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Hypertension, aorta & emboli flashcards

13 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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1. What are the NICE clinic BP targets for people under 80 and for those aged 80 and over?

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   Under 80: below 140/90 mmHg. Aged 80 and over: below 150/90 mmHg.

   Why? Home and ambulatory targets are 5 mmHg lower: 135/85 and 145/85.

2. Which antihypertensives are avoided in pregnancy, and which are used?

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   Avoid ACE inhibitors and ARBs (fetotoxic) and spironolactone. Use labetalol first-line; nifedipine if labetalol is unsuitable; methyldopa if both are unsuitable.

   Why? Blocking the renin–angiotensin system in pregnancy causes fetal renal damage and oligohydramnios.

3. In eclampsia, what is the first-line anticonvulsant, and what reverses its toxicity?

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   Magnesium sulfate. Toxicity is reversed with calcium gluconate.

   Why? Monitor for magnesium toxicity: loss of reflexes, respiratory depression and reduced urine output.

4. Stanford classification of aortic dissection: how is each type managed?

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   Type A (ascending aorta involved): immediate surgery. Type B (descending only): BP control if uncomplicated; endovascular repair (TEVAR) if complicated.

   Why? Ascending dissection can extend back to cause tamponade, acute aortic regurgitation or MI and is rapidly fatal without surgery.

5. Marfan syndrome: which gene and chromosome, and what is the inheritance?

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   FBN1 (fibrillin-1) on chromosome 15, autosomal dominant.

   Why? Defective fibrillin weakens connective tissue, especially the aortic media — the main cause of death is aortic root dilatation and dissection.

6. Two weeks after coronary angiography, a 72-year-old has painful purple toes with palpable foot pulses, livedo reticularis and a rising creatinine. Bloods show eosinophilia. What is the diagnosis?

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   Cholesterol embolism.

   Why? Catheter manipulation shatters atheromatous plaque, showering cholesterol crystals into small arteries of the skin, kidneys and other organs. Eosinophilia and low complement are typical.

7. What is the best test for a patent foramen ovale in a young person with a cryptogenic stroke?

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   Agitated saline contrast echo (bubble study) with Valsalva.

   Why? In a PFO, bubbles cross into the left atrium within 1–3 cardiac cycles, often only after Valsalva. Bubbles that appear after 3–6 cycles suggest an intrapulmonary shunt such as an AV malformation.

8. Clinic BP is 150/94 mmHg. What does NICE recommend to confirm hypertension?

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   Ambulatory BP monitoring (ABPM); home BP monitoring if ABPM is unsuitable.

   Why? Out-of-office readings exclude white-coat hypertension. Stage 1 hypertension is an ABPM/HBPM average of 135/85 mmHg or more.

9. NICE step 1 antihypertensive for a 45-year-old white man without diabetes?

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   An ACE inhibitor or an angiotensin II receptor blocker (ARB).

   Why? People under 55 who are not of Black African or African-Caribbean family origin tend to have higher renin, so RAS blockade works well. People with type 2 diabetes start with an ACE inhibitor/ARB at any age.

10. NICE step 1 antihypertensive for a 62-year-old without diabetes, or for an adult of Black African or African-Caribbean origin?

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    A calcium channel blocker (a thiazide-like diuretic if a CCB is unsuitable).

    Why? These groups tend to have low-renin hypertension, which responds better to CCBs than to RAS blockade. At step 2, an ARB is preferred over an ACE inhibitor in people of Black African/African-Caribbean origin.

11. Resistant hypertension on an ACE inhibitor, CCB and thiazide-like diuretic: what does NICE add if potassium is 4.5 mmol/L or less?

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    Low-dose spironolactone.

    Why? If potassium is above 4.5 mmol/L, consider an alpha-blocker or beta-blocker instead. First confirm resistance with ABPM/HBPM and check adherence.

12. In acute aortic dissection, which drug is given first to control heart rate and BP, and what are the targets?

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    An IV beta-blocker (labetalol or esmolol); systolic BP 100–120 mmHg and heart rate below 60/min.

    Why? Lowering the rate of rise of aortic pressure (dP/dt) reduces shear stress and slows propagation of the false lumen. Beta-blockade comes before any vasodilator to avoid reflex tachycardia.

13. A type A aortic dissection tracking back into a coronary ostium most often causes which MI?

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    Inferior MI, from right coronary artery involvement.

    Why? The dissection flap usually involves the right coronary ostium. Mistaking this for a simple STEMI and giving fibrinolysis can be fatal.