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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

(73 cards)

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1
Q

What medication can increase HDL levels

A

nicotinic acid

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2
Q

what are side effects of nicotininc acid

A

flushing: mediated by prostaglandins
impaired glucose tolerance
myositis

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3
Q

give causes of restricted cardiomyopathy

A

amyloidosis (e.g. secondary to myeloma) - most common cause in UK
haemochromatosis
post-radiation fibrosis
Loffler’s syndrome: endomyocardial fibrosis with a prominent eosinophilic infiltrate
endocardial fibroelastosis: thick fibroelastic tissue forms in the endocardium; most commonly seen in young children
sarcoidosis
scleroderma

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4
Q

what features would suggest a restrictive cardiomyopathy rather than constrictive pericarditis

A

prominent apical pulse
absence of pericardial calcification on CXR
the heart may be enlarged
ECG abnormalities e.g. bundle branch block, Q waves

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5
Q

what is coartication of the aorta

A

congenital narrowing of the descending aorta

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6
Q

give conditions associated with coartication of the aorta

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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7
Q

what is the strongest preditor of mortality and morbidity affter a STEMI

A

excercise capacity

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8
Q

what are the contraindications to excercise tolerance test

A

myocardial infarction less than 7 days ago
unstable angina
uncontrolled hypertension (systolic BP > 180 mmHg) or hypotension (systolic BP < 90 mmHg)
aortic stenosis
left bundle branch block: this would make the ECG very difficult to interpret

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9
Q

what would be your maximum predicted heart rate

A

220-patient age

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10
Q

what is the mechanism of action of ticagrelor

A

Ticagrelor is a P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependent platelet activation and aggregation

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11
Q

what actually causes patients to feel breathless on ticagrelor

A

adenosine accumulation

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12
Q

how does aspirin work

A

blocking prostaglandin synthesis. It is non-selective for COX-1 and COX-2 enzymes.

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13
Q

what medication can reduce the antiplatelet effect of clopidogrel

A

PPIs

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14
Q

what SPECIFIC ECG feature is present in pericarditis

A

PR depression

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15
Q

give causes of pericarditits

A 
viral infections (Coxsackie)
tuberculosis
uraemia (causes 'fibrinous' pericarditis)
trauma
post-myocardial infarction, Dressler's syndrome
connective tissue disease
hypothyroidism
malignancy
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16
Q

what investigation must be done for all pericarditis patients

A

echo

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17
Q

clinical features of aortic stenosis

A

chest pain
dyspnoea
syncope
murmur
an ejection systolic murmur (ESM) is classically seen in aortic stenosis
classically radiates to the carotids
this is decreased following the Valsalva manoeuvre

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18
Q

examination features of aortic stenosis

A 
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure
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19
Q

what is the management of aortic stenosis

A

if asymptomatic then observe the patient is general rule
if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
cardiovascular disease may coexist. For this reason an angiogram is often done prior to surgery so that the procedures can be combined
balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacemen

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20
Q

what are the causes of aortic stenosis

A

degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

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21
Q

what is the mechanism of long QTc

A

caused by defects in the alpha subunit of the slow delayed rectifier potassium channel.

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22
Q

what is a normal Qtc

A

430 in males

450 in females

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23
Q

name congenital causes of long qt syndrome

A

Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)
Romano-Ward syndrome (no deafness)

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24
Q

name drugs that prolong QT

A 
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
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25
give other causes of long QT (not drugs or congenital)
``` electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia acute myocardial infarction myocarditis hypothermia subarachnoid haemorrhage ```
26
How do statins work
by inhibiting HMG-CoA reductase (the rate limiting enzyme in hepatic cholesterol synthesis)
27
what are the containdications of statins
macrolides - clarithromycin, erythromycin pregnancy avoid if previous cerebral haemorrhage can cause myopathies discontinue if treatment has resulted in persistance of liver enzymes at 3 times the upper limit of normal
28
who should get a statin
all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease) following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10% patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
29
what type of statin should the person get
atorvastiain 20mg for primary prevention (increase the dose if non-HDL has not reduced for >= 40%) atorvastatin 80mg for secondary prevention
30
how is pericarditis treated
NSAID +/- colchicine all patients get an echo
31
how does amioderone work
blocks voltage gated calcium channels
32
how does dypyridamole work
phosphodiesterase inhibitor - reduces intercelular calcium and decreases cellular uptake of adensine
33
outline the two types of aortic dissection
type A - ascending aorta, 2/3 of cases | type B - descending aorta, distal to left subclavian origin, 1/3 of cases
34
what territory of MI is seen in aortic dissection
often inferior MI due to involvment of the right coronary artery
35
what murmur can you get with aortic dissection
aortic regurgitation
36
what is the half life of amioderone
20-100 days
37
what is streptococcus bovis associated with
bowel cancer
38
what medications can reduce the effect of adenosisne
aminophyline
39
where does furosemide act
the triple cotransporter on the ascending loop of henle
40
what causes eruptive xanthoma
familial hypertriglyceridaemia
41
where is the most common site for an atrial myxoma
left
42
what gene mutation is associated with brugada syndrome
SCN5A
43
what is eisenmengers syndrome
reversal of a left to right shunt due to congential hear defects - causes pulmonary hypertension
44
what drugs should you avoid in HOCM
ACE inhibitors ionotrpes nitrates
45
what can cause a falsely low BNP
obesity
46
what can be used for reversal of dabigatran
Idarucizumab
47
what would be the indications for surgical intervention in endocarditis
severe valvular incompetence aortic abscess (often indicated by a lengthening PR interval) infections resistant to antibiotics/fungal infections cardiac failure refractory to standard medical treatment recurrent emboli after antibiotic therapy
48
what should not be given in an inferior MI causing right ventricular dysfunction
nitrates - cause peripheral venodilation and therefor reduce preload to the heart
49
what are irregular cannon a waves associaeed with
complete heart block
50
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
51
slow rising pulse
aortic stenosis
52
collapsing pulse
``` aortic regurgpatent ductus arteriosus hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy) ```
53
pulsus alternans
severe LVF
54
bisferiens pulse
'double pulse' - two systolic peaks | mixed aortic valve disease
55
jerky pulse
HOCM
56
what is cardiac x syndrome
also called microvascular angina. Patients have a normal ECG at rest and normal coronary arteries but develop ST depression on exercise stress testing.
57
what is the mechanism of action of aspirin
inhibits the production of thromboxane A2
58
what is the functions of bnp
vasodilator diuretic and natriuretic suppresses both sympathetic tone and the renin-angiotensin-aldosterone system
59
give the indications for an implantable cardiac defibrillato
``` long QT syndrome hypertrophic obstructive cardiomyopathy previous cardiac arrest due to VT/VF previous myocardial infarction with non-sustained VT on 24 hr monitoring, inducible VT on electrophysiology testing and ejection fraction < 35% Brugada syndrome ```
60
what are u waves associated with
hypokalaemia
61
in what condition do u see delta waves
WPW | 'slurred upstroke' in QRS
62
what is Catecholaminergic polymorphic ventricular tachycardia
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.
63
how is catecholaminergic polymorphic VT treated
beta blocker | ICD
64
what causes CPVT
the most common cause is a defect in the ryanodine receptor (RYR2) which is found in the myocardial sarcoplasmic reticulum
65
what drug can precipaitate VF if used in VT
verapamil
66
what other factors can increase BNP levels
``` Ischaemia Tachycardia Right ventricular overload Hypoxaemia (including pulmonary embolism) GFR < 60 ml/min Sepsis COPD Diabetes Age > 70 Liver cirrhosis ```
67
what can cause decreased BNP levels
``` Obesity Diuretics ACE inhibitors Beta-blockers Angiotensin 2 receptor blockers Aldosterone antagonists ```
68
what marker is useful to look for reinfarction after an MI
CK-MB | as this returns to normal within 3 or 4 days
69
how do u treat torsades de pointes
magnesium
70
what rises first in an MI
myoglobin
71
epsilon waves are seen in what
ARVC
72
what is the first line treatment of congenital prolonged QT
beta blockers
73
what drug should be avoid in WPW
verapamil and digoxin

MRCP Part 1 (12 decks)

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