Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP Academy > 09. AKT: ECG/CKD > Flashcards

09. AKT: ECG/CKD Flashcards

1
Q

What is a precordial thump and when is it indicated?

A
  • A precordial thump is a single, sharp blow delivered by the rescuer’s fist to the mid sternum of the victims chest
  • It may be considered for patients with monitored, pulseless ventricular tachycardia if a defibrillator is not immediately available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is preferred for defibrillation, monophasic or biphasic?

A

Biphasic

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

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

V1-V2

A
  1. Septal
  2. Proximal LAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

V3-V4

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

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

V5-V6

A
  1. Apical
  2. Distal LAD, LCx or RCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

I, AVL

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

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

II, III, aVF

A
  1. Inferior
  2. 90% RCA. 10% LCx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?

V7, V8, V9 (reciprocal ST depressions are frequently evident in V1-V3)

A
  1. Posterolaeral (AKA inferobasal or posterior)
  2. RCA or LCx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is benign early repolarisation?

A
  • Benign early repolarization is a usually benign ECG pattern producing widespread ST segment elevation that is commonly seen in young, healthy patients less than 50 years old
  • J point morphology/fish hook pattern with a high take off
  • ST elevation is limited to the precordial leads
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Differentials for chest pain?

A

Isolated musculoskeletal chest wall pain
* Costochondritis
* Low rib pain syndrome
* Sternalist syndrome
* Thoracic costovertebral joint dysfunction

Rhuematic causes
* Fibromyalgia
* Rheumatoid arthritis
* Axial spondyloarthropathy (including anklyosing spondylitis)
* Psoriatic arthritis

Non-rheumatic systemic Causes
* Osteoporotic fracture
* Neoplasm with pathological fracture or bone pain

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

Pharmacotherapy for haemodynamically stable patient with sustained ventricular tachycardia (lasting more than 30 seconds)?

A

Amiodarone300mg IV infusion over 30 minutes, followed by 900mg IV infusion over 24 hours if required

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

Management for haemodynamically stable patient with narrow complex tachycardia?

A
  • Vagal manoeuvres
  • Adenosine 6mg rapid IV bolus; if unsuccessful, give 12mg; if unsuccessful, give further 12mg
  • Continuous ECG monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What must you always consider with a ventricular rate of 150bpm (range 130-170) with narrow QRS complexes?

A

Atrial flutter with 2:1 block (might be hard to see the sawtooth pattern)

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

How can you differentiate between atrial flutter with 2:1 block and AVNRT/AVRT?

A

Give a test dose of adenosine
* Atrial flutter: slowing of the ventricular rate shows the sawtooth pattern
* AVNRT/AVRT: will often revert to sinus rhythm

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

What are delta waves and what are they associated with?

A
  • Slurred upstroke of QRS
  • Associated with pre-excitation syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are characteristics ECG findings for Wolff-Parkinson-White syndrome?

A
  • Short PR interval (<120ms)
  • Broad QRS complex (>100ms)
  • Slurred upstroke of QRS (delta wave)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the ECG definitions for a ST elevation myocardial infarction?

A
  • ST elevation (length varies depending on the patient demographic) in 2 or more contiguous leads
  • Development of new onset left bundle-branch block (use Sgarbossa criteria)
18
Q

Contraindications for the use of GTN in the acute management of suspected cardiac related chest pain?

A
  • Suspected right ventricular myocardial infartion (pre-load sensitive)
  • Recent phoshodiesterase type 5 inhibitor use -> severe hypotension
19
Q

What medications should be given in out of hospital suspected cardiac chest pain?

A
  • GTN if blood pressure is good (0.3-0.6mg tablet OR 0.4-0.8mg spray sublingually every 5 minutes for 3 doses)
  • Aspirin 300mg PO STAT
  • IV opioids if pain is not responsive to GTN (fentanyl preferred as morphine may reduce absorption of oral antiplatelets)
20
Q

ECG characteristics for a posterior myocardial infarction?

A
  • ST depression in V1-3 (usually horizontal)
  • Tall, broad R waves (>30ms) in V1-3
  • Dominant R wave (R/S ratio > 1) in V2
  • Upright terminal portions of the T waves in V1-3

Note: in patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI

21
Q

What should you consider if a patient presents with cardiac ischaemic symptoms and has an ECG with horizontal ST depression in the anteroseptal leads (V1-3)?

A

Posterior myocardial infarction

22
Q

ECG changes in pericarditis?

A
  • Widespread concave ST elevation and PR depression throughout most of the limb leads and precordial leads
  • Reciprocal ST depression and PR elevation in lead aVR (+/- V1)
  • Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion
23
Q

What is Beck’s triad?

A
  • Hypotension
  • Elevated JVP
  • Muffled heart sounds

NB: indicates cardiac tamponade

24
Q

Clinical features of cardiac tamponade?

A

Beck’s triad:
* Hypotension
* Elevated JVP
* Muffled heart sounds

  • Tachypnoea
  • Tachycardia
  • Atrial arrhythmias - e.g. atrial fibrillation
  • Kussmaul sign (paradoxical rise in JVP on inspiration)
  • Positive hepatojugular reflux
  • Weakened peripheral pulses
  • Peripheral oedema
  • Cyanosis
  • Pulsus paradoxus
  • ECG: electrical alternans (alteration in the amplitude of QRS complexes thought to be due to the swinging movement of the heart within the pericardial cavity)
25
Q

What is normal QT interval?

A

Men: >440ms
Women: >460ms

26
Q

Causes of left ventricular hypertrophy?

A
  • Hypertension
  • Aortic stenosis
  • Aortic regurgitation
  • Mitral regurgitation
  • Hypertrophic cardiomyopathy
  • Coarctation of the aorta
27
Q

Clinical features of aortic stenosis?

A
  • Usually asymptomatic
  • Decreased exercise tolerance
  • Shortness of breath on exertion
  • Dizziness
  • Heart failure
  • Angina
  • Syncope
  • Low volume and slow rising carotid pulse
  • Mid to late peaking systolic murmur in the right intercostal space
28
Q
A
29
Q

How do you differentiate between the murmurs of aortic stenosis and hypertrophic cardiomyopathy?

A

HCM:
* An increase in intensity, due to enhancement of obstruction, is seen with the assumption of an upright posture from squatting, sitting, or supine position
* Increase in intensity during Valsalva manoeuvre
* Decrease in intensity, due to attenuation of obstruction, is heard after going from a standing to a sitting or squatting position

Aortic stenosis: does not change substantially with the above

30
Q

What is the management of acute symptomatic bradycardia?

A

Atropine 500microg IV, repeat after three to five minutes if necessary, up to a maximum of 3 mg

Note: if atropine isn’t effective, consider transcutaneous or temporary transvenous pacing

31
Q

Causes of frequent or symptomatic premature ventricular complexes?

A
  • Anxiety
  • Sympathomimetic’s
  • Beta agonists
  • Excess caffeine
  • Hypokalemia
  • Hypomagnesemia
  • Digoxin toxicity
  • Myocardial ischaemia
32
Q

What is the optimal long-term ventricular rate for patients in AF?

A

85 BPM

33
Q

List indications for dose reduced apixaban

A
  • Age 80 or older
  • Weight 60 kg or less
  • Serum creatinine 133 or more
34
Q

What complication are you concerned about after an inferior myocardial infarction?

A

Third degree atrio-ventricular block
* 20% of patients will develop a 2nd degree or 3rd degree AV block
* Bradyarrhythmias and AV block in the context of inferior STEMI are usually transient (lasting hours to days), respond well to atropine and do not require permanent pacing

35
Q

List some commonly prescribed drugs that may need to be reduced in dose or ceased in chronic kidney disease

A
  • Allopurinol
  • Apixaban
  • Benzodiazepine’s
  • Colchicine
  • Fenofibrate
  • Gabapentin
  • Gliclazide
  • Metformin
  • NSAIDs
  • Opioids
  • Pregabalin
  • Rivaroxaban
  • Sitagliptin
  • Sotalol
  • Spironolactone
36
Q

At what renal function is metformin contraindicated?

A

eGFR < 30

37
Q

What change in eGFR and serum potassium is acceptable when starting an ACEi or ARB?

A
  • Reduction in eGFR less than 25% within 2 months of starting therapy
  • 0.5mmol/L rise in serum potassium is expected
  • ACEi and ARBs can be safely prescribed at all stages of CKD and should not be deliberately avoided just because eGFR is reduced
38
Q

Causes of nephrotic syndrome in children?

A
  • Idiopathic - 90%
  • Systemic lupus erythematosus
  • Henoch Schonlein Purpura
39
Q

Classic triad of nephrotic syndrome?

A
  • Oedema - can be non-dependent locations e.g. periorbital
  • Proteinuria
  • Hypoalbuminuria
40
Q

Diagnostic criteria for nephrotic syndrome on investigations?

A
  • Heavy proteinuria (dipstick 3-4+ or urine protein/creatinine ratio >0.2g/mmol = >200mg/mmol)
  • Hypoalbuminaemia (<25g/L)

GP Academy (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions