position changed

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27
Q

What MAP is associated with pulmonary hypertension?

A

> 25mmHg

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28
Q

What pulmonary capillarly wedge pressure is associated with pulmonary hypertension

A

> 12mmh

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29
Q

In what positional changes does the ES murmur in hypertrophic cardiomyopathy worsen?

A

Accentures with valsava, attenuates on squatting

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30
Q

What effect does valsava have on AS?

A

Quietens murmur due to reducing preload to heart. Squatting conversely increased PVR and increases ventricular filling - making murmurs loud in AS.

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31
Q

Causes of split second heart sound

A

ASD, RHF and pulmonary hypertension

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32
Q

Causes of TDP

A

Metabolic (hypo), amiodarone, TCAs, phenothiazides, IHD, MV prolapse

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33
Q

Treatment for TDP

A

IV Mg2+

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34
Q

Causes of reverse split second heart sound

A

AS, hypertrophic cardiomyopathy and MI with LBBB

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35
Q

Causes of fixed split second heart sound

A

RBBB

36
Q

Murmur with MR

A

pan systolic murmur (also MR, TR and VSD)

37
Q

How long should you continue anticoagulation after cardioversion

A

4 weeks

38
Q

In what condition is adenosine CI?

A

asthma

39
Q

What valves most commonly affected (in order) in IE (non IVDU)

A

MV, AV, then AS and MV, TV then PV

40
Q

What antihypertensives are CI in lithium therapy

A

ACEI, ARB

41
Q

What is the bacteria associated with IE <1y post prosthetic valve replacement

A

S epidermis

42
Q

Most common bacteria in IE

A

S aureus

43
Q

Type of pulse with PDA

A

Slowly collapsing (also seen in patients with severe AR)

44
Q

With which condition is pulsus alterans seen

A

LVF

45
Q

With which condition is slow rising pulse seen

A

aortic stenosis

46
Q

With which condition is a jerky pulse seen

A

HOCM

47
Q

With which condition is pulsus parodoxus seen

A

constrictive pericarditis, cardiac tamponade and severe asthma

48
Q

ECG abnormalitiy in brugada

A

RBBB and anterior ST elevation

49
Q

Most common gene abnormalities seen in HOCM

A

MYH7 and MYBPC3

50
Q

Quiet 1st heart sound occurs with which conditions

A

MR, severe HF and LBBB (delayed systole of ventricles)

51
Q

What is associated with Heyde syndrome and aortic stenosis

A

GI tract angiodysplasia (Heyde syndrome - increased shearing of VWF due to resistance over stenotic valve causing anaemia - plts unable to bind to damaged blood vessels in GI tract)

52
Q

In which condition is flecanaide CI?

A

Hx IHD

53
Q

What is ABX regimen for strep viridans IE

A

benzylpenicillin and gentamicin. Ceftriaxone can be given in less severe cases

54
Q

Abnormalities associated with Marfarns

A

Aortic regurgitation (diastolic murmur lower sternal edge with wide pulse pressure) or mitral valve prolapse

55
Q

What effect does positive pressure ventilation have on the lungs

A

increases venous return and causes a fall in cardiac output

56
Q

WHat diuretic causes hypercalacaemia and hypochloraemic alkalosis

A

bendroflumethiazide

57
Q

What does prochlorperazine, chlorperazine, metocloperamide and promethazine all have in common

A

All D2 receptor antagonists

58
Q

What is the murmur with primary pulmonary hypertension

A

Intense P2 sound and also murmur Tricuspid regurg (pansystolic murmu loudest at left lower sternal edge)

59
Q

What is the abnormality seen with heart block on eamination of JVP

A

cannon a waves

60
Q

what is most likely to cause lower limb oedema - doxazocin or diltiazem

A

ddoxazocin - non dihydropyridine CCbs les likely to cause peripheral oedema

61
Q

where does splitting 4th heart sound occur

A

after p wave

62
Q

where does first sound heart occur

A

after qrs

63
Q

where does second heart sound occur

A

after t wave

64
Q

HLA positvity with BEhcet’s disease

A

HLLA B51

65
Q

what part of the heart is most arrythmogenic

A

coronary sinus

66
Q

Most commonly affected valve in IVDU

A

Tricuspid

67
Q

Most common valve in endocarditis in IVDU

A

Staph aureus

68
Q

Ecg hyperkalaemia

A

Tall tented t
Wide qrs
Absent p

69
Q

Ecg hypokalaemja

A

Inverted t waves
U wave
Prolonged pr
St depression

70
Q

J waves?

A

Hypothermia

71
Q

Amyloidosis - linked to what lung condition

A

Bronchiectasis chronic inflammation

72
Q

Negative concordance across chest leads .. more likely with vt or svt

A

Vt

73
Q

When is adenosine CI in SVT

A

Asthma
Use verapamil

74
Q

Why avoid verapamil in WPW

A

Selective AVN blockade could encourage rapid conduction of atrial arrhythmia

75
Q

Pan systolic murmur lodest at apex

A

Mitral regurg

76
Q

S1 heart sound with early diastolic murmur in aortic area with patient sitting forward and in expiration

A

Aortic regurg

77
Q

Mitral stenosis murmur

A

Mid to late diastolic
Left lateral position

78
Q

Post diastolic murmur left upper sternal edge

A

Pulmonary regurg

79
Q

What is most common in turner’s
Bicuspid aortic valve or coarctation

A

Bicuscipud aortic valve

80
Q

Difference in timing between carotid artery in stent thrombosis and in stent restenosis

A

Thrombosis most likely within first 30d and linked to DAPT
REstenosis much later and not linked to DAPT

81
Q

What murmur is a collapsing pulse associated with

A

Aortic regurg (third left intercostal space)

82
Q

What murmurs (x2) re associated with marfans

A

Aortic and pulmonary regurg

83
Q

what drug should be avoided in WPW

A

digoxin and beta blockeres

84
Q

what antiarrythmic should be avoided in structural or ischaemic heart disease

A

flecanaide

85
Q

bonsentan teratogenic?? yes or no

A

yes (sildenafil PDE5 inhib is ok)

86
Q
A

MRCP (14 decks)

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