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RACP > Cardiology > Flashcards

Cardiology Flashcards

(48 cards)

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1
Q

Genetic causes of familial hypercholesterolemia.

A

ApoB/E
ApoB
PCSK9 gain of function

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2
Q

Genetic causes of familial dysbetalipoproteinemia.

A

ApoE2/E2

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3
Q

Genetics of hypertriglyceridemia.

A

LPL gene

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4
Q

What electrolyte abnormalities worsen digoxin toxicity?

A

Hypokalaemia
Hypomagnesemia
Hypermagnesemia
Hypercalcaemia

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5
Q

What protein is the major component of cardiac relaxation?

A

Tropomyosin

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6
Q

Shunt fraction equation

A

(Aortic oxygen sats - mixed venous sats) / (pulmonary venous sats - pulmonary artery sats)

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7
Q

Which protein mutation is associated with ARVD?

A

Plakophilin 2 leading to desmosome dysfunction

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8
Q

What proteins are associated with HCM?

A

Alpha tropomyosin

Beta myosin heavy chain

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9
Q

Which form of metoprolol is used in hfpef?

A

Metoprolol succinate

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10
Q

What are the characteristic examination findings in HOCM?

A

Systolic murmur (AS and MR)

Softer - hand grip and squatting

Louder - standing and valsalva

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11
Q

Medications to avoid in HOCM?

A

Vasodilators

Diuretics

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12
Q

What is the medical management of HOCM?

A

Beta blockers

Ace inhibitors can be considered in severe symptomatic disease with low EF

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13
Q

What is the device management of HOCM?

A

2 or more major risk factors - for ICD

Survived SCA or VT - for ICD

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14
Q

What are the major risk factors of SCD in HOCM?

A 
Prior sustained ventricular arrhythmia 
Family history of SCD due to HCM
Syncope of cardiac origin 
Multiple episodes of NSVT
Massive LV hypertrophy >3cm
LV apical aneurysm 
End stage dis are with EF <50%
CMR with extensive LGE
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15
Q

What is the mechanism of Levosimendin?

A

Calcium sensitiser

PDE inhibitor in high doses

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16
Q

Which inotrope is renoprotective in low doses.

A

Dopamine

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17
Q

In what circumstances is ICD placement not recommended?

A

Reversible cause of VT/VF
Expected survival <1 year
If catheter ablation is a treatment option
Severe psychiatric illness
Class 4 heat failure who are not transplant or CRT candidates
Syncope without structural heart disease
Active infection

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18
Q

What are the indications for ICD in secondary prevention?

A

Resuscitated ventricular arrhythmia without reversible cause

Spontaneous VT with heart disease

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19
Q

In what primary prevention settings would you consider ICD placement?

A

MI 40 days prior with EF <30%
NYHA 2-3 with cardiomyopathy and EF <35%
Syncope with structural heart disease
Underlying disorder with high risk for ventricular arrhythmia (long qt, brugada, ARVD)

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20
Q

What are the patient selection criteria for CRT?

Study These Flashcards
A

NYHA 3-4

  • Wide qrs >120 (LBBB)
  • Low EF <35%

NYHA 2
- qrs >150

21
Q

What are the indications for heart transplant?

Study These Flashcards
A

Refractory class 3-4 heart failure
Severe ischaemia not amenable to intervention
Recurrent refractory ventricular arrhythmia
VO2 max <14ml/kg/min

22
Q

What drugs should be avoided in heart failure (non exhaustive)

Study These Flashcards
A

Nsaids
Thiazolidinediones
Diltiazem and verapamil

23
Q

What is the mechanism of the PCSK9 inhibitors

Study These Flashcards
A

PCSK9 causes LDL receptor internalisation and degradation.

Inhibition results in increased LDL receptors, reducing LDL serum levels

24
Q

What are the indications for statin therapy in primary prevention?

Study These Flashcards
A

Diabetes mellitus
LDL >4.9
10 year Cardiovascular risk >7.5%

25
What did the Promise study show regarding outcomes between CTCA and Functional studies in the setting of IHD investigation?
Equivalent hard endpoints | More coronary angio in anatomical imaging group
26
What is the indication for coronary calcium scoring?
Intermediate 10 year risk. (10-20%)
27
What is the ARR of cardiovascular death with FFR guided stent placement?
5%
28
What is the mechanism of ticagrelor mediated ventricular pauses and dyspnoea?
Adenosine
29
Is thrombectomy routine in stemi? Why/why not?
No Increased stroke risk for no benefit TOTAL TRIAL
30
What did the PRAMI study show regarding preventative PCI in the setting of ACS
Preventative PCI reduced non fatal MI if non culprit lesions was stented.
31
What did the CANTOS trial conclude regarding canakinumab use in the setting of IHD?
Reducing inflammation reduces cardiovascular events Canakinumab increased death rate from sepsis Overall, no mortality improvement
32
What are the high risk features of NSTEMI?
``` Repetitive or prolonged (<10 min) CP Elevated cardiac biomarker Dynamic ECG changes Transient St elevation (>0.5mm) Haemodynamic compromise Sustained VT Syncope PCI in last 6 months Prior CABG Diabetes Chronic kidney disease Left ventricular systolic dysfunction ```
33
What did the RACE 2 trial show regarding heart rate goals in AF?
No difference in outcome between HR of 110 vs 80
34
A rhythm control strategy is chosen for a patient with AF. What is the preferred agent in the setting of 1. Structurally normal heart 2. Ischaemic heart disease 3. Heart failure or structurally abnormal heart
1. Flecainide 2. Sotalol 3. Amiodarone
35
What is the management of LQTS?
1. Avoid competitive sports 2. Avoid qt prolonging drugs Previous VT - beta blocker and ICD No VT, high risk - beta blocker and ICD No VT, low risk - beta blocker
36
What is the management of VT in heart disease?
1. Beta blocker and ICD 2. Add antiarrhythmic (still symp) 3. Catheter ablation (still symp)
37
What are the contraindications to prasugrel?
Age >75 Hepatic impairment TIA or stroke
38
Ticagrelor contraindications
``` Hepatic impairment Weight <60 Bradycardia Gout ICH or peptic ulcers ```
39
What is the classical ecg finding in CPVT?
Bidirectional VT
40
What is the most common genetic cause of CPVT?
Ryanodine receptor mutation | Autosomal dominant
41
What do PCSK9 inhibitors increase?
VLDL
42
Which channel is responsible to maintaining the testing potential of ventricular cardiomyocytes?
Inward rectifier K channel currents
43
What are the three most common causes of aortic stenosis?
Calcification Rheumatic heart disease Congenital bicuspid valve
44
What are the causes of chronic AR?
``` Rheumatic disease Infective endocarditis Degenerative disease Collagen vascular disease Surgical/traumatic Aortic root dilation Inflammatory (AS, syphilitic aortitis) ```
45
What are the causes of mitral stenosis?
``` Rheumatic heart disease Degenerative Radiation associated Congenital Inflammatory (SLE and RA) Carcinoid disease Whipples disease Fabrys disease ```
46
What are the causes of chronic MR?
``` Degenerative disease Rheumatic heart disease Infective endocarditis Traumatic Drugs (bromocriptine, cabergoline) ```
47
Mechanism of ezetimibe?
Decreased cholesterol absorption.
48
Mechanism of fenofibrate?
PPAR agonist | Increase lipoprotein lipase

RACP (16 decks)

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