MRCP Part 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

(113 cards)

Study These Flashcards
1
Q

Outline the action potential physiology of the SAN and atrial/ventricular myocytes.

A

Sinoatrial node (SAN):
- Slow Na influx (HCN “pacemaker” channel)
- Rapid Ca influx (depolarisation)
- K efflux (repolarisation)

Atrial/ventricular myocytes:
- Rapid Na influx (depolarisation)
- K efflux vs Ca influx (plateau phase)
- K efflux exceeds Ca influx (repolarisation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anterior, inferior, lateral ECG leads and which coronary artery they represent?

A

Anterior = V1-V4 (left anterior descending)
Inferior = II, III and aVF (right coronary)
Lateral = I, V5, V6 (left circumflex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal PR, QRS and QTc duration?

A

PR = 0.12-0.2 secs
QRS = < 0.1 secs
QTc = 0.35-0.44 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Virchow’s triad?

A

Stasis
Endothelial damage
Hyper-coagulability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which coronary artery supplies the AVN and significance?

A

Right coronary artery
→ RCA infarcts (inferior MI) can cause heart block
→ Pacing may be required but observation appropriate if haemodynamically stable
→ LAD infarct with heart block = urgent pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ECG feature of posterior MI?

A

Reciprocal changes in leads V1-V3 (e.g. ST depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of a STEMI?

A

MONA + P2Y12 receptor antagonist then:
→ PCI if symptom onset <12 hours and available <120 mins (preferably radial access with UFH + GPI bailout)
OR
→ Thrombolysis + fondaparinux
OR
→ Medical management e.g. DAPT + fondaparinux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antiplatelet for PCI and patient with high bleeding risk?

A

PCI = prasugrel
High bleeding risk = clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ECG monitoring post-thrombolysis?

A

ECG after 60-90 mins
Consider PCI if ongoing ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List some contraindications to thrombolysis?

A

Severe hypertension
Bleeding/coagulation disorder
Active internal bleeding
Recent bleed, trauma or surgery
Stroke < 3 months ago
Intracranial neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most sensitive enzyme in MI, first enzyme to rise and best for investigating re-infarction?

A

Most sensitive = troponin I
→ elevates in 4-6 hours
→ returns to normal at 7-10 days
First to rise = myoglobin
Best for re-infarction = CK-MB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common cause of death post-MI?

A

Ventricular fibrillation (VF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complication of vascular surgery or angiography and features?

A

Cholesterol embolism:
Eosinophilia
Renal disease
Livedo reticularis
Purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of NSTEMI and unstable angina?

A

MONA + fondaparinux (if urgent PCI not planned) then:
Unstable = urgent angiography +/- PCI
GRACE score > 3% = angiography +/- PCI within 72 hours
GRACE score ≤ 3% = DAPT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Secondary drug prevention of ACS?

A

Block An ACS:
→ beta-blocker
→ aspirin (lifelong)
→ ACEi
→ clopidogrel or ticagrelor or prasugrel (12 months)
→ statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DVLA guidance for MI, cardiac arrest and ICD?

A

MI = 1 month off
→ 1 week if successful angioplasty
Cardiac arrest = 6 months off
ICD = 6 months off if shock delivered, 1 month if fitted prophylactically, surrender licence if group 2 driver (e.g. HGV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigation for stable angina?

A

CT coronary angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of stable angina?

A

Aspirin + statin + GTN then:
1st line = beta-blocker or diltiazem or verapamil
2nd line = beta-blocker + dihydropyridine CCB (e.g. amlodipine)
3rd line = add isosorbide mononitrate or ivabradine or nicorandil or ranazoline
4th line = PCI or CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Technique for preventing tolerance to standard-release isosorbide mononitrate?

A

Asymmetric dosing intervals e.g. 7 hours apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mechanism of action of aspirin, clopidogrel, prasugrel and ticagrelor?

A

Aspirin = irreversible COX-1 and COX-2 inhibitor
Clopidogrel/prasugrel/ticagrelor = P2Y12 receptor inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mechanism of action of warfarin, heparin, rivaroxaban, apixaban, edoxaban, dabigatran, fondaparinux and bivalirudin?

A

Warfarin = vitamin K antagonist
Heparin/fondaparinux = activates antithrombin III
Rivaroxaban/apixaban/edoxaban = direct factor Xa inhibitor
Dabigatran/bivalirudin = direct thrombin inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of INR 5.0-8.0 (no bleed vs bleed), INR > 8 (no bleed vs bleed) and major haemorrhage?

A

INR 5.0-8.0 (no bleed) = withhold 1 or 2 doses, reduce maintenance dose
INR 5.0-8.0 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
INR > 8 (no bleed) = stop warfarin, oral vitamin K, restart warfarin when INR < 5.0
INR > 8 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
Major haemorrhage = stop warfarin, IV vitamin K, prothrombin complex (1st line) or FFP (2nd line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Statin examples, mechanism of action and side effects?

A

Examples = atorvastatin, simvastatin
Mechanism of action = inhibits HMG-CoA reductase
Side effects = myalgia, myositis, rhabdomyolysis, deranged LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of regular narrow complex tachycardia e.g. SVT?

A

Stable = vagal manoeuvres (1st line), adenosine 6mg → 12mg → 18mg (2nd line)
Unstable = synchronised DCCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Management of regular broad complex tachycardia e.g. VT?
Stable = amiodarone or lidocaine Unstable = synchronised DCCV
26
Management of torsades de pointes?
Stable = IV magnesium sulphate Unstable = synchronised DCCV
27
Outline the types of AF?
Acute (< 48 hours) Paroxysmal AF (< 7 days, episodic) Persistent AF (> 7 days, responds to cardioversion) Permanent AF (> 7 days, no response to cardioversion)
28
Overview of acute AF management?
< 48 hours = rate OR rhythm control > 48 hours or uncertain = rate control
29
Rhythm control management of AF?
Heparin + synchronised DCCV OR Pharmacological cardioversion → structural heart disease = amiodarone → no structural heart disease = flecainide or amiodarone
30
Rate control management of AF?
1st line = beta-blocker or diltiazem or verapamil or digoxin 2nd line = dual therapy of beta-blocker + diltiazem or digoxin (beta-blocker + verapamil = heart block)
31
Outline DCCV if AF > 48 hours or uncertain?
3 weeks anticoagulation then DCCV, followed by 4 weeks anticoagulation OR TOE to exclude thrombus then immediate DCCV
32
Score to assess stroke vs bleeding risk of AF patients?
Stroke = CHA2DS2VASC Bleeding risk = ORBIT
33
CHA2DS2VASC criteria and recommendation based on score?
CHF, HTN, Age ≥75 (2) or 65-74 (1), DM, stroke/TIA/VTE (2), vascular disease, female 0 = no treatment 1 = consider anticoagulation (male), no treatment (female) ≥ 2 = anticoagulation
34
Management of atrial flutter?
Initially the same as AF e.g. rate/rhythm control Radiofrequency ablation is curative
35
Management of bradycardia?
1st line = atropine 500mcg (repeat up to 3mg) 2nd line = IV isoprenaline or transcutaneous pacing 3rd line = transvenous pacing
36
Outline the types of heart block?
1st degree = PR > 0.2, regular 2nd degree (Mobitz I) = PR prolongs until dropped beat 2nd degree (Mobitz II) = PR interval constant but beat sometimes dropped e.g. 2:1, 3:1 3rd degree = no association between P wave and QRS
37
Which types of heart block require a permanent pacemaker?
Mobitz type II 3rd degree (complete) heart block
38
Shockable vs non-shockable cardiac arrest rhythms?
Shockable = VF and pulseless VT Non-shockable = PEA and asystole
39
4 Hs and 4 Ts of reversible cardiac arrest?
Hs = hypoxia, hypothermia, hyper/hypo and hypovolaemia Ts = thrombosis, toxins, tamponade and tension pneumothorax
40
Drug management of non-shockable vs shockable cardiac arrest?
Non-shockable = adrenaline 1mg STAT → adrenaline every 3-5 mins Shockable = adrenaline 1mg + amiodarone 300mg after 3 shocks → adrenaline every 3-5 mins
41
Adrenaline doses for anaphylaxis vs cardiac arrest?
Anaphylaxis = 500mcg → 0.5ml 1:1000 IM Cardiac arrest = 1mg → 10ml 1:10,000 IV or 1ml 1:1000 IV
42
Amiodarone mechanism of action and side effects?
Mechanism of action = blocks K channels Side effects = bradycardia, long QT, fibrosis, thyroid dysfunction, photosensitivity
43
Atropine mechanism of action and side effects?
Mechanism of action = muscarinic antagonist Side effects = anticholinergic (e.g. dry eyes/mouth, urinary retention)
44
Adenosine mechanism of action and side effects?
Mechanism of action = causes transient AVN block Side effects = bronchospasm, chest pain, flushing
45
Ivabradine mechanism of action and side effects?
Mechanism of action = blocks the pacemaker channel Side effects = heart block, bradycardia, luminous phenomena
46
Digoxin mechanism of action and side effects?
Mechanism of action = blocks the Na+/K+ ATPase Side effects = GI upset, anorexia, yellow-green vision, arrhythmias, gynaecomastia
47
ECG feature of digoxin use?
ST "scooped out" or "reverse tick sign"
48
Features and management of cardiac tamponade?
Beck's triad: → hypotension → raised JVP → muffled heart sounds Breathlessness Tachycardia Pulsus paradoxus (drop in BP on inspiration) Electrical alternans Management = pericardiocentesis
49
Features, investigations and management of pericarditis?
Generally unwell (e.g. fever) Pleuritic chest pain (worse lying down) Pericardial rub Pericardial knock (loud S3) Right heart failure e.g. peripheral oedema Investigation = ECG, transthoracic echo Management = NSAID + colchicine
50
ECG features of pericarditis?
PR depression (most specific) Widespread "saddle" ST elevation
51
JVP feature of constrictive pericarditis?
Kussmaul's sign (JVP rises on inspiration)
52
Features, investigation and management of myocarditis?
Generally unwell (e.g. fever) Chest pain Typically young patient Commonly seen with pericarditis Investigation = endomycocardial biopsy Management = supportive management
53
Modified Duke's criteria?
Major = positive blood cultures, endocardial involvement Minor = predisposition, fever > 38 °C, negative microbiology, vascular phenomena, immunological phenomena
54
Most common valve affected in infective endocarditis in IVDUs vs non-IVDUs?
IVDUs = tricuspid valve Non-IVDUs = mitral valve
55
Most common endocarditis pathogen vs dental issues vs prosthetic valve surgery and GI pathology?
Most common = staphylococcus aureus Dental issues = streptococcus viridans Prosthetic valve surgery = staphylococcus epidermidis GI pathology = streptococcus bovis
56
Antibiotic management of infective endocarditis?
Native valve = amoxicillin + gentamicin Prosthetic valve = vancomycin + gentamicin + rifampicin Staph aureus = flucloxacillin Strep viridans = benzylpenicillin
57
Stanford classification of aortic dissection?
Type A (most common) = ascending aorta Type B = descending aorta
58
Features, investigations and management of aortic dissection?
Tearing chest pain Radio-radial delay Pulse deficit BP different between arms Investigations = CXR, CT angiography (stable) or TOE (unstable) Management = BP control e.g. IV labetalol + surgery (type A) OR conservative management (type B)
59
Rule for hearing murmurs best?
RILE: → right-sided on inspiration → left-sided on expiration
60
Examination features of aortic regurgitation?
Diastolic murmur Wide pulse pressure Collapsing pulse Quincke's sign (nailbed pulsation) De Musset's sign (head bobbing)
61
Examination features of aortic stenosis?
Ejection systolic murmur Narrow pulse pressure Slow rising pulse Quiet/absent S2 LVH or LVF
62
Most common cause of aortic stenosis in older vs younger patients?
Older (> 65) = calcification Younger (< 65) = bicuspid valve
63
Management of valve disease?
Asymptomatic = monitor, surgery if severe Symptomatic = surgery e.g. replacement, vavuloplasty
64
Indication for aortic valve surgery in an asymptomatic patient?
Valvular gradient > 40mmHg + LVD
65
Antithrombotic treatment for prosthetic vs mechanical valve?
Prosthetic = aspirin Mechanical = aspirin + warfarin
66
Features of right-sided vs left-sided heart failure?
Right-sided = peripheral oedema, raised JVP, hepatomegaly, anorexia Left-sided = dyspnoea, orthopnoea, PND, pulmonary oedema
67
Investigations for heart failure?
NT-proBNP (1st line) Tranthoracic echocardiogram
68
Management of patients with raised NT-proBNP?
> 2000ng/L = 2 week referral for assessment + echo 400-2000ng/L = 6 week referral for assessment + echo
69
NYHA classification of heart failure?
Class I = no symptoms Class II = mild Class III = moderate Class IV = severe (symptoms at rest)
70
What is ejection fraction and value for heart failure diagnosis?
Percentage of ventricular diastolic volume ejected during ventricular systole → < 40% = HFrEF → ≥ 40% = HFpEF
71
Management of acute heart failure?
Non-hypotensive = IV loop diuretic, nitrates Hypotensive = inotropic agents (e.g. dobutamine), vasopressors (e.g. adrenaline)
72
Management of chronic heart failure?
1st line = ACEi + beta-blocker + aldosterone antagonist + SGLT2i 2nd line = switch ACEi to sacubitril-valsartan 3rd line = ivabradine, digoxin, hydralazine/nitrate, CRT
73
Drugs which reduce mortality in chronic heart failure?
ACEi/ARB Beta-blocker Aldosterone antagonist
74
Vaccination recommendations for heart failure?
One-off pneumococcal + annual influenza
75
Drug options for hypertension?
1st line = A (< 55 or T2DM) OR C (> 55 or Afro-Caribbean) 2nd line = A+C or A+D (< 55 or T2DM) OR C+A OR C+D (> 55 or Afro-Caribbean) 3rd line = A+C+D 4th line = spironolactone (K < 4.5) OR alpha-blocker e.g. doxasozin or beta-blocker e.g. atenolol (K > 4.5)
76
Blood pressure targets for < 80 years vs > 80 years?
< 80 = 140/90 > 80 = 150/90
77
ACEi/ARB examples, side effects and cautions?
ACEi = ramipril, lisinopril, perindopril ARB = losartan, candesartan, irbesartan Side effects = hypotension, hyperkalaemia, cough (ACEi), angioedema (ACEi) Cautions = pregnancy, renovascular disease/stenosis
78
ACEi/ARB mechanism of action?
Blocks RAAS: (ACEi/ARB) Reduced effects of angiotensin II causes dilation of efferent arterioles (ACEi) Reduced effects of aldosterone causes Na and water excretion
79
Beta-blocker examples, side effects and cautions?
Cardioselective (β1) = atenolol, bisoprolol, metoprolol Non-cardioselective (β1/β2) = propanolol, carvedilol, labetalol Side effects = bronchospasm, hyperkalaemia, cold extremities, erectile dysfunction, sleep issues, fatigue Cautions = asthma, uncontrolled HF, verapamil use
80
Calcium channel blocker examples and side effects?
Dihydropyridines = amlodipine, nifedipine Non-dihydropyridines = verapamil, diltiazem Side effects = peripheral oedema, flushing, headache
81
Thiazide diuretic examples, mechanism of action and side effects?
Thiazide = bendroflumethiazide Thiazide-like = indapamide Mechanism of action = blocks NaCl reabsorption in the DCT Side effects = hyponatraemia/hypokalaemia, hypercalcaemia, impaired glucose tolerance, gout, erectile dysfunction
82
Loop diuretic examples, mechanism of action and side effects?
Examples = furosemide, bumetanide Mechanism of action = blocks Na reabsorption in the thick ascending LoH via Na/K/Cl cotransporter Side effects = hyponatraemia/hypokalaemia/hypocalcaemia, hypercalciuria, ototoxicity
83
Potassium sparing diuretic, mechanism of action examples and side effects?
Aldosterone antagonists = spironolactone, eplerenone → blocks action of aldosterone which normally facilitates Na reabsorption and K loss ENaC inhibitors = amiloride → blocks ENac channels which normally faciltate Na reabsoprtion Side effects = hyperkalaemia, endocrine dysfunction (aldosterone antagonist)
84
Criteria and management of orthostatic hypotension?
Drop of ≥ 20mmHg systolic +/- ≥ 10mmHg diastolic within 3 mins of standing Management = midodrine or fludrocortisone
85
Score used to investigate patients with low suspicion of a PE and interpretation?
Pulmonary embolism rule-out criteria (PERC) All must be absent for negative result
86
Score used to investigate patients with suspected PE and values?
Wells score > 4 points = PE likely ≤ 4 points = PE unlikely
87
Investigations for PE?
Wells > 4 = urgent CTPA Wells ≤ 4 = D-dimer → +ve D-dimer = urgent CTPA
88
Indications for V/Q scan in PE and why?
Renal disease or pregnancy No contrast required (renal), no increased risk of breast cancer (pregnancy)
89
Management of VTE?
Provoked = 3 months of DOAC Unprovoked or cancer = 6 months of DOAC
90
Management of unstable vs recurrent PE?
Unstable = thromboylsis e.g. alteplase Recurrent = IVC filter
91
Score used to investigate patients with suspected DVT and values?
Wells score ≥ 2 = DVT likely < 2 = DVT unlikely
92
Investigations for a likely DVT (Wells ≥ 2)?
Wells ≥ 2= urgent leg USS Wells < 2 = D-dimer → +ve D-dimer = urgent leg USS
93
Preferred anticoagulant in pregnancy and why?
LMWH e.g. dalteparin → does not cross the placenta
94
Most common cardiomyopathy?
Dilated cardiomyopathy
95
ECG feature of Wolff-Parkinson White (WPW) syndrome and management?
Slurred QRS upstroke (delta wave) Management = radiofrequency ablation
96
ECG feature of Brugada syndrome and management?
ST elevation in V1-V3 followed by inverted T wave Management = ICD
97
Heart condition associated with DiGeorge vs Turner's syndrome?
DiGeorge = Tetralogy of Fallot Turner's = coarctation of the aorta
98
Outline the screening programme for AAA?
One-off abdominal USS for men age 65 → < 3cm = no action → 3-4.4cm = re-scan every 12 months → 4.5-5.4cm = re-scan every 3 months → ≥ 5.5cm = refer for intervention
99
High rupture risk features of AAA?
Symptomatic ≥ 5.5cm Grown > 1cm/year
100
Management of AAA?
Endovascular repiar (EVAR) Open aneurysm repair
101
Abnormal ABP values?
< 0.9 or > 1.2
102
Location of venous vs arterial ulcers and management?
Venous = above medial/lateral malleoli → compression bandaging Arterial = toes, shins, pressure points → modify risk factors e.g. hypertension
103
What does peripheral arterial disease (PAD) cover?
Intermittent claudication Critical limb ischaemia Acute limb-threatening ischaemia
104
Features and management of intermittent claudication?
Pain in leg muscles during exercise then resolves at rest Management = exercise regime + statin + clopidogrel
105
Features and management of critical limb ischaemia?
Rest pain (hang legs out of bed) Ulceration Gangrene Management = endovascular revascularisation (< 10cm) or open surgical revascularisation (> 10cm)
106
Features and management of acute limb-threatening ischaemia?
Pale, pulseless, painful, paralysed, paraesthesis, perishingly cold Management = analgesia + urgent vascular review
107
ECG finding in ~50% ARVC patients?
Epsilon wave (notch after QRS)
108
When should anticoagulation be started after TIA vs acute ischaemic stroke?
TIA = immediately (if no haemorrhage) Acute ischaemic stroke 2 weeks (delay if large infarction)
109
Estimated oxygen saturation of blood return from vena cava to right atrium?
70%
110
Definition of pulmonary arterial hypertension?
Resting mean pulmonary artery pressure of ≥ 20mmHg
111
Features, investigation and management of pulmonary arterial hypertension?
Exertional dyspnoea Signs of RHV or RVF Investigation = acute vasodilator testing Management = prostacyclin analogue e.g. iloprost, endothelin receptor antagonist e.g. bosentan (negative test) or CCB (positive test)
112
Auscultation findings of severe aortic stenosis?
Soft/absent S2 S4 (gallop rhythm)
113
Features and management of heparin-induced thrombocytopenia?
Fall >50% platelets after starting heparin Thrombosis Necrosis at injection sites Management = start alternative anticoagulant e.g. direct thrombin inhibitor
MRCP Part 1
flashcards
Decks in class (15)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions