Cardiology Flashcards

Question

CREST and beta blockers

Answer 1

can worsen raynauds

Answer 2

Elongated transverse aortic arch – 40-50% Bicuspid aortic valve – 15-30% (although this is actually the risk of aortic valve abnormalities in total which is mainly Bicuspid aortic valve) Coarctation of Aorta – up to 17% Ventricular Septal Defect 1-4% Atrial Septal Defect 1-2%

Answer 3

This lady has an atrial septal defect. Indications for surgery include presence of symptoms (particularly orthodexia platypnoea), evidence of RV failure with a Qp/Qs>1.5/1, the presence of a paradoxical embolism in a patient less than 60 years old with other causes of stroke being excluded. The presence of severe pulmonary hypertension and/or Eisenmenger syndrome contraindicates surgery as at this point it is too late.

Answer 4

Nitroprusside or dobutamine - to allow foward flow Avoid beta blocker as it may take way compensatory tachycardia --> hypotension

Answer 5

Good results in less LDL-R breakdown, thus more LDL-R on surface --> reduce circulating LDL

Answer 6

- smoking cessation represents the single most effective nonsurgical intervention to reduce the risk of aneurysm-related complications and/or death.

Answer 7

Both ostium primum and secondum are associated with RBBB, with primum having left axis deviation typically where as secondum is associated with right axis deviation. Ostium primum defects tend to occur low down in the AV septum and therefore can affect the function of the anterior leaflet of the mitral valve causing mitral regurgitation

Answer 8

* Limitations include false positives due to a hypertensive response during exercise * false negatives in patients with single vessel disease * the potential of rapid resolution of ischaemia prior to image acquisition post exercise.

Answer 9

Natriuretic peptide levels are elevated in some patients with non-heart failure conditions such as coronary heart disease, valvular heart disease, pulmonary hypertension, and sepsis. Obese patients tend to have lower plasma BNP and NT-proBNP concentrations than nonobese patients. The other options listed above may elevate BNP in the absence of heart failure.

Answer 10

Sacubitril is a pro-drug NT-ProBNP should be used to monitor rather than BNP SE:hypotension, hyperkalemia, cough, dizziness, and renal failure. Angioedema is a less frequent adverse effect but may be life threatening. ## Footnote Should not use in pregnancy

Answer 11

LDL level --> Smoking --> psychosocial stressors --> abdominal obesity --> reduced exercise

Answer 12

1. There is evidence of benefit for revascularisation of non culprit lesions in ST elevation myocardial infarction. 2. Currently there is insufficient evidence suggesting that staged PCI vs index PCI is inferior/superior therefore the current recommendation is to do the intervention prior to discharge. 3. The caveat to this is with patients who present with cardiogenic shock, **culprit vessel only PCI** is preferred over multi vessel PCI due to poorer outcomes with the latter

Answer 13

* In nearly all cases, MS is caused by rheumatic involvement of the mitral valve * Atrial fibrillation is often the first trigger of symptoms in asymptomatic patients * Death from MS is due to progressive right-sided heart failure and/or pulmonary edema in over 60 percent of cases

Answer 14

TAVI is generally associated with lower rates of major bleeding and atrial fibrillation, - but higher rates of short-term aortic valve reintervention, pacemaker requirement, and paravalvular aortic regurgitation compared to SAVR.

Answer 15

(PAP-PAWP)/Qp

Answer 16

Suggestive of RV failure --> one of the indication for ASD closure

Answer 17

* History of ANY intracranial haemorrhage * Ischaemic stroke <3MONTHS * cerebral vascular malformation or a primary or metastatic intracranial malignancy * symptoms suggestive of aortic dissection * Significant closed-head or facial trauma within the preceding 3 MONTHS * A bleeding diathesis or active bleeding, with the exception of menses; thrombolytic therapy may increase the risk of moderate bleeding, which is offset by the benefits of thrombolysis

Answer 18

* large PFO * large/spontaneous R->L shunt * greater PFO flap mobility * prominent Eustachian valve or Chiari network * presence of an ASA (atrial septal aneurysm)

Answer 19

4 weeks, due to risk of AF recurrence

Answer 20

RVSP is calculated using RA + 4V^2 where RA is the right atrial pressure and V is the tricuspid jet velocity. 4+ 9x4 = 40

Answer 21

Duration of AF and size of LA

Answer 22

how to differentiate between constrictive pericarditis (TB) and restrictive cardiomyopathy (amyloidosis). The most important distinguishing factor is the finding of ventricular interdepenence on ECHO in patients with constrictive pericarditis: In patients with constrictive disease a deep inspiration causes a rise in RV pressure which causes a decrease in the LV pressure. Low voltage and raised right atrial pressures are present in both. E' is a measure of relaxation velocity- this is low in restrictive cardiomyopathy and high in constrictive cardiomyopathy

Answer 23

Age >75 Weight <60 Prev. history of stroke

Answer 24

non-invasice assessment of pan-cardiac status - quatification of capacity - detection of myocardial ischaemia via RWMA's - Causes of dyspnoea - Predictor of outcome: ischaemia, HF Ideally tredmill, but if you can't then dobutamine.

Answer 25

Metabolic abnormalities (ATP) Relaxation disturbances Contractile disturbances RWMA ECG abnormalities Angina symptoms

Answer 26

Calculate E/e' at rest and post-exercise In normal pt - the ratio remains the same (7-8). but if you have diastolic dysfunction then it will increase > 12 post exercise positive diastolic stress test is associated with poor survival and HF admission But if you had a ratio >12 at rest, and similar post exercise you had similar outcomes to those with negative study

Answer 27

1. Endocarditis - Staph: ABE - leaves abscess, valve distruction, large vegetation and embolic phenomenon, perforations - Strep etc: SBE: indolent. Vegetation without abscess or deep tissue destruction 2. Cardioversion - TOE cardioversion has a stroke risk of 0.6%, which is the same as the conventional method of waiting 4 weeks on anticoagulation

Cardiology Flashcards

(54 cards)