passmed

Question 1

long QT - what is normal

Answer 1

QT interval in females = <450ms and in males <430ms

Question 2

causes of long QT syndrome

Answer 2

Inherited mutations - Jervell Lange Nielsen, Romano Ward
Acquired causes:
-Electrolyte imbalance - HYPOKALAEMIA, HYPOCALCAEMIA, HYOPMAGNAESAEMIA
-Meds - tramadol, amiodarone, TCAs, SSRIs, erythmocyin, methadone, chloroquine, terfenadine etc
-CNS lesions: SAH + ischaemic stroke
-Malnutrition
-Hypothermia

Question 3

what can long QT syndrome lead to

Answer 3

VT / TdP –> collapse/sudden death

Question 4

cholesterol of 5.1 + QRISK score of 11%

what is the mx

Answer 4

statins - atorvastatin 20mg 1st line for primary prevention

• INCREASE DOSE IF NON-HDL has not REDUCED by >40%
• atorvastatin 80mg for secondary prevention
• simvastatin for those who can’t tolerate it
• save dietary measures for those with qrisk <10%

Question 5

statins MoA and adverse effects (3)

Answer 5

HMG CoA reductase INHIBITOR , rate-limiting enzyme, in hepatic CHOLELSTEROL synthesis
Adverse effects:
-MYOPATHY - myalgia, myositis, rhabdomyolysis + asympt raised CK
-LIVER IMPARIMENT - check LFTs at baseline, 3m, 12m
-STATINS - can incr risk of ICH in pts who hv had previous stroke - effect not seen in primary prevention

Question 6

statins CI (2)

Answer 6

Macrolides = stop statins till pt course complete

pregnancy

Question 7

difference between primary and secondary preventio

Answer 7

primary - measures to prevent onset of illness before disease process begins eg QRISK >10% OR most T1DM pts OR CKD eGFR<60 —> ATORVASTATIN 20mg
secondary - measures that lead to early dx and prompt tx of disease eg known IHD OR CVD OR PAD –> ATORVASTATIN 80mg OD

Question 8

ECG changes for thrombolysis or PCI

Answer 8

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

Question 9

how do loop diuretics work

Answer 9

furosemide and bumetanide are loop diuretics that act by INHIBITING NA-K-Cl cotransporter in the thick ascending LoH, reducing the absorption of NaCl

Question 10

Loop diurtics adverse effeects

Answer 10

LOW BP, Na+, K+, Mg+, Cl
LOW Ca2+ –> excess PTH secretion –> more calcium released from bone –> weakens structure
RENAL IMPAIRMENT (from dehydration + direct toxic effect)
HIGH GLUCOSE (less common than with thiazides)
GOUT

Question 11

posterior MIs ECG findings

Answer 11

cause reciprocal changes in V1-3 (anterior leads) as these leads are directly opposite posterior surface

• ST depression
• tall broad R waves
• upright T waves
• dominant R wave in V2

Question 12

complete heart block following an MI, where is the lesion

Answer 12

commonly RCA lesion

-AVN is supplied by a branch of the RCA, posterior interventricular artery

Question 13

aortic stenosis mx

Answer 13

• observe pt is general rule
• if symptomatic then valve replacement
• if asymptomatic but valvular gradient >40mmHg and features eg LV systolic dysfunction then consider surgery
• as CVD can coexist, often do angiogram before surgery so procedures can be combined with PCI
• BALLOON VALVULOPLASTY limited to pts with critical aortic stenosis

Question 14

acute pericardits acute mx

Answer 14

NSAIDs + colchicine used 1st line - for pts with acute idiopathic or viral pericarditis

Question 15

thiazides affect on calcium levels - in blood + urine

Answer 15

BLOOD - HYPERCALCAEMIA

URINE - HYPOCALCIURIA

Question 16

MX for bradycardia + signs of shock

Answer 16

require 500micrograms of IV atropine (repeated up to max 3mg)

• bradycardia only req tx when HR is less than 60 + SYMPTOMATIC/signs of haemodynamic compromise
• if this fails then consider TCPacing
• NB. amiodarone is a RF for dev severe bradycardai

Question 17

cardiac tamponade becks triad

Answer 17

HYPOTENSION
RAISED JVP
MUFFLED HEART SOUNDS

Question 18

cardiac tamponade : JVP, Pulsus Paradoxus, Kussmauls sign

Answer 18

JVP - absent Y descent - TAMpaX
PP - present
K..Sign - Rare

Question 19

Constrictive pericarditis: JVP, Pulsus paradoxus, Kussmauls, Char Feat

Answer 19

JVP - X+Y present
PP - absent
Kussmauls- present - JVP rises on inspiration
Char feat - pericardiac calcification on CXR

Question 20

trifascicular block

Answer 20

RBBB + left anterior or posterior hemiblock + 1st-degree heart block = trifasicular block

Question 21

bifascicular block

Answer 21

combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation

Question 22

how to reduce the risk of sudden cardiac death in HOCM

Answer 22

ICD

Question 23

can LBBB be normal in athletes

Answer 23

NO NEVER NORMAL - means underlying ischaemic or structural heart disease

Question 24

what are cannon a waves and when do they occur

Answer 24

due to atria and ventricles contracting together –> RA contracts against closed tricuspid valve , column of blood shoots up the SVC into the jugular vein
-COMPLETE HEART BLOCK

Question 25

what JVP waveform is seen in TR

Answer 25

Large V waves

-ventricular contraction causing blood to surge through an incompetent TV through RV into Jugular vein

Question 26

what is Kussmaul sign + what is it caused by

Answer 26

paradoxical rise in JVP on inspiration
-caused by conditions that impari ventricular filling
eg CONSTRICTIVE PERICARDITIS

Question 27

what JVP waveform is seen with tricuspid stenosis

Answer 27

Slow Y descent

Question 28

what happens to JVP in SVCO

Answer 28

raised JVP with ABSENT PULSATION

Question 29

what is dresslers syndrome

Answer 29

PERICARDITIS after MI (can cause pericardial effusion)
2-10 weeks later due to production of AUTOANTIBODIES after MI
DIFFERENT to simple post-MI pericarditis 2-4 DAYS after MI