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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

(60 cards)

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1
Q

Features of aortic regurgitation

A

S3
High-pitched, decrescendo early diastolic murmur.
Collapsing pulse
Wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)

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2
Q

First line treatment in atrial flutter

A

Catheter radiofrequency ablation

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3
Q

Medications that cause bradyarrhythmias

A

Digoxin
Beta-blocker
Diltiazem
Amiodarone.

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4
Q

4 main underlying heart rhythms in a cardiac arrest

A

Shockable - Pulseless VT + Ventricular fibrillation
Non-shockable - Pulseless electrical activity (PEA) + Asystole

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5
Q

Reversible causes of cardiac arrest

A

hypoxia, hypovolaemia, hypothermia, hypo/hyperkalaemia (or other metabolic disturbances, eg magnesium or calcium)

thrombosis (coronary or pulmonary MI/PE), tension pneumothorax, tamponade (cardiac), toxins.

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6
Q

Beck’s triad (cardiac tamponade)

A

Hypotension, elevated JVP and muffled heart sounds

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7
Q

Enzyme Inhibition Drugs + Fruit

A

Omeprazole
Disulfuram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides

Grapefruit
Cranberry

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8
Q

Pan systolic murmur at apex

A

Mitral regurgitation

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9
Q

Mid-late diastolic murmur

A

Mitral stenosis

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10
Q

Right-sided heart failure signs

A

Raised JVP
Ascites,
Hepatomegaly (non-pulsatile),
Oedema
Cachexia.

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11
Q

Hyperkalaemia ECG changes

A

Tall T waves, widened QRS, VF and asystole.

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12
Q

ACEi Side Effects

A

cough
hyperkalaemia
first-dose hypotension

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13
Q

ECG Changes for MI

A

Anterior - V1-V4 Left anterior descending
Inferior - II, III, aVF Right coronary
Lateral - I, V5-6 Left circumflex

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14
Q

Infection occurring 4-6 weeks post MI

A

Dressler’s syndrome (Acute pericarditis)

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15
Q

ECG Changes for Pericarditis

A

Widespread
‘Saddle-shaped’ ST elevation
PR depression

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16
Q

First line treatment for pericarditis

A

NSAIDs/Colchicine

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17
Q

SVT Termination Drug

A

Adenosine

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18
Q

Prasugrel contraindications

A

Prior stroke or TIA, high risk of bleeding, and prasugrel hypersensitivity

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19
Q

Ticagrelor contraindications

A

High risk of bleeding, history of ICH and severe hepatic dysfunction.

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20
Q

Non shockable rhythm treatment

A

Adrenaline 1 mg as soon as possible
Repeat adrenaline 1mg every 3-5 minutes

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21
Q

Shockable rhythm treatment

A

Adrenaline 1 mg is given after the third shock
Amiodarone 300 mg after 3 shocks
Then amiodarone 150 mg after 5 shocks
Lidocaine alternative for amiodarone

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22
Q

PE suspected in cardiac arrest

A

Thrombolytic drugs
CPR should be continued for an extended period of 60-90 minutes

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23
Q

Amiodarone SEs

A

Thyroid dysfunction: hypothyroidism and hyper-thyroidism
Corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Peripheral neuropathy, myopathy
Photosensitivity
‘Slate-grey’ appearance
Thrombophlebitis and injection site reactions
Bradycardia
Lengthens QT interval

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24
Q

Angina Treatment

A

Beta-blocker or a calcium channel blocker first-line
if calcium channel blocker used as monotherapy use verapamil or diltiazem
if combined with beta-blocker then use amlodipine, modified-release nifedipine

Add ons:
a long-acting nitrate
ivabradine
nicorandil
ranolazine

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25
Angiotensin II receptor blockers examples and SEs
Candesartan, losartan, irbesartan Hypotension and hyperkalaemia.
26
ACS DAPT
Aspirin (lifelong) & ticagrelor (12 months) If aspirin contraindicated, clopidogrel (lifelong)
27
Aortic stenosis signs
Ejection systolic murmur Radiates to the carotids Decreased following the Valsalva manoeuvre
28
Naxos disease
Autosomal recessive variant of arrhythmogenic right ventricular cardiomyopathy Triad of ARVC, palmoplantar keratosis, and woolly hair
29
Arrhythmogenic right ventricular cardiomyopathy symptoms and ECG changes
Palpitations, syncope, sudden cardiac death Abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - a terminal notch in the QRS complex
30
AF Rate Control
betablocker diltiazem digoxin
31
Cardioversion for AF
<48 hrs: electrical - 'DC cardioversion' pharmacology - amiodarone if structural heart disease, flecainide or amiodarone in those without structural heart disease >48hrs: anticoagulation should be given for at least 3 weeks prior
32
Atropine Uses
First line bradycardia treatment Organophosphate poisoning
33
Bivalirudin
Reversible direct thrombin inhibitor used as an anticoagulant in management of ACS
34
Brugada syndrome ECG changes
Convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave Partial right bundle branch block
35
Cholesterol embolisation features
eosinophilia purpura renal failure livedo reticularis
36
Heart Failure Treatment
1st line: ACE-inhibitor and a beta-blocker 2nd line: aldosterone antagonist + SGLT-2 inhibitors 3rd line: ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy
37
Clopidogrel uses
First-line in patients following an ischaemic stroke and in patients with peripheral arterial disease.
38
Constrictive pericarditis Features
dyspnoea right heart failure: elevated JVP, ascites, oedema, hepatomegaly JVP shows prominent x and y descent pericardial knock - loud S3 Kussmaul's sign is positive CXR - pericardial calcification
39
Cardiac tamponade features
Classical features - Beck's triad: hypotension raised JVP muffled heart sounds Other features: dyspnoea tachycardia an absent Y descent on the JVP - this is due to the limited right ventricular filling pulsus paradoxus - an abnormally large drop in BP during inspiration Kussmaul's sign - much debate about this ECG: electrical alternans
40
ECG: digoxin
down-sloping ST depression ('reverse tick', 'scooped out') flattened/inverted T waves short QT interval arrhythmias e.g. AV block, bradycardia
41
ECG: hypokalaemia
U waves small or absent T waves (occasionally inversion) prolong PR interval ST depression long QT
42
ECG: hypothermia
bradycardia 'J' wave (Osborne waves) - small hump at the end of the QRS complex first degree heart block long QT interval atrial and ventricular arrhythmias
43
Increased P wave amplitude
Cor pulmonale
44
Broad, notched (bifid) P waves
Sign of left atrial enlargement, classically due to mitral stenosis
45
Eclampsia Treatment
IV bolus MgSO4 4g over 5-10 minutes followed by an infusion of 1g / hour Continue for 24 hours after last seizure /delivery
46
Hypercalcaemia features
'bones, stones, groans and psychic moans' corneal calcification shortened QT interval on ECG hypertension
47
HOCM Echo findings
mitral regurgitation (MR) systolic anterior motion (SAM) of the anterior mitral valve leaflet asymmetric hypertrophy (ASH)
48
ICD Indications
long QT syndrome HOCM previous cardiac arrest due to VT/VF previous MI with non-sustained VT on 24 hr monitoring, inducible VT on electrophysiology testing and ejection fraction < 35% Brugada syndrome
49
Kawasaki disease management
High-dose aspirin IV immunoglobulin
50
Mitral stenosis common causes
Rheumatic fever
51
Ejection Systolic Murmur
Louder on expiration: aortic stenosis hypertrophic obstructive cardiomyopathy Louder on inspiration: pulmonary stenosis atrial septal defect also: tetralogy of Fallot
52
Pansystolic murmurs
mitral/tricuspid regurgitation (high-pitched and 'blowing' in character) tricuspid regurgitation becomes louder during inspiration ventricular septal defect ('harsh' in character)
53
Late systolic murmur
mitral valve prolapse coarctation of aorta
54
Early diastolic murmurs
aortic regurgitation (high-pitched and 'blowing' in character) Graham-Steel murmur (pulmonary regurgitation, again high-pitched and 'blowing' in character)
55
Mid-late diastolic murmur
mitral stenosis ('rumbling' in character) Austin-Flint murmur (severe aortic regurgitation, again is 'rumbling' in character)
56
Continuous machine murmur
patent ductus arteriosus
57
Pre eclampsia triad
new-onset hypertension proteinuria oedema
58
Atrial septal defect murmur
ejection systolic murmur louder on inspiration
59
Ambrisentan (MOA)
endothelin receptor A antagonist
60

MRCP Part 1 (3 decks)

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