Heart failure & cardiomyopathies flashcards
16 high-yield MRCP Part 1 cards from the Intellect Medicos Cardiology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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In suspected heart failure, an NT-proBNP above 2,000 ng/L should prompt urgent specialist assessment and transthoracic echocardiography within ______.
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2 weeks
Why? Very high natriuretic peptide levels reflect high ventricular wall stress and carry a poor prognosis, so these patients are fast-tracked.
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Ivabradine slows the heart by blocking the funny current (If) in the SA node, so it only works in patients in ______ rhythm.
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sinus
Why? Its only target is the SA node pacemaker. In atrial fibrillation the ventricular rate is set by AV node conduction, so ivabradine has no useful effect.
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What are the four drug classes of first-line "quadruple therapy" for HFrEF?
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ACE inhibitor + beta-blocker + mineralocorticoid receptor antagonist (MRA) + SGLT2 inhibitor.
Why? Each class independently reduces mortality or hospitalisation. If symptoms persist on maximum tolerated doses of all four, the ACE inhibitor can be switched to an ARNI (sacubitril–valsartan). If an ACE inhibitor is not tolerated (other than angioedema), NICE 2025 offers an ARNI instead, with an ARB if ARNI is not tolerated.
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In HFrEF, when does NICE suggest considering hydralazine plus a nitrate?
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When ACE inhibitors, ARNIs and ARBs are not tolerated (with specialist advice).
Why? Hydralazine (arterial dilator) and nitrate (venodilator) reduce afterload and preload without acting on the renin–angiotensin system.
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Cardiac resynchronisation therapy is considered in HFrEF when the QRS is at least ______ and the ejection fraction is 35% or less.
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120 ms
Why? A broad QRS (especially LBBB) means the ventricular walls contract out of sync. Pacing both ventricles restores coordinated contraction and improves output.
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Cardiac resynchronisation therapy is considered in HFrEF when the QRS is at least 120 ms and the ejection fraction is ______.
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35% or less
Why? A broad QRS (especially LBBB) means the ventricular walls contract out of sync. Pacing both ventricles restores coordinated contraction and improves output.
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A 68-year-old woman develops chest pain and breathlessness hours after her husband's funeral. ECG shows anterior ST elevation; troponin is only mildly raised. Coronary angiography is normal. Echo: apical akinesia with basal hyperkinesis. What is the diagnosis?
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Takotsubo (stress) cardiomyopathy.
Why? A catecholamine surge stuns the apical myocardium, producing "apical ballooning". The troponin rise is small relative to the wall motion abnormality, and function usually recovers.
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Which vitamin deficiency causes a dilated (high-output) cardiomyopathy, and what is it called?
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Thiamine (vitamin B1) deficiency — wet beriberi.
Why? Thiamine is essential for cardiac energy metabolism. Deficiency (for example in alcohol excess) causes peripheral vasodilation and high-output heart failure.
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Which chemotherapy class classically causes a dose-dependent dilated cardiomyopathy?
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Anthracyclines (for example doxorubicin).
Why? Anthracyclines generate free radicals that damage cardiac myocytes, which have limited antioxidant defences. Cumulative dose drives the risk.
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What is the commonest cause of restrictive cardiomyopathy?
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Amyloidosis.
Why? Amyloid deposits infiltrate the myocardium, making the ventricles stiff with preserved ejection fraction, severe diastolic dysfunction and enlargement of both atria.
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What is the first-line investigation for suspected chronic heart failure?
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Serum NT-proBNP (N-terminal pro-B-type natriuretic peptide).
Why? It decides who needs echocardiography and how urgently. A level below 400 ng/L in an untreated person makes heart failure unlikely.
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In heart failure with reduced ejection fraction, when does NICE (2025) say to consider intravenous iron?
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When haemoglobin is below 150 g/L and there is iron deficiency (transferrin saturation below 20% or ferritin below 100 ng/mL).
Why? IV iron improves symptoms and exercise capacity; oral iron is poorly absorbed in heart failure.
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Which three beta-blockers are licensed for heart failure with reduced ejection fraction?
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Bisoprolol, carvedilol and nebivolol.
Why? Start at a low dose once the patient is stable and titrate slowly, because beta-blockers can briefly worsen fluid retention.
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What is the gold-standard non-invasive investigation for suspected myocarditis?
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Cardiac MRI (showing oedema and subepicardial or mid-wall late gadolinium enhancement).
Why? Troponin is almost always raised and the ECG may mimic MI. Endomyocardial biopsy is reserved for selected cases.
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Which gene is the commonest genetic cause of familial dilated cardiomyopathy?
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TTN (titin) — truncating variants.
Why? Titin is the giant "spring" protein of the sarcomere. Familial DCM is usually autosomal dominant; idiopathic DCM is the commonest overall category in the notes.
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What is the first-line drug for acute heart failure with fluid overload?
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An intravenous loop diuretic (e.g. furosemide).
Why? NICE advises against routine opiates or nitrates in acute heart failure. IV nitrates are kept for specific situations such as concomitant ischaemia, severe hypertension or regurgitant valve disease.
More Cardiology topics
- Physiology & haemodynamics
- Heart sounds, pulses & murmurs
- Valvular heart disease
- ECG & arrhythmias
- Inherited & sudden cardiac death syndromes
- Ischaemic heart disease
- Pericardial disease
- Endocarditis & rheumatic fever
- Congenital heart disease
- Hypertension, aorta & emboli
- Cardiovascular pharmacology
- Lipids & statins