MRCP Part 1 Cardiology: 50 Rapid-Review Facts
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MRCP Part 1 Cardiology: 50 Rapid-Review Facts

Why Cardiology Matters in MRCP Part 1

Cardiology remains one of the most frequently examined domains in MRCP Part 1, touching electrophysiology, pharmacology, ischaemic disease, heart failure, valve disease, congenital lesions, and ECG interpretation. The MRCP Part 1 exam is delivered in two 3-hour papers of 100 “best of five” MCQs each. Royal Colleges of Physicians UK+1

Because cardiology spans both basic clinical science and applied clinical scenarios, consolidating discrete facts is helpful as memory “hooks” during timed question practice. But these must be backed by understanding and repeated testing.

Below are:

  • 50 rapid-review facts (grouped by subtopic)

  • One illustrative MCQ with explanation

  • A short study-tip checklist

  • Common pitfalls to watch out for

You may also cross-reference this with your full MRCP revision plan or ECG masterclasses to strengthen integration.


50 Rapid-Review Facts (Grouped by Subtopic)

A. Electrophysiology & Conduction (10 facts)

  1. Normal PR interval = 120–200 ms; > 200 ms = 1st degree AV block. Geeky Medics+1

  2. The sinoatrial node is the normal pacemaker (phase 4 spontaneous depolarisation).

  3. Fast response action potential (e.g. atrial, ventricular myocytes) has phases 0–4; slow response (AV node) lacks a clear phase 1/2.

  4. Reentry circuits (e.g. AVNRT, atrial flutter) require anterograde + retrograde limb and unidirectional block.

  5. Class I antiarrhythmics block Na⁺ channels (Ia prolongs repolarisation; Ib shortens; Ic minimal effect on repolarisation).

  6. Class III antiarrhythmics (e.g. amiodarone, sotalol) prolong effective refractory period via K⁺ channel blockade.

  7. The intrinsic AV nodal delay protects ventricles from very high atrial rates.

  8. In bradycardias, first assess if reversible (e.g. drug effect, electrolyte) before permanent pacing.

  9. QRS width ≥ 120 ms suggests bundle branch block or ventricular origin conduction.

  10. The His–Purkinje system propagation is very rapid (~2–4 m/s).


B. ECG & Arrhythmias (10 facts)

  1. Atrial flutter typically shows a “sawtooth” pattern in inferior leads at ~250–350 bpm. PMC+1

  2. Atrial fibrillation shows no discrete P waves, irregularly irregular RR intervals. MedlinePlus+3nhs.uk+3Wikipedia+3

  3. In 2:1 flutter conduction, ventricular rate ~150 bpm if atrial ~300 bpm.

  4. In left bundle branch block (LBBB): broad R wave in V6, deep S in V1, QRS ≥ 120 ms.

  5. T-wave inversion in V1–V3 may be normal; in lateral leads suggests ischaemia.

  6. ST elevation >1 mm in ≥2 contiguous leads suggests STEMI if clinical context fits.

  7. In hyperkalaemia, tented T waves and widening QRS precede sine-wave morphology.

  8. Electrical alternans (alternating QRS amplitude) may signal pericardial tamponade.

  9. Long QT (>450 ms male, >470 ms female) predisposes to torsades de pointes.

  10. Brugada pattern: coved ST ≥ 2 mm V1–V3 + RBBB appearance.


C. Heart Failure & Cardiomyopathies (10 facts)

  1. S3 gallop reflects increased filling pressures in dilated ventricles.

  2. B-type natriuretic peptide (BNP) is released from ventricular stretch; aids in dyspnoea workup.

  3. ACE inhibitors reduce afterload, preload, aldosterone, and remodelling.

  4. In HFrEF, beta-blockers (e.g. bisoprolol, metoprolol) improve mortality when started gradually.

  5. Spironolactone (mineralocorticoid antagonist) reduces mortality in NYHA class II–IV.

  6. Loop diuretics act on thick ascending loop of Henle (Na-K-2Cl) to relieve congestion.

  7. In diastolic (HFpEF) failure, ventricular compliance is reduced; ejection fraction preserved.

  8. Cardiac resynchronisation therapy (CRT) beneficial in LBBB + low EF + symptoms.

  9. Ventricular remodelling involves myocardial hypertrophy, fibrosis, chamber dilation.

  10. Dilated cardiomyopathy may be due to toxins (alcohol, chemotherapy) or viral myocarditis.

D. Ischaemic Heart Disease / ACS (10 facts)

  1. STEMI: ST elevation in contiguous leads + reciprocal ST depression.

  2. NSTEMI: elevated troponins without persistent ST elevation.

  3. Primary PCI is preferred within 120 min; if delayed, consider fibrinolysis (within 12 h).

  4. Dual antiplatelet therapy = aspirin + P2Y12 inhibitor (e.g. clopidogrel) post-ACS.

  5. Beta-blockers reduce myocardial oxygen demand; contraindicated in decompensated heart failure.

  6. High-intensity statin (e.g. atorvastatin) is indicated unless contraindications.

  7. In unstable angina/NSTEMI: early invasive strategy considered in high-risk patients.

  8. Post-MI, ACE inhibitors reduce remodelling and risk of ventricular dilation.

  9. Risk factors: hypertension, diabetes, smoking, dyslipidaemia, family history.

  10. Silent ischaemia is common in diabetic patients.


E. Valvular Disease & Structural / Congenital (10 facts)

  1. Mitral regurgitation murmur: pan-systolic, radiates to axilla.

  2. Aortic stenosis murmur: ejection systolic, crescendo-decrescendo, radiates to carotids.

  3. Aortic regurgitation: early diastolic decrescendo, bounding pulses (water-hammer).

  4. Mitral stenosis: opening snap + diastolic rumble, more symptomatic in atrial fibrillation.

  5. In VSD, holosystolic murmur best heard left sternal edge; small defects = louder murmur.

  6. In coarctation of aorta: upper limb hypertension and delayed femoral pulses.

  7. Atrial septal defect (ostium secundum) may cause fixed split S2; risk of paradoxical emboli.

  8. Eisenmenger syndrome: reversal of left-to-right shunt due to pulmonary vascular disease.

  9. Hypertrophic cardiomyopathy: asymmetric septal hypertrophy, systolic anterior motion (SAM).

  10. Infective endocarditis prophylaxis (e.g. dental) only in selected high-risk valves per guidelines.


    Stethoscope on ECG strip representing cardiology review for MRCP Part 1.

Example MCQ & Explanation

Question (Single Best Answer):A 55-year-old patient presents with palpitations and mild breathlessness. ECG shows a regular narrow complex tachycardia at ~180 bpm with no visible P waves. Vagal manoeuvres fail. What is the best first-line drug to attempt termination?

A. AmiodaroneB. AdenosineC. VerapamilD. Digoxin

Answer & Explanation: B. Adenosine This is a classic narrow-complex, regular supraventricular tachycardia (likely AV nodal re-entrant). Adenosine is appropriate for acute termination via transient AV block. Verapamil is a slower alternative. Amiodarone is reserved for more complex arrhythmias. Digoxin is too slow for acute conversion.


Study-Tip Checklist for MRCP Cardiology

  • Create and actively use a 50-fact flash deck covering the five subtopics above.

  • Review with spaced repetition (1, 3, 7, 14 days).

  • During QBank practice, pause before reading explanations—try to recall the fact relevant to the question.

  • On wrong questions, immediately convert one fact from that topic into your flash deck.

  • Assign one weekend to cardiology “deep-dive” with textbooks and guidelines.

  • Use full mock exams (e.g. from MRCP resources) to simulate real timing and integrate cardiology under pressure.

  • After each mock, extract 2–3 “must-remember” cardiology facts and add to front of your review queue.


Common Pitfalls & How to Avoid Them

Pitfall

Fix

Mistaking artifact or noise for ventricular arrhythmia

Slow ECG sweep or check limb leads to confirm abnormal signal

Jumping to rhythm control before rate control

Always stabilise rate first in tachyarrhythmias unless unstable

Blindly memorising mnemonics without mechanism

Link mnemonics back to ion-channel or pathophysiology

Ignoring bradyarrhythmias or blocks in cardiology review

Allocate mini-modules on conduction blocks and syncope

Equating normal ECG with absence of disease

Always correlate with history, echo, biomarkers

FAQs (People Also Ask)

Q: How many cardiology questions are in MRCP Part 1?

Cardiology typically represents around 10–15 % of the MRCP Part 1 exam, distributed across ECG, pharmacology, heart failure, ischaemia and structural lesions.

Q: Will memorising 50 facts guarantee a high cardiology score?

No. These facts act as memory scaffolds but must be backed by question practice, deeper reading, and understanding of mechanisms.

Q: Should I prioritise ECG or pharmacology in cardiology revision?

Both are essential. Many trainees start with ECG basics, but pharmacology should go hand in hand because drug mechanisms clarify rhythm therapy.

Q: How early should I begin cardiology review?

Start early (months ahead) and escalate in your final 8–12 weeks, integrating with mock exams and flashcard recall cycles.

Q: Are online flashcard decks sufficient for cardiology?

They are useful, but you must tailor to your errors, cross-check with trusted references and supplement with question banks and guidelines.


Ready to start?

Use this 50-fact list to build your personal flash deck and integrate it into every revision session. Pair it with timed MCQs and full mock exams to anchor recall under exam conditions. For structured coverage, explore our MRCP Part 1 resources and ECG masterclasses. Stay consistent, test often, and let these facts form the backbone of your cardiology recall.


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