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DPD Amir Sam GK > 1. Clinical presentation - Case Histories > Flashcards

1. Clinical presentation - Case Histories Flashcards

1
Q

IV Drug use cardiac complication

A

Infective endocarditis affecting right side of heart

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2
Q

30 yr old woman
Upper Resp Tract Infection
Pleuritic chest pain
Better leaning forward

A

Pericarditis

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3
Q

Differentiate between split S2 and S3

A

S3 better heard with Bell of stethoscope

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4
Q

Raised JVP DDx

A

R heart failure
Tricuspid regurgitation
Constrictive Pericarditis

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5
Q

Acute Fast AF
BP 120/80

Management

A

Rhythm Control:
-if onset more than 48hrs ago, anticoagulate for 3-4wks before cardioversion

Rate Control:

  • beta blocker
  • digoxin

(Treat underlying cause and manage complications)

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6
Q

ECG: Fast, No P waves, Regular

A

SVT

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7
Q 
60 yr old
Chest Pain
Tight 4hrs
Nausea
Sweating
Breathlessness
HTN
DH: Amlodipine
A

Myocardial Infarction

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8
Q

Slow rising pulse

A

Felt in carotid, like a thrill in neck.

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9
Q

3rd Degree Heart Block

A

Complete Dissociation P/QRS

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10
Q

P not followed by QRS

A

2nd Degree Heart Block

or 3rd

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11
Q

Congestive Cardiac Failure

A

R failure secondary to L failure

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12
Q

Pericarditis ECG

A

ST elevation in all leads

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13
Q

STEMI treatment?

A

Aspirin, Clopidogrel, Percutaneous Coronary Intervention

```
MONABASH:
Morphine
Oxygen
NTG PRN chest pain
Aspirin
Beta blocker
ACE inhibitor
Statin
Heparin
~~~

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14
Q

Broad QRS, Fast

A

VT unless proven otherwise

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15
Q

Palpitations/Tachycardia diagnoses (by ECG)

A 
Sinus Tachycardia
SVT
Atrial Fibrillation
Atrial Flutter
VT 
(VF)
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16
Q

Cardiac Arrest Reversible Causes

A

Four H’s Four T’s:

Hyper/Hypokalaemia
Hypoxia
Hypothermia
Hypovolaemia
Thromboembolism
Tension Pneumothorax
Toxicity
Cardiac Tamponade
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17
Q

Examination Aortic Dissection

A

Difference BP two arms;

Early diastolic murmur (aortic regurgitation)

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18
Q

Coronary Artery

ECG changes in Inferior MI

A

RC artery

II, III, aVF

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19
Q

Adenosine Contraindication

A

Asthmatics

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20
Q

ECG: Fast, No P waves, irregular

A

AF

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21
Q

Gold standard LVH

A

Echocardiogram

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22
Q

Acute Fast AF

BP 60/30

A

Cardioversion

Be aware of clots having formed

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23
Q

Features of seizures

A

Aura, Stereotypical Movements, Tongue Biting, Incontinence

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24
Q

Pan Systolic Murmur DDx

A

Mitral regurgitation
Tricuspid Regurgitation
VSD

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25
Constrictive Pericarditis
Fibrosis of pericardium e.g. TB. Raised JVP, hepatomegaly, calcification of pericardium on CXR
26
PE Risk Factors
Immobility, malignancy, smoking, birth control, pregnancy, prior DVT
27
Postural Hypotension Investigations
Lying/Standing BP
28
``` 65 yr old woman Breathlessness Onset few hours Orthopnoea PMHx: 2 MIs DH: Aspirin, Simvastatin, Ramipril, Bisoprolol Temp 36.5 Raised JVP S1+S2+S3 Fine Crackles Peripheral Oedema ``` Cause + Management
Heart Failure Sit her up and 60-100% O2
29
S1
Closure of Mitral Valve
30
``` 30 yr old man Collapse HPC: no warning no tongue biting not confused FH brother died at young age HS S1+S2 BP 120/80 lying 115/75 standing Vesicular breath sounds Abdomen SNT ```
Tachyarrhythmia - Ventricular Tachycardia
31
Common cause of gastritis
Excessive Alcohol intake
32
VT Management
IV Amiodarone Cause and Complications Think about ICD (implantable cardiac defibrillator) Pulseless VT -> Defibrillate
33
Outflow Obstruction O/E and Investigations
``` (L: Aortic Stenosis, HOCM R: PE) Low Volume/Slow rising pulse Ejection Systolic Murmur Echocardiogram ```
34
Fixed wide splitting of S2
Atrial Septal Defect
35
Oesophageal Infection during immunosuppression
Oesophageal Candidiasis
36
Long QT Syndrome
Abnormal Ventricular Repolarisation Congenital e.g. mutations in K+ channels Acquired: Low K+/Mg2+, drugs FH of sudden death
37
2nd Degree Heart Block
P not followed by QRS
38
Delta waves
AVRT ECG finding in sinus rhythm
39
Coronary Artery and ECG changes in Anterior MI
LAD artery | V1-V4
40
ALS algorithm
``` VF/Pulseless VT: Shock CPR 2mins Assess rhythm Adrenaline every 3-5mins Correct reversible causes ``` Asystole/Pulseless electrical activity: CPR Correct reversible causes
41
Pericarditis characteristic pain
Pleuritic Chest Pain (worse on inspiration) - better by leaning forward. Also maybe preceding flu-like illness
42
Chest Pain Investigations
1. ECG 2. Troponin +ve: coronary angiography and PCI -ve: Exercise Tolerance Test 3. Echocardiography
43
SVT, BP 120/80 Management
Valsava Manoeuvre | Adenosine
44
Systolic Murmur DDx
Aortic Stenosis Mitral regurgitation Tricuspid Regurgitation VSD Differentiate by where loudest, radiation, associated features
45
Displaced apex beat in which cardiac condition
Mitral regurgitation
46
Prolonged PR interval | >0.2s
1st Degree Heart Block
47
Acute Heart Failure Managment
``` Sit up Oxygen Furosemide (IV) GTN infusion Diamorphine ``` (all venodilators - reduce preload of heart) Treat underlying cause
48
S4
Associated with ventricular filling Caused by atria contracting forcefully to overcome stiff/hypertrophic ventricle
49
Sinus Tachycardia DDx
Sepsis, Hypovolaemia, Endocrine (thyrotoxicosis, phaeochromocytoma) Anxiety
50
Tricuspid regurgitation causes
Valve leaflet defects | R ventricle dilatation
51
PE timing
Sudden onset pain
52
``` 60 yr old man Chest Pain Tight 2hrs Nausea and Sweating PMH HTN DH amlodipine Temp 37.0 HS S1+S2 BP: 120/80L 118/75R Chest Clear Abdomen SNT ``` Most appropriate investigation?
ECG (STEMI/NSTEMI?) | Then serial Troponin, then Echocardiogram
53
SVT subtypes
AVNRT AVRT -> ECG in sinus rhythm has short PR and Delta wave
54
Chest Pain DDx
Cardiac: IHD, Aortic Dissection, Pericarditis Resp: PE, Pneumonia, Pneumothorax GI: Oesophageal spasm, Oesophagitis, Gastritis Musc: Costochondritis, Rib Fracture
55
R heart failure causes
``` Secondary to L failure Pulmonary HTN (PE, COPD etc) ```
56
Collapse DDx
1. Hypoglycaemia 2. Cardiac: Vasovagal Arrhythmia Outflow obstruction Postural Hypotension 3. Neurological - Seizure
57
1st Degree Heart Block
Prolonged PR interval | >0.2s
58
Ventricular Tachycardia DDx
Ischaemia, Electrolyte abnormality, long QT
59
``` 45 yr old man Fever Malaise IV drug use Temp 38 Raised JVP to earlobes S1+S2+PSM louder on inspiration Hepatomegaly ```
Tricuspid Regurgitation | PSM louder inspiration due to increased venous return Hepatomegaly due to back pressure - hepatic congestion.
60
Risk Factors Aortic Dissection
HTN
61
NSTEMI treatment?
Aspirin, Clopidogrel, Fondaparinux
62
Why need to take serial troponins?
Rapid increase to peak after MI, then slower decrease after peak is reached - need to know where on graph you are for timing.
63
S2
Closure of Aortic Valve
64
LVH DDx
Aortic Stenosis | HTN
65
Bundle of Kent
Accessory pathway in AVRT (SVT)
66
Arrhythmia O/E and Investigations
(Tachycardia/Bradycardia) ECG (?Long QT - predisposes to VT) Cardiac Monitor 24hr tape
67
LVH by VC
LVH by Voltage Criteria Deep S in V1/V2 Tall R in V5/V6 S in V1 + R in V5/V6 (whichever is bigger) greater or equal than 7 large squares
68
Risk Factors IHD
Smoking HTN Diabetic
69
Pathologies suggested by ECG
Ischaemia: ST elevation T inversion Q waves ``` Arrhythmia/Conduction Defects: Rate/Rhythm PR long Broad QRS QT ``` Ventricular Strain/Hypertrophy: Axis
70
``` 65 yr old man Breathlessness Palpitations PMH: HTN DH Bendroflumethiazide Temp 38 PR 160, irregular BP 110/80 Dull percussion note and coarse crackles L base ```
Atrial Fibrillation | Caused by Pneumonia
71
Features Aortic Dissection
Pain radiating to back; | Sudden onset
72
Complete Dissociation P/QRS
3rd Degree Heart Block
73
SVT and BP 60/30 Management
Cardioversion | Adenosine
74
Constrictive pericarditis causes
Infection e.g. TB Inflammation e.g. CTD Malignancy
75
Features IHD
Tight Nausea Sweating etc
76
Atrial Fibrillation DDx
Thyrotoxicosis, Alcohol Heart: Pericariditis, IHD, Rheumatic Heart disease, Endocarditis (Remember layers: Heart, Valve, Pericardium) Lungs: Pneumonia, PE, cancer
77
Pleuritic Chest Pain DDx
``` Pericarditis Pneumothorax PE Pneumonia Pleural Pathology ``` Sub-diaphragmatic pathology
78
Coronary Artery and ECG changes in Lateral MI
Circumflex artery | V5, V6, I, aVL

DPD Amir Sam GK (5 decks)

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