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RAI - MRCP > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Fast irregular Narrow Complex tachycardia
How do you treat

A

IV Flecanide ( if not heart structural abnormality)

IV Amiodarone ( If structural abnormality present)

DIrect Synchronised Dc conversion
( If Hemodynamically unstable) - Syncope, CP, Hypotension , pulm oedema

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2
Q

Systolic murmur in Tricuspid region
T wave inversion in V3,V4,V5
( anterior leads)

What should you think of

A

HOCM

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3
Q

when do you se amdioarone for fast Af and when do you use digoxin for fast AF

A

✔ Amiodarone → Unstable AF, WPW, refractory cases.
✔ Digoxin → AF with heart failure, hypotension, or sedentary patients.

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4
Q

What type of tachycardia is A-V nodal re-enerant tachycardia

A

type of SVT
(seen in cocain/ amphetamine abuse)

mx: same as SVT

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5
Q

Pt. with HOCM and
Non sustained VT;

what is the Mx

A

ICD

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6
Q

when do you use single chamber Pacemaker vs Double chamber

A

✔ Single-chamber (VVI) → Permanent AF with bradycardia
✔ Dual-chamber (DDD) → AV block, sinus node disease with AV block (preserves synchrony)

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7
Q

Which drug should be stopped prior to coronary angiography

A

Metfromin (as angiography can worsen renal function)
- Can restart metformin 48 hrs post angiography if renal functions are stable

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8
Q

Romano- Ward syndrome

A

Long Qtc syndrome
Sudden collapses after physical activity
Family history
LQT1-6 mutation ( LQT1 and LQT2) most common

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9
Q

Jervell-Lange-Nielson Syndrome

A

Prolonged Qtc
Deafness
JLN1 and JLN2 mutations

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10
Q

Low voltage -Small Complex ECG
Signs LVH on ECG
Physical signs of Right heart Failure and Postural Drops

Echo :
Dilatation fo atria ;
Concentric Left Ventricular thickening
Diastolic dysfunction

What is your Dx

A

Cardiac Amylodosis

Note: Sparkling Granular Appearance of Myocardium

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11
Q

What kind of cardiomyopathy do you see in Cardiac Amylodosis

A

Restrictive Cardiomyopathy

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12
Q

What is the difference between Obstructive and Restrictive Cardiomyopathy

A

Key Takeaways:
✔ Obstructive (HOCM) → LVOT obstruction, systolic murmur, risk of SCD
✔ Restrictive → Severe diastolic dysfunction, bi-atrial dilation, right heart failure

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13
Q

What is the 1st line Mx of HOCM

A

Beta Blockers

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14
Q

Post Valve Replacement
Pt, is dyspneic and SOB
Bloods show Anemia;
Low Iron
Increase Fibrin Degraion product
Coombs :- ve

What is the Dx

A

Valve Hemloysis
( Fragmentation of erythrocytes on prosthetic Valve)

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15
Q

What is the target LDL in Pt. with peripheral arterial disease

A

LDL cholesterol goal < 1.8 mmol/l

( as Pt.;s with PAD have increased risk of CVD)

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16
Q

Classification of severity of AS

A

Parameter
Mild AS Moderate AS Severe AS Critical AS
Aortic Valve Area (AVA)
>1.5 cm² ; 1.0–1.5 cm² ;<1.0 cm² <0.6 cm²

Mean Pressure Gradient
<20 mmHg ; 20–40 mmHg ;
>40 mmHg ; >50 mmHg

Peak Aortic Jet Velocity
<2.5 m/s 2.5–4.0 m/s >4.0 m/s >5.0 m/s

Symptoms
None May be asymptomatic Symptomatic (angina, syncope, dyspnoea) Severe HF symptoms

Key Takeaways:
✔ Severe AS → AVA <1 cm², Gradient >40 mmHg, Velocity >4 m/s
✔ Symptoms in Severe AS → SAD (Syncope, Angina, Dyspnoea)
✔ Critical AS → AVA <0.6 cm², High risk of cardiogenic shock

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17
Q

Cardio-inhibitory Carotid Sinus Hypersensitivity ;
What kind of pacemaker would you use

A

Dual Chamber Pacemaker

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18
Q

Representaion 1-8 weeks after MI
Fever, Malaise, Pericardial Pain
Raised ESR
Negative trops
Possible pleurites / pneumonitis

What is your Dx and Mx

A

Dressler syndrome

Aspirin x 650mg x QDS

Note: Sydrome due to release of cardiac antigen which stimulate antibody production. The immune complexes are deposited in Pleura, Lung, heart

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19
Q

Prominent a waves in JVP
Soft Systolic murmur in left sternal border

A

Pulm Stenosis

( seen in Noonan Syndrome)

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20
Q

What is the definitive mx for Post MI ; ventricle Septal Rupture

A

Surgery

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21
Q

What are the key ECG changes in HOCM

A

Bundle branch block
T wave inversions ( in anterior leads)
Right/Left Axis deviation
Prolonged PR

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22
Q

What murmur do you hear in HOCM

A

Displaced Apex beat and Ejection systolic murmur

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23
Q

What do you see in familial hypertriglycerdimeia

A

Eruptive Xanthomata
Branch retinal vein occlusion

MX: Fenofibrate

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24
Q

Late systolic murmur loudest over thoracic Spine

A

Coarctation of aorta

Note:
We also see radiofemoral delays

Scalloping of posterior ribs on car can also be seen

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25
Acute Mitral regurgitation post MI ( median onset time 13 hrs after) What is the cause
Papillary muscle Rupture
26
What is the criteria for valve replacement in AR
If symptomatic if EF <55% If LVESD > 50mm
27
Out of hospital, cardiac arrest , now having eneurology What is suggested
Therapeutic Hypothermia ( aim 36 degrees)
28
What gene is associated with Marfans Syndrome
FBN1 Gene
29
Where do you see pacts escavatum and thoracolumbar striae
Marfans Syndrome
30
What is Hyede Syndrome
Angiodysplasia with severe AS Microcytic anemia due to loss of VWF that goes through narrow AS
31
What is the criteria for Cardiac Resynchronisation Therapy
Pt. already on optimised medical therapy EF < 35% + Conduction delays in ECG;s LBBB QRS >120
32
How do you treat palpitations with long Congenital Long QtC
1st line - Metoprolol 2nd Line - ICD ( if above fails)
33
What is the definitive Ix for Coarctation of Aorta
Echo !
34
What is the criteria for anticoagulant in HF
If Pt.has HF and low EF and any of the following, anticoagulation is recommended ; > prev thrombotic event > Intracardiac thrombus > Left Ventricular Aneurysm
35
What is the Mx of NSTEMI in someone with an eGFR of <20
Aspirin, Ticagrelor , Unfractioned Heparin /LMWH
36
What is the Mx of primary pulm HTN ( >25mmhg)
Acute Vasoreactive test : If positive ; Choose CCB ( amodipine/ Diltiazem) If signs of relative bradycardia ; Choose Amlodipine ( Non rate limiting) Acute Vasoreactive test : If Negative ; -> Bosentan ( Endotheline receptor antagonist) -> Iloprost ( Prostacycline Anologue) -> Sildenafil ( Phosphodiesterase 5 inhibitor)
37
What are the key feature of Familial Hypercholestrolemia
> raised Cholesterol and LDL > Normal Triglcerides > Tendon Xanthomata ; Corneal Arcus , XAnthelasma Mx: Atorvastatin Statin x 80mg x OD Ezetimibe Evolocumab ( PCSK9 inhibitor)
38
What drugs are uses in Hypertensive Emergency.
Sodium Nitroprusside/ Labetolol x IV Note : Do NOT use Nifedipine x S/L it an rapidly reduce the BP and cause stroke
39
What are the indication for a PPM after a holter monitoring
3rd degree HB Symptomatic 2nd degree HB Asymptomatic 2nd Degree HB (type2) Pauses > 3 seconds
40
Q waves in ECG post few weeks of MI VT/VF few weeks after PCI What is the Mx
ICD insertion Q wave indicates full thickness infarct
41
What are the key takeaways of p-mitrale
Bifid P Waves (P Mitrale) – Meaning & Clinical Significance ✔ Definition: A bifid (notched) P wave seen on ECG, classically associated with left atrial enlargement (LAE). ✔ ECG Features: Lead II → Broad, notched 'M-shaped' P wave (>120 ms). V1 → Biphasic P wave with a deep, broad negative terminal component. ✔ Clinical Causes of P Mitrale: Left Atrial Enlargement (LAE) → Due to increased left atrial pressure or volume overload. Mitral Valve Disease (e.g., Mitral stenosis, Mitral regurgitation). Left Ventricular Hypertrophy (LVH) (e.g., Hypertension, Aortic stenosis). ✔ Key Takeaway: Bifid P waves = P mitrale → Suggests left atrial enlargement.
42
ST elevation in precordial leads With " J notches' What is your Dx
Early Repolarisation
43
What are the key features of Early Repolarisation
Key Characteristics of Early Repolarization (Benign Early Repolarization - BER) ✔ Definition: A benign ECG pattern seen in young, healthy individuals, often mistaken for myocardial ischemia. ✔ ECG Features: Concave ("smiley face") ST elevation (most prominent in precordial leads, V2–V5). J-point elevation (typically ≥0.1 mV) with a notched or slurred appearance. No reciprocal ST depression (helps differentiate from ischemia). Prominent T waves (tall and symmetrical, especially in anterior leads). Stable over time (does not progress to infarction). ✔ Clinical Significance: Typically benign and seen in young, athletic individuals. No chest pain or ischemic symptoms. Must be differentiated from pericarditis and STEMI.
44
What is the common cause of IE post bowel resection
Bacteriodes Although S. Bovis can also be seen
45
What is a key difference between Beckers Muscular Dystrophy (BMD) and Duschens Muscular Dystrophy (DMD)
BMD has cardiomyopathy and HF and milder Proximal Myopathy Pt. may present with HF and then the proximal myopathy will be found In DMD Proximal myopathy is severe and will present in much earlier age
46
What are the key MRCP features of rheumatic fever
Key MRCP Features of Rheumatic Fever (Jones Criteria - Revised) ✔ Cause: Post-streptococcal autoimmune reaction (Group A Streptococcus). ✔ Diagnosis: Based on the modified Jones criteria (evidence of recent streptococcal infection + 2 major OR 1 major + 2 minor criteria). Major Criteria ("J♥NES") Joint involvement (migratory polyarthritis) – large joints, asymmetrical. ♥ Carditis (pancarditis) – new murmur, pericarditis, heart failure. Nodules (subcutaneous, painless, firm). Erythema marginatum – pink rings on trunk, non-itchy. Sydenham's chorea – involuntary movements, emotional lability. Minor Criteria Fever Arthralgia Raised inflammatory markers (ESR, CRP) Prolonged PR interval on ECG ✔ Investigations ASO (Anti-Streptolysin O) titre → evidence of prior Strep infection. Throat culture or rapid Strep test. ✔ Management Penicillin V (eradication of Strep infection). NSAIDs for arthritis. Corticosteroids for severe carditis. Long-term prophylaxis: Penicillin IM (monthly) for years.
47
What are the septal leads
V1, V2
48
What are the Anterior leads
V3, V4
49
What are the lateral leads
V5, V5, I
50
What do you use to treat VT In digoxin toxicity in someone ho is hemodynamically stable
IV lidocaine / IV phenytoin
51
When do you choose mitral valve replacement over Mitral vagotomy
Mod to serve MR Left atrial thrombus Severe calcified Mitral Valve Concomitant coronary artery or other valve defect needing sx
52
What is the definitive Mx for WPW
Radiofrequency Ablation
53
SVT in asthmatics who have failed carotid sinus massage. What is the Mx
IV x Verapamil
54
What are some normal findings in cardiac monitoring post PCI for MI
Bradycardia Type 1 HB Morbitz Type 1 HB Ventricular ectopics Accelerated idioventricular rhythm
55
Pt. hs HF, on ACE and Diuretics. Has not tolerated beta blocker. ha edema and crackles. if HR >75 What can you add next to improve prognosis
Ivabradine
56
Which medication can help prognostic value in those affected by mild to moderate AR
ACE int
57
Pt. already on CCB and Beta blocker Angina symptoms persist HR >70 What is the next step
Ivabradine Note: Never use Verpamail ( CCB) and BTea blocker together; risk of severe bradycardia
58
CXR shows calcifications over cardiac sillouhette What is your Dx
AS
59
What drug should be used with caution in cardiac amylodosis
Digoxin As it can bind with the amyloid fibrils and worsen digoxin tocxicity
60
When do you use dioxin in HF
If they have associated AF with it.
61
What re some key differences between In-stent thrombosis vs in-stent restenosis
Both can be seen where bare metal stents are used Both can be seen in diabetics In stent-restenosis ; presents with Angina like symptoms Mx: Use Coated/drug eluting stents In stent thrombosis occurs with ACS/STEMI ( usually occurs with/coincides with cessation of Antiplateltes)
62
Pt. is an athlete Complains of periods of palpitations Feeling dizzy ECG and CXR normal Bradycardia seen Wat is your Dx
Paroxysmal AF Note in Atrial and ventricular topics; they feel like their heart is skipping abet. there is no period of palpitations and no dizzines
63
What is the time period of peripartum Cardiomyopathy
Last month of pregnancy to upto 5 month post delivery
64
What is the 3 criteria to dx peripartum Cardiomyopathy
1) Absence of heart disease prior to last mont of pregnancy 2) No other cause of HF 3) Confirmed systolic dysfcution
65
How do you manage Staph Endocarditis
IV Fluclox
66
How do you manage Empirical Endocarditis in native valve where organism is not confirmed yet
Benzylpencillin + Gent
67
How do you treat IE with MRSA +ve
Vanc
68
What is the mx of IE for staph if pt is alergryc to penicillin
Clarithromycin
69
Symptomatic Wencheback phenomenon ( type 1 morbitz) what is the definitve Mx
PPM Note: If asymptomatic, no indication NOte: But if Type 2 Morbitz, irrespective of symptoms o symptoms -> PPM is indicated
70
How long do tissue valves last
10 years
71
What is a good peri-operative measurement of Cardiac function
Stress Echo ( dobutamine stress test)
72
What is the normal response to BP n stress test
SBP should gradually increase DBP will remain same/slightly decrease Abnorma findings; Drop In SBP SBP >250
73
Choosing Between Thallium Cardiac Scanning & Dobutamine Stress Echo (DSE) How do you do it?
Flowchart for Choosing Between Thallium Cardiac Scanning & Dobutamine Stress Echo (DSE) Step 1: Can the patient exercise? ➡ Yes → Do Exercise Stress Test (ECG, Echo, or Perfusion Scan). ➡ No → Move to Step 2. Step 2: What do you need to assess? ✅ Myocardial Perfusion & Viability? → Thallium Perfusion Scan ✅ Wall Motion & Ischemia-Induced Dysfunction? → Dobutamine Stress Echo (DSE) Step 3: Special Considerations 🔹 Thallium Scan → Use if the patient has LBBB, pacemaker, or if you need to check viability before revascularization. 🔹 DSE → Use if assessing valvular disease (AS, MR) or ischemia-related wall motion changes. 📌 Quick Rule of Thumb: "Thallium = Think Perfusion" (Blood flow & viability). "Dobutamine = Think Motion" (Wall motion & ischemia).
74
How do you Mx peripartum cardiomyopathy
Fluid restriction Diuretics Digoxin VTE prophylaxis - with heparin ( as at risk of thromboembolism)
75
Pt. on tx for IE But continues have fever , stagnant inf. markers and pronged PR interval What are you thinking >
Possible aortic root abscess Ix: ECho Mx: Will need debridement and valve repalcement
76
What is the dukes criteria for IE
Duke’s Criteria for Infective Endocarditis (IE) – MRCP Key Points 1. Major Criteria ✅ Positive Blood Cultures (one of the following): Typical organism (Strep viridans, Staph aureus, Enterococcus, HACEK) in two separate cultures Persistently positive cultures (≥2 positive cultures >12 hrs apart) Single Coxiella burnetii culture or IgG titre >1:800 ✅ Endocardial Involvement (one of the following): Echo findings: Vegetation, abscess, new partial dehiscence of prosthetic valve New valvular regurgitation (not just worsening of pre-existing murmur) 2. Minor Criteria 🔹 Predisposition (e.g., prosthetic valve, IVDU, structural heart disease) 🔹 Fever ≥38°C 🔹 Vascular phenomena: Janeway lesions, arterial emboli, mycotic aneurysm, intracranial hemorrhage 🔹 Immunological phenomena: Osler nodes, Roth spots, glomerulonephritis, RF+ 🔹 Microbiological evidence: Positive cultures not meeting major criteria Diagnosis Definite IE = 2 Major, or 1 Major + 3 Minor, or 5 Minor Possible IE = 1 Major + 1 Minor, or 3 Minor
77
Pt. is hypertensive and in CCF What is the Mx
IV diuresis
78
Where do you see palmar Xanthomas
Disbetalipopreotenaemia
79
If a pt. has severe impaired LVD and shows possibly severe AS what do you do
Repeat Echo ( dobutamine) stress test As , in Pt. withs severe HF or LVF/dysfcumtion, AS can be false +ve
80
What is the 1st line Mx of Prolonged Qtc
Atenolol IF no benefit, the ICD ( esepceilly in high risk, family, etc) But note; always start with atenolol or in conjunction
81
What is a very poor marker of prognosis of CCF
Hyponatremia
82
What is the 1st line for symptomatic severe Mitral Stenosis
Baloon Valvuloplasty
83
In Pt. who need Pacemaker and have AF, how do you know if they need single chamber or double chamber PPM
1) if paroxysmal AF, then double chamber PPM 2) If AF, is longstanding, permanent , persistent, then single chamber
84
What are the features of Mg toxicity in Eclampsia
Depressed Deep tendon reflexes Oliguira Hypoventialtion Mx: Calcium Chloride/ Calcium Gluconate
85
What is Lutembaker Syndrome
Booth MS and ASD are present
86
What is Eisenmenger Syndrome
Reversal of Left to right Shunt to Right to Left Shunt
87
What are the features of severe MS
Prolonged duration of murmur Soft S1 Presence of parasternal Heave Decreased interval between A2-OS Loud P2
88
Where do you see petechial hemorrgahes in conductive and membranes
IE
89
How do you create unstable angina or NSTEMI in someone with significant renal impairement
Use unfractioned heparin over Fondaparinux ( if creat >265)
90
POST PCI/ MI; Pt. becomes hemodynamically unsatable and dies in few moments What is the complication
Ventricular Free Wall Rupture
91

RAI - MRCP (13 decks)

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