Cardiology Flashcards

Question

Selenium

Answer 1

Selenium deficiency is known to cause Keshan disease, a type of dilated cardiomyopathy.

Answer 2

- idiopathic: the most common cause - myocarditis: e.g. Coxsackie B, HIV, diphtheria, Chagas disease - ischaemic heart disease - peripartum - hypertension - iatrogenic: e.g. doxorubicin - substance abuse: e.g. alcohol, cocaine - inherited: either a familial genetic predisposition to DCM or a specific syndrome e.g. Duchenne muscular dystrophy around a third of patients with DCM are thought to have a genetic predisposition a large number of heterogeneous defects have been identified - the majority of defects are inherited in an autosomal dominant fashion although other patterns of inheritance are seen - infiltrative e.g. haemochromatosis, sarcoidosis + these causes may also lead to restrictive cardiomyopathy - nutritional e.g. wet beriberi (thiamine deficiency

Answer 3

Prominent V waves on JVP → tricuspid regurgitation

Answer 4

Onset < 48 hours If the atrial fibrillation (AF) is definitely of less than 48 hours onset patients should be heparinised. Patients who have risk factors for ischaemic stroke should be put on lifelong oral anticoagulation. Otherwise, patients may be cardioverted using either: electrical - 'DC cardioversion' pharmacology - amiodarone if structural heart disease, flecainide or amiodarone in those without structural heart disease Following electrical cardioversion if AF is confirmed as being less than 48 hours duration then further anticoagulation is unnecessary Onset > 48 hours If the patient has been in AF for more than 48 hours then anticoagulation should be given for at least 3 weeks prior to cardioversion. An alternative strategy is to perform a transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus. If excluded patients may be heparinised and cardioverted immediately. NICE recommend electrical cardioversion in this scenario, rather than pharmacological. If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion Following electrical cardioversion patients should be anticoagulated for at least 4 weeks. After this time decisions about anticoagulation should be taken on an individual basis depending on the risk of recurrence

Answer 5

- right coronary artery lesion

Answer 6

Features - syncope - heart failure - regular bradycardia (30-50 bpm) - wide pulse pressure - JVP: cannon waves in neck - variable intensity of S1 Types of heart block - First degree heart block PR interval > 0.2 seconds - Second degree heart block type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex - Third degree (complete) heart block there is no association between the P waves and QRS complexes

Answer 7

Arrhythmogenic right ventricular cardiomyopathy is characterised by right ventricular myocardium replaced by fatty and fibrofatty tissue. Investigation ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex echo changes are often subtle in the early stages but may show an enlarged, hypokinetic right ventricle with a thin free wall magnetic resonance imaging is useful to show fibrofatty tissue Management drugs: sotalol is the most widely used antiarrhythmic Catheter ablation to prevent ventricular tachycardia implantable cardioverter-defibrillator Naxos disease an autosomal recessive variant of ARVC a triad of ARVC, palmoplantar keratosis, and woolly hair.

Answer 8

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a form of inherited cardiac disease associated with sudden cardiac death. It is inherited in an autosomal dominant fashion and has a prevalence of around 1:10,000. Pathophysiology the most common cause is a defect in the ryanodine receptor (RYR2) which is found in the myocardial sarcoplasmic reticulum Features exercise or emotion induced polymorphic ventricular tachycardia resulting in syncope sudden cardiac death symptoms generally develop before the age of 20 years Management - beta-blockers - implantable cardioverter-defibrillator

Answer 9

The most common type now implanted is the bileaflet valve. Ball-and-cage valves are rarely used nowadays Mechanical valves have a low failure rate Major disadvantage is the increased risk of thrombosis meaning long-term anticoagulation is needed. Warfarin is still used in preference to DOACs for patients with mechanical heart valves Following the 2017 European Society of Cardiology guidelines, aspirin is only normally given in addition if there is an additional indication, e.g. ischaemic heart disease. Target INR aortic: 3.0 mitral: 3.5

Answer 10

B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain. Very high levels are associated with a poor prognosis. BNP NTproBNP High levels > 400 pg/ml (116 pmol/litre) > 2000 pg/ml (236 pmol/litre) Raised levels 100-400 pg/ml (29-116 pmol/litre) 400-2000 pg/ml (47-236 pmol/litre) Normal levels < 100 pg/ml (29 pmol/litre) < 400 pg/m

Answer 11

Left ventricular hypertrophy Ischaemia Tachycardia Right ventricular overload Hypoxaemia (including pulmonary embolism) GFR < 60 ml/min Sepsis COPD Diabetes Age > 70 Liver cirrhosis

Answer 12

Obesity Diuretics ACE inhibitors Beta-blockers Angiotensin 2 receptor blockers Aldosterone antagonists

Answer 13

a' wave = atrial contraction large if atrial pressure e.g. tricuspid stenosis, pulmonary stenosis, pulmonary hypertension absent if in atrial fibrillation Cannon 'a' waves caused by atrial contractions against a closed tricuspid valve are seen in complete heart block, ventricular tachycardia/ectopics, nodal rhythm, single chamber ventricular pacing 'c' wave closure of tricuspid valve not normally visible 'v' wave due to passive filling of blood into the atrium against a closed tricuspid valve giant v waves in tricuspid regurgitation 'x' descent = fall in atrial pressure during ventricular systole 'y' descent = opening of tricuspid valve

Answer 14

Acute management - vagal manoeuvres: - Valsalva manoeuvre: e.g. trying to blow into an empty plastic syringe carotid sinus massage - intravenous adenosine rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg contraindicated in asthmatics - verapamil is a preferable option electrical cardioversion - Prevention of episodes beta-blockers radio-frequency ablation

Answer 15

Takotsubo cardiomyopathy also known as 'Broken heart syndrome' and 'Takotsubo apical ballooning syndrome' describes a cardiomyopathy induced by severe stressful triggers (e.g. emotional upset). It is commoner in women. In this scenario, we assume that the patient is in bereavement which precipitated the stress cardiomyopathy. Takotsubo is a Japanese word that describes an octopus trap; this is used to describe the appearance of the heart on left ventriculogram, CMR or echocardiogram. This apical ballooning appearance occurs due to severe hypokinesis of the mid and apical segments with preservation of activity of the basal segments. In simple terms, the bottom of the heart (the apex) does not contract and therefore appears to balloon out. However, the area closer to the top (the base) continues to contract (creating the neck of the octopus trap).

Answer 16

5H - Hypoxia - Hypovolaemia -Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders - Hypothermia - Thrombosis (coronary or pulmonary) - Tension pneumothorax - Tamponade - cardiac - Toxins

Answer 17

Ventricular septal defects (VSD) are the most common cause of congenital heart disease. They close spontaneously in around 50% of cases. Aetiology - Congenital VSDs are often association with chromosomal disorders Down's syndrome Edward's syndrome Patau syndrome cri-du-chat syndrome - congenital infections - Acquired causes - post-myocardial infarction VSDs may be detected in utero during the routine 20 week scan. Post-natal presentations include: - Failure to thrive - Features of heart failure - hepatomegaly - Tachypnoea - Tachycardia - Pallor Classically a pan-systolic murmur which is louder in smaller defects Management is clearly highly specialised small VSDs that are asymptomatic often close spontaneously and simply require monitoring moderate to large VSDs usually result in a degree of heart failure in the first few months nutritional support medication for heart failure e.g. diuretics surgical closure of the defect Complications - Aortic regurgitation Aortic regurgitation is due to a poorly supported right coronary cusp resulting in cusp prolapse infective endocarditis - Eisenmenger's complex due to prolonged pulmonary hypertension from the left-to-right shunt results in right ventricular hypertrophy and increased right ventricular pressure. This eventually exceeds the left ventricular pressure resulting in a reversal of blood flow this in turn results in cyanosis and clubbing Eisenmenger's complex is an indication for a heart-lung transplant - Right heart failure - Pulmonary hypertension Pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality

Answer 18

Q fever is caused by Coxiella burnetii, a rickettsia. The source of infection is typically an abattoir, cattle/sheep, or it may be inhaled from infected dust. Features Typically prodrome: - fever, malaise - causes pyrexia of unknown origin - Transaminitis. - atypical pneumonia - endocarditis (culture-negative) Management - Doxycycline

Answer 19

>>Initial blind therapy Native valve amoxicillin, consider adding low-dose gentamicin If penicillin allergic, MRSA or severe sepsis vancomycin + low-dose gentamicin >>If prosthetic valve vancomycin + rifampicin + low-dose gentamicin >>Native valve endocarditis caused by staphylococci Flucloxacillin if penicillin allergic or MRSA vancomycin + rifampicin >>Prosthetic valve endocarditis caused by staphylococci Flucloxacillin + rifampicin + low-dose gentamicin If penicillin allergic or MRSA vancomycin + rifampicin + low-dose gentamicin >>Endocarditis caused by fully-sensitive streptococci (e.g. viridans) Benzylpenicillin If penicillin allergic vancomycin + low-dose gentamicin >>Endocarditis caused by less sensitive streptococci Benzylpenicillin + low-dose gentamicin If penicillin allergic vancomycin + low-dose gentamicin

Answer 20

Idarucizumab ( praxbind) is a recently developed monoclonal antibody fragment which binds dabigatran with an affinity that is 350 times as high as with thrombin. Consequently, idarucizumab binds free and thrombin-bound dabigatran and rapidly neutralises its activity

Answer 21

>>Angioplasty (elective) - 1 week off driving >>CABG - 4 weeks off driving >>acute coronary syndrome- 4 weeks off driving >>1 week if successfully treated by angioplasty >>Angina - driving must cease if symptoms occur at rest/at the wheel >>Pacemaker insertion - 1 week off driving >>Implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia, cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers >>successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving. >>heart transplant: do not drive for 6 weeks, no need to notify DVLA

Answer 22

1st line: CT coronary angiography 2nd line: non-invasive functional imaging (looking for reversible myocardial ischaemia) 3rd line: invasive coronary angiography

Answer 23

Examples of non-invasive functional imaging: 1- myocardial perfusion scintigraphy with single photon emission computed tomography (MPS with SPECT) or 2- stress echocardiography or first-pass contrast-enhanced magnetic 3- resonance (MR) perfusion or MR imaging for stress-induced wall motion abnormalities

Answer 24

Associations - Congenital heart disease: PDA, ASD - Cardiomyopathy - Turner's syndrome - Marfan's syndrome, Fragile X - Osteogenesis imperfecta - Pseudoxanthoma elasticum - Wolff-Parkinson White syndrome - long-QT syndrome - Ehlers-Danlos Syndrome - Polycystic kidney disease

Answer 25

Flecainide is a Vaughan Williams class 1c antiarrhythmic. It slows conduction of the action potential by acting as a potent sodium channel blocker (specifically the Nav1.5 sodium channels). This may be reflected by widening of the QRS complex and prolongation of the PR interval.

Answer 26

In adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l

Answer 27

Statins are contraindicated during pregnancy as they cross the placental barrier and may cause foetal harm. There is evidence that statins can interfere with cholesterol-dependent embryonic development and may be teratogenic. Guidelines recommend discontinuing statins at least 3 months before planned conception and throughout pregnancy.

Answer 28

-Ventricular septal defects (VSD) - most common, accounts for 30% - Atrial septal defect (ASD) - Patent ductus arteriosus (PDA) - Coarctation of the aorta - Aortic valve stenosis

Answer 29

3T - Tetralogy of Fallot - transposition of the great arteries (TGA) - tricuspid atresia Fallot's is more common than TGA but TGA is most common at birth.

Answer 30

A history of hypertension before pregnancy or an elevated blood pressure > 140/90 mmHg before 20 weeks gestation

Answer 31

Hypertension (as defined above) occurring in the second half of pregnancy (i.e. after 20 weeks)

Answer 32

Pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours)

Answer 33

Aortic dissection type A - ascending aorta - control BP (IV labetalol) + surgery type B - descending aorta - control BP(IV labetalol)

Answer 34

Antibiotic prohylaxis to prevent infective endocarditis is not routinely recommended in the UK for dental and other procedures

Answer 35

An LVEF of < 40% bars him from driving a lorry, even if he becomes asymptomatic with treatment

Answer 36

Pulsus paradoxus greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration severe asthma, cardiac tamponade Slow-rising/plateau aortic stenosis Collapsing aortic regurgitation patent ductus arteriosus hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy) Pulsus alternans regular alternation of the force of the arterial pulse severe LVF Bisferiens pulse 'double pulse' - two systolic peaks mixed aortic valve disease 'Jerky' pulse hypertrophic obstructive cardiomyopathy* *HOCM may occasionally be associated with a bisferiens pulse

Answer 37

For patients of black African or African-Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider an angiotensin receptor blocker in preference to an ACE inhibitor

Answer 38

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500. Management Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis* Drugs to avoid nitrates ACE-inhibitors inotropes

Answer 39

All antiarrhythmic drugs have the potential to cause arrhythmias. Coexistent hypokalaemia significantly increases this risk.

Answer 40

Amiodarone is a class III antiarrhythmic agent used in the treatment of atrial, nodal and ventricular tachycardias. The main mechanism of action is by blocking potassium channels which inhibits repolarisation and hence prolongs the action potential. Amiodarone also has other actions such as blocking sodium channels (a class I effect)

Answer 41

Monitoring of patients taking amiodarone TFT, LFT, U&E, CXR prior to treatment TFT, LFT every 6 months

Answer 42

- thyroid dysfunction: both hypothyroidism and hyperthyroidism - corneal deposits - pulmonary fibrosis/pneumonitis - Liver fibrosis/hepatitis - peripheral neuropathy, myopathy - photosensitivity - 'slate-grey' appearance - thrombophlebitis and injection site reactions - bradycardia - lengths QT interval

Answer 43

- If there is a positive response to acute vasodilator testing (a minority of patients) oral calcium channel blockers If there is a negative response to acute vasodilator testing (the vast majority of patients) - prostacyclin analogues: treprostinil, iloprost - endothelin receptor antagonists non-selective: bosentan - selective antagonist of endothelin receptor A: ambrisentan - phosphodiesterase inhibitors: sildenafil

Answer 44

Pulmonary arterial hypertension (PAH) may be defined as a resting mean pulmonary artery pressure of >= 20 mmHg. Endothelin is thought to play a key role in the pathogenesis of PAH. It is more common in females and typically presents between the ages of 30-50 years

Answer 45

- Right ventricular heave - Loud P2 - Raised JVP with prominent a waves - Tricuspid regurgitation

Answer 46

NICE specifically state that we should not use QRISK2 for type 1 diabetics. Instead, the following criteria are used: older than 40 years, or have had diabetes for more than 10 years or have established nephropathy or have other CVD risk factors

Answer 47

Hypertension in pregnancy in usually defined as: systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

Answer 48

Dyspnoea is a common side effect of ticagrelor and is estimated to occur in up to 15% of patients started on this medication. It is hypothesised that the sensation of dyspnoea in ticagrelor-treated patients is triggered by adenosine, because ticagrelor inhibits its clearance (by inhibiting the enzyme adenosine deaminase), thereby increasing its concentration in the circulation.

Answer 49

- Aortic regurgitation - Infective endocarditis - Eisenmenger's complex d Eisenmenger's complex is an indication for a heart-lung transplant - Right heart failure - pulmonary hypertension Pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality

Answer 50

Ventricular septal defects (VSD) are the most common cause of congenital heart disease. They close spontaneously in around 50% of cases. Aetiology Congenital VSDs are often association with chromosomal disorders - Down syndrome - Edward's syndrome - Patau syndrome - cri-du-chat syndrome - congenital infections acquired causes - post-myocardial infarction

Answer 51

Severe pre-eclampsia - restrict fluids Important for meLess important Restrictions of fluids to 80 mL/hr i

Answer 52

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

Answer 53

RILE Right-sided murmur → heard best on Inspiration Left-sided murmur → heard best on Expiration

Answer 54

Patients with recurrent venous thromboembolic disease may be considered for an inferior vena cava filter.

Answer 55

Target INR aortic: 3.0 mitral: 3.5

Answer 56

Flecainide is a Vaughan Williams class 1c antiarrhythmic. It slows conduction of the action potential by acting as a potent sodium channel blocker (specifically the Nav1.5 sodium channels). This may be reflected by widening of the QRS complex and prolongation of the PR interval.

Answer 57

Adverse effects negatively inotropic bradycardia proarrhythmic oral paraesthesia visual disturbances

Answer 58

Causes of left axis deviation (LAD) left anterior hemiblock left bundle branch block inferior myocardial infarction Wolff-Parkinson-White syndrome* - right-sided accessory pathway hyperkalaemia congenital: ostium primum ASD, tricuspid atresia minor LAD in obese people Causes of right axis deviation (RAD) right ventricular hypertrophy left posterior hemiblock lateral myocardial infarction chronic lung disease → cor pulmonale pulmonary embolism ostium secundum ASD Wolff-Parkinson-White syndrome* - left-sided accessory pathway normal in infant < 1 years old minor RAD in tall people

Answer 59

Ivabradine use may be associated with visual disturbances including phosphenes and green luminescence

Answer 60

In older adults, the main factor that accounts for a large pulse pressure is reduced aortic compliance

Answer 61

Obese, young female with headaches / blurred vision think idiopathic intracranial hypertension

Answer 62

- Weight Loss - Carbonic anhydrase inhibitors e.g. acetazolamide - topiramate, is also used, and has the added benefit of causing weight loss in most patients - Repeated lumbar puncture may be used as a temporary measure but is not suitable for longer-term management - Surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure

Answer 63

Poor prognostic factors Staphylococcus aureus infection (see below) prosthetic valve (especially 'early', acquired during surgery) culture negative endocarditis low complement levels Mortality according to organism staphylococci - 30% bowel organisms - 15% streptococci - 5%

Answer 64

Infective endocarditis - streptococcal infection carries a good prognosis

Answer 65

bendroflumethiazide acts at the proximal part of the distal convoluted tubules

Answer 66

Foods to avoid - tyramine-containing foods e.g. cheese, pickled herring, Bovril, Oxo, Marmite, broad beans

Answer 67

JVP: cannon waves Caused by the right atrium contracting against a closed tricuspid valve. May be subdivided into regular or intermittent - Regular cannon waves ventricular tachycardia (with 1:1 ventricular-atrial conduction) Atrioventricular nodal re-entry tachycardia (AVNRT) - Irregular cannon waves Complete heart block

Answer 68

Features of severe aortic stenosis narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure

Answer 69

Atrial septal defects (ASDs) are the most likely congenital heart defect to be found in adulthood. They carry a significant mortality, with 50% of patients being dead at 50 years. Two types of ASDs are recognised, ostium secundum and ostium primum. Ostium secundum are the most common Features ejection systolic murmur, fixed splitting of S2 embolism may pass from venous system to left side of heart causing a stroke Ostium secundum (70% of ASDs) associated with Holt-Oram syndrome (tri-phalangeal thumbs) ECG: RBBB with RAD Ostium primum present earlier than ostium secundum defects associated with abnormal AV valves ECG: RBBB with LAD, prolonged PR interval

Answer 70

Long QT syndrome - usually due to loss-of-function/blockage of K+ channels

Answer 71

Takayasu's arteritis Takayasu's arteritis is a large vessel vasculitis. It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse. It is more common in younger females (e.g. 10-40 years) and Asian people. Features systemic features of a vasculitis e.g. malaise, headache unequal blood pressure in the upper limbs carotid bruit and tenderness absent or weak peripheral pulses upper and lower limb claudication on exertion aortic regurgitation (around 20%) Associations renal artery stenosis Investigations vascular imaging of the arterial tree is required to make a diagnosis of Takayasu's arteritis either magnetic resonance angiography (MRA) or CT angiography (CTA) Management steroids

Answer 72

Causes of ST depression - secondary to abnormal QRS (LVH, LBBB, RBBB) - ischaemia - digoxin - hypokalaemia - syndrome X

Answer 73

In mitral stenosis, an opening snap indicates the leaflets still have some mobility

Answer 74

Dentistry in warfarinised patients - check INR 72 hours before procedure, proceed if INR < 4.0

Answer 75

NICE guidelines recommend the introduction of an ACE inhibitor prior to a beta-blocker in patients with chronic heart failure

Answer 76

Mechanism of action inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels other actions include reducing cellular uptake of adenosine and inhibition of thromboxane synthase

Answer 77

An increased risk of aortic dilatation and dissection is the most serious long-term health problem for women with Turner's syndrome

Answer 78

Pulmonary arterial hypertension (PAH) may be defined as a resting mean pulmonary artery pressure of >= 20 mmHg. Endothelin is thought to play a key role in the pathogenesis of PAH. It is more common in females and typically presents between the ages of 30-50 years.

Answer 79

If there is a positive response to acute vasodilator testing (a minority of patients) oral calcium channel blockers If there is a negative response to acute vasodilator testing (the vast majority of patients) - prostacyclin analogues: treprostinil, iloprost - endothelin receptor antagonists non-selective: bosentan selective antagonist of endothelin receptor A: ambrisentan - phosphodiesterase inhibitors: sildenafil Patients with progressive symptoms should be considered for a heart-lung transplant.

Answer 80

Pulsus paradoxus greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration severe asthma, cardiac tamponade Slow-rising/plateau aortic stenosis Collapsing aortic regurgitation patent ductus arteriosus hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy) Pulsus alternans regular alternation of the force of the arterial pulse severe LVF Bisferiens pulse 'double pulse' - two systolic peaks mixed aortic valve disease 'Jerky' pulse hypertrophic obstructive cardiomyopathy* *HOCM may occasionally be associated with a bisferiens pulse

Answer 81

Pulsus alternans - seen in left ventricular failure

Answer 82

Causes of a loud S2 hypertension: systemic (loud A2) or pulmonary (loud P2) hyperdynamic states atrial septal defect without pulmonary hypertension Causes of a soft S2 aortic stenosis Causes of fixed split S2 atrial septal defect Causes of a widely split S2 deep inspiration RBBB pulmonary stenosis severe mitral regurgitation Causes of a reversed (paradoxical) split S2 (P2 occurs before A2) LBBB severe aortic stenosis right ventricular pacing WPW type B (causes early P2) patent ductus arteriosus

Answer 83

Aspirin is a non-reversible COX 1 and 2 inhibitor. -Aspirin is a non-reversible inhibitor of COX 1 and COX 2. It inhibits the conversion of arachidonic acid to prostaglandin, prostacyclin, and thromboxane. Thromboxane A2 promotes platelet aggregation and vasoconstriction. High-dose aspirin is given acutely in acute coronary syndrome to prevent enlargement of the coronary thrombus.

Answer 84

Hyperuricaemia may be associated with both hyperlipidaemia and hypertension. It may also be seen in conjunction with the metabolic syndrome

Answer 85

Mechanism of action inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form this in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C.

Answer 86

Second heart sound (S2) loud: hypertension soft: AS fixed split: ASD reversed split: LBBB

Cardiology Flashcards

(119 cards)