Cardio Cardio

Front 1

Criteria for Brugada Syndrome?

Back 1

ECG + 1 or > of 6 :

Documented (VF) or polymorphic ventricular tachycardia (VT)

FH of sudden cardiac death at <45 y

Coved-type ECGs in family members

Inducibility of VT with programmed electrical stimulation

Syncope

Nocturnal agonal respiration

Hint 1

Front 2

Most Common Arrythmia Post MI?

Back 2

Ventricular Ectopics

Front 3

Drugs CI in Cardio?
AF+IHD:
Junctional Tachy:
AF+WPW:
Aortic Dissection:
HOCM:

HF:

Back 3

AF+IHD,WPW: Flecainide

Junctional Tachy: Flecainide

AF+ WPW: Digoxin or Verapamil

Aortic Dissection: CCB
HOCM:∙ ACE-I ∙ Inotropes, Nitrates (AIN)

HF: Verapamil and diltiazem

Front 4

+ve or -ve qrs concordance?

Back 4

كل الفيات ال ار كلهة فوووك او كلهة جوة

Front 5

HT a/w which type of HF?

Back 5

Diastolic Dysfunction: EF>50%

Front 6

Hyer or HypoTHYROID IN DCM?

Back 6

Hyper

Hypo cause Pericardial Effusion

Hint 6

التكيكارديا تنيج اخت الهارت فبعدين يهور ويصير ديالاتيد

Front 7

ECG Changes in Pericarditis?

4 stages?

Back 7

PR Depression with AVR Elevation

ST Elevation in All Leads+ AVR Depress

Hint 7

stage I: ST elevation in all leads.

PR depression (depression between the end of the P-wave and the beginning of the QRS- complex)

stage II: pseudonormalisation (transition)

stage III: inverted T-wavess

tage IV: normalisation

Front 8

Mx of Acute Pericarditis?

Back 8

اللي راح تعبر Anticogulaed

if Recurrent: Steroids

Hint 8

if Infected, Malignancy , Not resolved in 3 months: Surgery

Avoid RCU

Front 9

Most Forgotten cause for P.Eff?

Back 9

Hypothyroidism

Front 10

Mx of Temponade?

Back 10

Pericardiocentesis

Hint 10

CI: in Malignancy, Dissection

Go for Surgery

Front 11

Indications of Pericardiectomy in Pericarditis?

Back 11

Constrictive pericarditis,

Effusive C pericarditis, or

Recurrent pericarditis + multiple attacks, steroid dependence, and/or intolerance to other medical management.

Front 12

Poor Prognosis in HOCM?

Back 12

∙ syncope

∙ FH of sudden death

∙ young age

∙ non-sustained VT on 24 or 48-hour Holter monitoring

∙ Abnormal BP changes on exercise

∙ increased septal wall thickness

Front 13

CHA2DS2-VASc ?
انتبه دائما يستخدم لل نون فالفالفولار

Back 13

C Congestive heart failure 1

H Hypertension (or treated hypertension) 1

A2 Age >= 75 years 2

D Diabetes 1

S2 Prior Stroke or TIA 2

V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1

A Age 65-74 years 1

S Sex (female) 1

Hint 13

Score Anticoagulation In NonV

0 No treatment is preferred to aspirin

1 Oral anticoagulants preferred to aspirin; dabigatran is an alternative

2 or more Oral anticoagulants; dabigatran is an alternative

Front 14

Agents with proven efficacy in the pharmacological cardioversion of atrial fibrillation∙

Back 14

Amiodarone

∙ flecainide (if no structural heart disease)

∙ others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone

Hint 14

Less effective agents

∙ beta-blockers (including sotalol)

∙ calcium channel blockers

∙ digoxin

∙ disopyramide∙ procainamide

Front 15

5 WPW Associations (4 Structural 1systemic) and Mx?

Back 15

Associations of WPW

∙ HOCM

∙ mitral valve prolapse

∙ Ebstein's anomaly

∙ thyrotoxicosis

∙ secundum ASD

Management

∙ definitive : radiofrequency ablation of the accessory pathway

∙ medical therapy: sotalol**, amiodarone, flecainide*in the majority of cases, or in a question without qualification,

Hint 15

بزمن ولاية الذيب : الاسد حكم ابشتاين وهو عندة غدة وترهل

**sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AVnode may increase the rate of transmission through the accessory pathway, increasing the ventricular rate andpotentially deteriorating into ventricular fibrillation

syndrome is caused by a congenital accessory conducting pathway between theatria and ventricles leading to a atrioventricular re-entry tachycardia (AVRT).

As the accessory pathway does notslow conduction AF can degenerate rapidly to VF

Front 16

Two important updates on mx of Hypertension

Back 16

∙ calcium channel blockers are now considered superior to thiazides

∙ bendroflumethiazide is no longer the thiazide of choice

Front 17

AHA-ACC-CDC Advisory Bp Mx Recommendation?

Back 17

• BP goal of < 139/89 mmHg

• Stage I HTN (SBP 140-159 or DBP 90-99 mmHg)

• Lifestyle modifications

• +/- Thiazide diuretic

• Stage II HTN (SBP > 160 or DBP > 100 mmHg) • Thiazide + (ACE-I or ARB) or + Calcium channel blocker

• Titrate doses if not at goal or add different drug class

Front 18

Bp Classification?

Back 18

Stage : Clinic BP >= 140/90 and subsequent ABPM >= 135/85

Stage 2: Clinic BP >= 160/100 and subsequent ABPM >= 150/95

Severe hypertension

Clinic systolic BP >= 180 , or

clinic diastolic BP >= 110 mmHg

Front 19

Direct renin inhibitors∙ e.g. Aliskiren (branded as Rasilez)?

Back 19

∙ by inhibiting renin blocks the conversion of angiotensinogen to angiotensin I∙ no trials have looked at mortality data yet. Trials have only investigated fall in blood pressure. Initial trials suggest aliskiren reduces blood pressure to a similar extent as angiotensin converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists∙ adverse effects were uncommon in trials although diarrhoea was occasionally seen∙ only current role would seem to be in patients who are intolerant of more established antihypertensive drugs

Front 20

Bp Targets?

Back 20

< 80 years 140/90 135/85

> 80 years 150/90 145/85

Hint 20

لا تدوخ نفسك : زيد عشرة علة ال systolic مال ال standard

Front 21

Agents used to maintain sinus rhythm in of atrial fibrillation?

Back 21

∙ sotalol

∙ amiodarone

∙ flecainide

∙ others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine

Front 22

Factors favouring rate control

Back 22

Older than 65 yearsHistory of ischaemic heart disease

Hint 22

∙ beta-blockers

∙ calcium channel blockers

∙ digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure)

Front 23

Factors favouring Rhythm control?

Back 23

Younger than 65 years

Symptomatic

First presentation

Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)

Congestive heart failure

Front 24

Pericarditis Causes?

Back 24

∙ viral infections (Coxsackie

)∙ tuberculosis

∙ uraemia (causes 'fibrinous' pericarditis)

∙ trauma

∙ post-myocardial infarction, Dressler's syndrome

∙ connective tissue disease

∙ hypothyroidism

Front 25

MI: Secondary Prevention?

Back 25

All patients:

∙ ACE inhibitor

∙ beta-blocker

∙ aspirin

∙ statin

Clopidogre

∙ STEMI: patients treated with a combination of aspirin and clopidogrel: first 24 hours & for at least 4 weeks

∙NTEMI): clopidogrel 12 months if the 6 month mortality risk* is >1.5%

Hint 25

Aldosterone antagonists∙ patients who have had an acute MI and who have symptoms and/or signs of heart failure and leftventricular systolic dysfunction, treatment with an aldosterone antagonist licensed for post-MI treatment(e.g. eplerenone) should be initiated within 3-14 days of the MI, preferably after ACE inhibitor therapy

Front 26

Mild OLD + HF? BB can be given?

Back 26

Yes, beha majal

Front 27

Bnp interptetation affected by?

Back 27

Obesity ↓ age, women CKD ↑

Hint 27

مرة جبيرة عدهة عجز كلة فاكيد يصعد واكيد راح تكون ضعيفة

اذا سمينة يجوز يتعادل

Front 28

When to use High sensitive crp?

Back 28

Recassify Intermediate risk CAD

Front 29

Mx of AV مستحق + bicuspid ?

Back 29

ال root بدربك شيلة

Front 30

Donedarone on Kidney

Back 30

↓ Crcl but not GFR

Front 31

Whats eptifebatide MOA?

Back 31

GP 2B3A inhibitor

Front 32

Indications for GP IIb/IIIa inhibitor ?

Back 32

Major

ongoing chest pain,

dynamic electrocardiographic changes,

elevated troponin on presentation,

Minor

heart failure,

and diabetes mellitus.

Front 33

Specific Echo/CXR features in Constrictive pericarditis?

Back 33

LVH,

Ventricular independence with Respiration (Increase Variations)

Flow Velocity transMitral Annulus: > restrictive > 12, < 8 respectively. if in bw : nonDx(so but not Sens)

Hepatic venous flow reversal — reverses during expiration in constrictive pericarditis but reverses during inspiration in restrictive cardiomyopathy.

± Ventricular end-diastolic pressures — Right and left ventricular end-diastolic pressures (RVEDP and LVEDP) are equal or nearly equal in constrictive pericarditis, while LVEDP is usually higher than RVEDP in restrictive cardiomyopathy

Hint 33

Calcification(by CT>> or Echo): Highly specific but not sensitive

Absent pul. Congestion

Front 34

Causes of Kussmaul signs?

Back 34

Constrictive Preri.

Restrictive MyopAthy

Others

RV Infarction in Inf MI

Massive pulmonary embolism

Partial obstruction of the vena cavae

Right atrial and right ventricular tumors

Occasionally

tricuspid stenosis

congestive heart failure

Rarely

cardiac tamponade

Hint 34

tamponade: x descent, absent y constrictive pericarditis: (prominent x and y descent),

Front 35

Rx of chronic cP?

Back 35

NYHA 2-3:

Front 36

Drugs css cP

Back 36

Hydralazine, Procainamide, Doxuribicin

Hint 36

واحد منهم يوخر المي يبقي بس ال Ca

Front 37

Single drug cause rCMP

Back 37

Anthracyclin

Hint 37

Other idiopathic, infiltrative, Non infiltrative, Fabry, Radiation

Front 38

Pulsus Paradoxus css ?

Back 38

Hint 38

Have high Negative Predictive value not specificity

Front 39

Af + IHD or structural? MX?

Back 39

Amiodarone

Front 40

Indication of operative PS mx?

Back 40

Annulus

Moderate to sever MR

Supra/suv valvular PS

Front 41

Maze precedure?

Back 41

AF mx in PostTOF repair mx

Front 42

Preffered CCB IN UA CI BB?

Back 42

Diltiazem

Hint 42

Amlodipine for Associated HT

Front 43

End stage HF + Hypot?

Back 43

Ass for Transplant

Front 44

Radiation Hx + Murmur?

Back 44

AR UPOW

Front 45

INR Decrements (Inducers)? RifampIn-ducer

INR Increments (Inhibitors)? Iso- Inhibitor

Back 45

Rifampin

Aprepitant

Barbiturates

Carbamazepin

Cholestyramine

Griseofulvin

Mercaptopurine

Mesalamine

Methimazole

Nafcillin

Rifabutin

Hint 45

Isoniazid

Alcohol

Amiodarone

Cimetidine

Ciprofloxacin

Citalopram

Clofibrate

Diltiazem

Erythromycin

Fenofibrat

Fluconazole, Miconazole, Voriconazole, Metronidazole

NSAIDs/COX-2 inhibitors, Omeprazole

Quinidines

Sulfinpyrazone

Tamoxifen

TMP-SMZ

Riampicin بين ال ديوس

رجلهة ايزو منعهة

Front 46

3 days post MI, Fever + SOB+ elevated Cardiac enzymes?

Back 46

Myopericarditis UPOW

Hint 46

Akin to MI

No JVP distention

Front 47

Features of IE + PR prolongation?

Back 47

Aortic Root Abcess
Go for Surgery

Front 48

Restrictive CMP most imp Echo finding?

Back 48

Diastolic dysfunction with preserved systolic function

NB: PAH PRESENT

Note: Also cP have so it is not a feature of Diff.

Hint 48

Unlike the other cardiomyopathies that are classified according to morphological criteria, i.e. hypertrophic, dilated, right ventricular;

Restrictive is a functional classification

Front 49

Echocardiographic features of amyloid infiltration of the heart

Back 49

Increased LV wall thickness

Increased RV wall thickness

Small, well, or poorly contracting LV

Enlarged LA

Valve thickening (all valves)

Mitral regurgitation (usually mild)

Thickened atrial septum

E/A ratio >1

Pericardial effusion (advanced disease)

Front 50

Indications for a temporary pacemaker?

3 Tri

Back 50

∙ symptomatic/haemodynamically unstable bradycardia, not responding to atropine

∙ q-ANTERIOR MI: Mobits type 2 or complete heart block*

∙ trifascicular block prior to surgery

Front 51

BI sphereience Not Alternate Pulse?

Back 51

Mixed Aortic Valve disease

Front 52

2nd line in Mx of SVT ?

Back 52

Verapamil esp if adenosine CI

Front 53

Duke Criteria of IE?

Back 53

Infective endocarditis diagnosed if

∙ pathological criteria positive, or

∙ 2 major criteria, or

∙ 1 major and 3 minor criteria, or

∙ 5 minor criteria

Front 54

Pathological Criteria?

Back 54

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue,vegetations, embolic fragments or intracardiac abscess content)

Front 55

Major Criteria?

Back 55

Positive blood cultures

∙ two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or

∙ persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive bloodcultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or

∙ positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, o

r∙ positive molecular assays for specific gene targets

Evidence of endocardial involvement

∙ positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation ordehiscence of prosthetic valves), or

∙ new valvular regurgitation

Front 56

Minor Criteria? 5

Back 56

∙ predisposing heart condition or intravenous drug use

∙ microbiological evidence does not meet major criteria

∙ fever > 38ºC

∙ vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, petechiae or purpura

∙ immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots, Janeway lesions

Front 57

3 differnces bw Thrombosis and stenosis in post Cath?

Back 57

T(1)rombosis:

1 month

1-2 %

M1 presentasion

Hint 57

S(5)tenosis

5 months

25 %

Angina Symptoms

Front 58

Myocardial action potential Nemonic?

Back 58

الصوديوم سوة هجوم سريع هو دخل وفرغ الشحنات ووكفت ال قنوات

جماعة من البوتاسيوم شالو غراضهم وطلعوا اشتغلت القنوات

2 اجة الكالسيوم دخل وكعد علة البليتة صار هدوء

بقية البوتاسيوم فنشو وانهزموا كلهم وصار كونتراكشن

وبعدين استعدلت الحالة الأيونية

Hint 58

0 Rapid depolarisation :Rapid sodium influx

These channels automatically deactivate after a few ms

1 Early repolarisation Efflux of potassium

2 Plateau Slow influx of calcium

3 Final repolarisation Efflux of potassium

4 Restoration of ionic concentrations

Front 59

In of ASD closure?

Back 59

Rt side enlargement - PAH (absent)

Front 60

HOCM + RTA+Shock? MX

Back 60

Phenylpherine

Hint 60

LVOO

Front 61

How to dx ASD L-R shunt?

Back 61

Agitated sline echo

Front 62

Mechanism of Action of Hydralazin?

Back 62

Direct Vasodilator

Front 63

Mechanism of Action of Nitroprusside?

Back 63

Vascular Smooth muscle Relaxant

Front 64

Mx of IE Cause of Prosthetic Valave

Back 64

G+V+R

Front 65

• young patient with acute history

•chest pain, SOB + Hx of Toxoplasmosis inf?

Back 65

Myocarditis

Front 66

∙ wide pulse pressure

∙ JVP: cannon waves in neck

∙ variable intensity of S1

Back 66

Complete Heart Block

Front 67

T wave inversion in leads V1- 3 associated with a notch at the end of the QRS complex

Back 67

Arrhythmogenic right ventricular cardiomyopathy / An epsilon wave is found in about 50%

MX by Satolol

Hint 67

Management

∙ drugs: sotalol is the most widely used antiarrhythmic

∙ catheter ablation to prevent ventricular tachycardia

∙ implantable cardioverter-defibrillator

Front 68

triad of ARVC, palmoplantar keratosis, and woolly hair

Back 68

Naxos disease

variant of ARVC

Front 69

∙ left anterior hemiblock

∙ left bundle branch block

∙ Wolff-Parkinson-White syndrome* - right-sided accessory pathway

∙ hyperkalaemia

∙ congenital: ostium primum ASD, tricuspid atresia

∙ minor in obese people

Back 69

LAD :

تذكر لادا وعلي حيدر (الذيب :سمين اجة من الينمة صعد لان متكفي من ورة LLBBB, LAHB وهو طويل ياكل موز فصار عندة هايبر كاليميا ومن الطبيعي شكلة مشوه خلقيا فصلكوا عندة أسد صف أول

Front 70

∙ left anterior hemiblock

∙ left bundle branch block

∙ Wolff-Parkinson-White syndrome* - right-sided accessory pathway

∙ hyperkalaemia

∙ congenital: ostium primum ASD, tricuspid atresia

∙ minor LAD in obese people

Back 70

LAD : تذكر لادا وعلي حيدر (سمين اجة من الينمة صعد لان متكفي باب الكراج وهو طويل ياكل موز فصار عندة هايبر كاليميا ومن الطبيعي شكلة مشوه خلقيا فعبالهم أسد من اول شوفة

Front 71

Hypertension in DM Mx?

Back 71

ACEI even if Old age

Front 72

Centrally Acting Antihypertensives

Back 72

∙ methyldopa

∙ moxonidine NOT Minoxidi

∙ clonidine

Front 73

MVP Associations

(Cardio2, Arrythmia2, Rheumato5, Endocrine1, Nepro1)

Back 73

∙ congenital heart disease: PDA, ASD

∙ cardiomyopathy

∙ Wolff-Parkinson White syndrome

∙ long-QT syndrome

∙ Turner's syndrome

∙ Ehlers-Danlos Syndrome

∙ Marfan's syndrome, Fragile X

∙ osteogenesis imperfecta

∙ pseudoxanthoma elasticum

∙ polycystic kidney disease

No Dawn Syndrome

Front 74

In MX of Any Case With AF or Aortic valve Look for?

Back 74

Age

Front 75

Prinzmetal Anginal Definition & Mx?

Back 75

Coronary Vasospasm rather than ischemic Pathology

CCB

Hint 75

Exposure to cold weather

Stress

Medicines that tighten or narrow blood vessels

Smoking

Cocaine use

Front 76

1st Line Rx in HF, IHD resp ?

Back 76

ACEI, Aspirin

Take care

Front 77

Anti Hypertensive Drugs may cause lithium toxicity?

Back 77

Diuretics,

ACE-i

Nephrotoxicity: Verapamil or Deltiazem

Hint 77

Amlodipine is safe

Front 78

PPH Mx Steps?

Back 78

1st : treating underlying conditions,

2nd acute vasodilator testing

A + response: oral CCBs

B - response : 1 of 3

1 prostacyclin analogues: treprostinil, iloprost

2 endothelin receptor antagonists: bosentan

3 phosphodiesterase inhibitors: sildenafil

Hint 78

Endothelin : بوسنتان تكلب الاندوثيليوم علة البطانة

Front 79

Hypertension/NF1 associations?

Back 79

1 coexistant essential hypertension

2 phaechromocytoma

3 renal vascular stenosis secondary to fibromuscular dysplasia

Front 80

Atrial flutter 2 Mx tricks ?

Back 80

1. More sensitive to cardioversion :lower energy levels used
2. Radiofrequency ablation of the tricuspid valve isthmus is curative for most patients Not Accessory Pathway

Hint 80

Flutter waves may be visible following carotid sinus massage or adenosine

Front 81

2 Steps in Mx of MAT

Back 81

1 correction of hypoxia and electrolyte disturbances

2 rate-limiting CCB used first-line

Hint 81

Cardioversion and digoxin are not useful in the management of MAT

Front 82

Who blindly considered High Risk CAD chest painers?

Back 82

All men > 70 years who have typical anginal symptoms

Front 83

Forgotten Causes of DCMP?

Back 83

Iherited (30%)

∙ nutritionale.g. Kwashiorkor, pellagra, B1, selenium deficiency

Infections e.g. Coxsackie A and B, HIV, diphtheria, parasitic

∙ Duchenne muscular dystrophy

∙ Doxorubicin

Hint 83

Infiltrative causes may also be a cause

Front 84

1st line mx in Stable Angina?

Back 84

BB or

CCB:

Monotherapy: rate-limiting: verapamil or diltiazem

Combination: Long Acting DHP (nifedipine or Felodipine) / Risk of CHB

long-acting nitrate, ivabradine, nicorandil or ranolazine

Hint 84

Combination no Benefit:

Front 85

Why to Check electrolytes with Amiodarone?

Back 85

Risk of Hypokalemia

Hint 85

∙ thyroid dysfunction∙ corneal deposits∙ pulmonary fibrosis/pneumonitis∙ liver fibrosis/hepatitis∙ peripheral neuropathy, myopathy∙ photosensitivity∙ 'slate-grey' appearance∙ thrombophlebitis and injection site reactions∙ bradycardia

Front 86

Second heart sound (S2)?

∙ loud:

∙ soft:

∙ fixed split

∙ reversed split:

Back 86

∙ loud: hypertension

∙ soft: AS

∙ fixed split: ASD

∙ reversed split: LBBB

Front 87

Pregnancy Induced Hypertension?

Back 87

2ND half of pregnancy (i.e. after 20 weeks)

No proteinuria, no oedema

Hint 87

Occurs in 3-5% of pregnancies

>> in older women

Front 88

How to Prevent recurrence of SVT?

Back 88

BB

∙ radio-frequency ablation

Front 89

Hepatic Inducers

Back 89

******** CRAP GPS induces my rage!

St. John's wort

Carbamazepine Rifampin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbital Sulfonylureas

Hint 89

Sulphonylurea anD PHenytoin

Front 90

CYP450 inhibitors

VICK'S FACE All Over GQ stops ladies in their tracks.

Back 90

Valproate Isoniazid Cimetidine Ketoconazole Sulfonamides Fluconazole Alcohol (acute) Chloramphenicol Erythromycin (macrolides) Amiodarone Omeprazole Grapefruit juice Quinidine

Hint 90

Quinines: Anti-Malarials

Even Qweens in Africa shuold take AntiMalarials

Sulphonamide:

Antimicrobials

Diuretics: Thiazide and Loop

Sulphonylurea

Sulphasalazine

Front 91

Mx of hyperCa in Sarcoid?

Back 91

STEROIDS

Front 92

>> presentation of SLE manifestations?

Back 92

Front 93

Mx of Sarcoid?

Back 93

Hint 93

يعني السؤال يجي

All of the following used in Mx of Sarcoid except ?

كذلك ال Behjet

Front 94

Dx of Whipple?

Back 94

Front 95

Post Pharangitis 3 weeks what u suspect?

Back 95

Hint 95

Pharynx → Heart → Cerebellum, Joints and Skin Rarely

Front 96

Extraglandular Manif. Of Sjogren?

Back 96

Arithritis> Reynauds> Lung & Vasculitis> Lymphoma 5 %

Front 97

PR Interval interp?

Back 97

Front 98

Acetozalamide SE?

Back 98

Front 99

VT Triad of Association? / pacemaker Imdication?

Back 99

Front 100

Back 100

S3

Soft S1 + Heave

loud, palpable P2, heard best when lying on the left side

Front 101

Murmur in Atrial Myxoma

Back 101

Mid diastolic (Tumor plop)

Hint 101

Clubbing, Wt Loss ass

Front 102

3 Ass of Bicuspid Aortic Valve

Back 102

Left Coronary Dominence*

Turner

COA

Hint 102

يعني البوستيريور ديسيندنگ من السيركمفلكس مو من ال رايت كوروناري

Front 103

3 forgotten features of PDA

Back 103

Wide pulse pressure

Collapsing pulse (Large volume)

Heaving Apex beat

Front 104

Factors ↓ BNP (F-ve)

Back 104

Obesity

AntiHT (unless Alpha blockers)

Front 105

Forgotten PP in IE

Back 105

Low Complements

Hint 105

STAPH Aureus also

Front 106

2 forgotten F of AS?

Back 106

LVF

Thrill

Hint 106

common:

Soft S2

S4

Narrow, Slow Pulsd

Delayed ESM

Duration of, Murmur

Front 107

Ichemic chest pain May be repeoducible by palpations

True or False?

Back 107

True

Front 108

معلومة مهمة

Back 108

Verapamil is CI in patient with CI to BBC unlike other CCBs

T or F?

Hint 108

F

Nifedipine is

Front 109

Forgotten Changes in Cardiogenic Shock?

Back 109

hypokalemia

hypomagnesemia

acidosis

Hint 109

Correction is essential

Front 110

Distributive Shock Causes

Back 110

Septic +

Other causes;

SIRS due to noninfectious inflammatory conditions such as burns and pancreatitis;

toxic shock syndrome (TSS);

anaphylaxis;

reactions to drugs or toxins, including insect bites, transfusion reaction, and heavy metal poisoning;

addisonian crisis;

hepatic insufficiency;

and neurogenic shock due to brain or spinal cord injury

Front 111

Any cause of LVF may lead to pulmonary hypertension

T or F?

Back 111

T

By pulmonary venous congestion and hence PH

Front 112

Frog Sign?

Back 112

(prominent venous pulsations in the neck due to cannon A waves seen in AV dissociation) on physical examination is frequently present and suggests simultaneous atrial and ventricular contraction→ AVRT

Front 113

Imp MKSAP Question?

Back 113

17 even if asymptotic HF → BB unless pulmonary edema or low CO 19 Bicuspid → SURGERY 4 ROOT & VALVE,24bNYHA class 3-4 on Acei & BB → Add Aldactone ,31 Ascending AD → Urgent surgery ,37 CHADS2 <2 no bridging just in RF subtherpetic, > 2 → theraptic 42 Mechanical Valve + Surgery→ no risk factor → 43 PS → SEE VHD DIAG47→ Down → AVSD → ↑ risk of eisenminer / COA: ECG → LVH, O/E→CXR : figure 3 sign + Rib notch sys mrmr in infraclav. Or over back → , E ANOMALY→ TR + RT HEART enlargement → ECG Himalayan P waves+ prolonged QRS , RBBB , preexitation → CXR _→ Rt heart enlarge+ small pul.AsCyanosis in PFO + SEVER TR or ASD with reversed shunt 52 AF ABLATION → 3 months continue warfarin and chk,57 Angina + CI to BB → CCCB → Be 1st Line راجع مخطط ال angina,58 acute HF + ARF → DIURETICS,63 acute MR → Surgery 73 ❎ Trip methoprin DIDNOT cause Long QT ال U wave ما ينحسب وياها اذاىاكثر من ٥٠٠ او ديزداد ٦٠ ورة مياخذ الدوة ,78 see VHD 80 acute edema + discharge → within 1 week hospital check,81, > 5.5 AAA + comorbid condition → Conservative 82 New HF + RF like DM → CAD → CATH ,84 Resolving Constrictive Pericarditis → Continue Mx86 Asymptomatic sever MR + PHT→Repair Surgery ,87 Cardiac allograft VASCULOPATHY >> COMPLICATION OF Transplant 90, exercise test in AS in LV Systolic Dysfunction ➕ low gradient 92 → LBBB, ventricular pacing , st t changes Ventricular preexitation → Stress with IMAGING → Incapable → Pharmacological stress Echo test 95 D(Dilated)oxurubicin induced CMP 96 → Myopericarditis → HF due to MI + pericardiis Post MI syndrome didn't cause HF ,102 → ACE I CI in HF (↑k or ↓ GFR)→ hydralazine + Dinitate ,108, → Sarcoidosis → cmr not Biopsy 111 Marphan + Thoracic AA → SURGERY 113 Cyanotic , Congenital heart disease + HB 15.5 + ↓ Ferritin → Masking of anemia → Rx

Front 114

اجاك واحد CHF وعندة PAD مثل حجي لازم محسن(الله يرحمه) ما تكدر تنطي ؟

Back 114

cilastazol

Front 115

اجاك مريض HF وعلة ال loop diuretics الزينة وكلب af دير بالك لاتجفت وتنطي ؟

Back 115

amiodarone

Hint 115

لان هذا يزيد الtoxicity والسبب السبب هو hypokalemia

Front 116

ABCDE Mx of HOCM?

CI?

Back 116

Amiodarone

· Beta-blockers or verapamil for symptoms

· Cardioverterdefibrillator

· Dualchamber pacemaker

· Endocarditis prophylaxis

Hint 116

NAI

Nitrates

AceI

Inotropes: Digoxin, Milrenone, Insulin

Front 117

+ve Inotropes?

Back 117

Amiodaron

Calcium

Dopamine

Dobutamine

Epinephrine (adrenaline)

Isoprenaline (isoproterenol)

Norepinephrine (noradrenaline)

Digoxin

Prostaglandins[1]

Phosphodiesterase inhibitors

Milrinone

Theophylline

Glucagon

Insulin

Hint 117

Positive: Increase Myocaridal C

Front 118

-ve Inotropes?

Back 118

Beta blockers

Verapamil

Ditiazem

Class 1A

Procainamide

Disopyramide

Class 1C

Flecainide

Hint 118

Negative : Decrease Myocardial Contarctility

Front 119

Dental Extraction AB Prophylaxis

Back 119

1. prosthetic cardiac valve or prosthetic material used for cardiac valve repair
2. a history of infective endocarditis
3. a cardiac transplant that develops cardiac valvulopathy
4. the following congenital (present from birth) heart disease:

• aunrepaired cyanotic congenital heart disease, including palliative shunts and conduitsa
• completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
• any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibit endothelialization)
  

Front 120

ECG changes in ASD?

Back 120

PR prolongation

Axis Deviation (1 L 2 R)

Incomplete RBBB

Front 121

main indications for (ASD) closure is ?

Back 121

1. RV En without PH
   

with or without symptoms (eg, exercise intolerance, fatigue, dyspnea, heart failure, paradoxical emboli, arrhythmias) [1].

2. paradoxical embolism or documented orthodeoxia-platypnea

Front 122

any patient with an unexplained elevation in JVP,

particularly if there is a history of a predisposing condition such as

Malignancy,

prior cardiac surgery,

or prior radiation therapy.

Back 122

Pericardial constriction should be considered in

Front 123

RCMP due to Amyloid \ which drug should avoid?

Back 123

Digoxin

as it is thought that digoxin may bind to amyloid fibrils and lead to increased toxicity.

There I some suggestion that calcium channel blockers and beta blockers should also be avoided.

Front 124

Post MI PW chest pain, shortness of breath, hypotension,

biventricular failure, and shock within hours to days. Patients often present with a new, loud, and harsh holosystolic murmur. This murmur is loudest along the lower left sternal border and is associated with a palpable parasternal systolic thrill.
Likely Dx?

Back 124

Ventricular Septal Rupture

Hint 124

RV and LV S3 gallops are common.

Front 125

Post MI one week pw Arrythmia, and features of Cardiogenic Shock with Recurrent ST elevations ?

Back 125

FVWR

usually aw Pericardial effusion and Temponade

involve the Anterior wall

Treat by PCI

Front 126

Mx of VSR?

Back 126

1. Hemodynamic stabilization with the administration of oxygen and mechanical support with use of an intra-aortic balloon pump, administration of vasodilators (to reduce afterload and thus LV pressure and the left-to-right shunt), diuretics, and inotropic agents.
2. Cardiac catheterization
3. urgent surgical repair.
   

Front 127

A 62 year old woman undergoes thrombolysis for a myocardial infarction. After 48 hours you are asked to review here as she is complaining of shortness of breath and her saturations have dropped to 92 per cent. Her blood pressure is 100/65 mmHg and is tachycardic 110 bpm. On auscultation she has a systolic murmur, loudest at the apex, and bilateral crackles to mid zone. What is the likely cause for her deterioration?

Back 127

Papillary muscle Rupture

Front 128

Tall R wave in V1 + Inverted T wave ?

Back 128

Post MI

Front 129

1st ECG change in MI?

Back 129

Hyperacute T wave

Front 130

Dxtic Criteria of SLE?

Back 130

SOAP BRAIN MD

Hint 130

S: Serositis
O:Oral Ulcers
A: Arthralgia

P: phtosensitivity

B: Blood disorders (1 of 4)
R: Renal Disease
A: ANA
I: Immune : Abs
N: Neuro : Seizure or Psychosis

M:Malar Rash

D: Discoid Rash

Front 131

Classification for CA Indication?

Back 131

1

2

3

Front 132

Diff bw segment & interval?

Back 132

Interval : begining to End

Segment: End to Begining

Front 133

Main management of Cholesterol emboli Syndrome

Back 133

Supportive :)

Front 134

Which cardiac Chamber mostly involved in Radiation toxicity?

Back 134

RV → RVF

Front 135

At which level Warfarin shod be avoided?

Back 135

1st: Emberyopathy

3rd: Risk of ICH of fetus

Front 136

3 Novel Drugs used in Mx of Peripartum CMP?

Back 136

Immune globulin

Pentoxyphilline

Bromocriptine

Hint 136

In addition to anti failure Drugs

Front 137

In women with LV dysfunction below 35%?

How to AntiCoagulate?

Back 137

Warfarin with INR (2-3)

Front 138

Increased Risk of PP CMP?

Back 138

من النقطة للنقطة

Front 139

When to Prefer Cesarean delivery in CVD pregnant

Back 139

Obstetric causes

Warfarin Use

Sever PHT

Dilated Ascending Aorta

Front 140

Earliest Feature of Radiation Cardiotoxixity?

Back 140

Reduced Contractile Reserve

Hint 140

Absence of Significant ↑ in EF after stress echo

Front 141

Which type of CMP will occur late after Receiving Cardiotoxic Chemotherapy?

Back 141

DCMP

Poor prognosis

Front 142

Wch type of CMP occur acc Period of Exposure?

1. 2-5 m
2. 7 y
3. 10 - 25y
4. Years
5. Years to Decade

Back 142

1. Pericarditis (pericardial eff)
2. CAD (may manifest as MI)
3. Valvular fibrosis & Regurgitation
4. Myocardial fibrosis, DD, RCMP
5. Dysrythmia, Bradycardia, HB
6. اخر شي

Front 143

Whats the meaning of Ulcerative Plaque?

Back 143

It means Irregular Surface → high risk for clot formation