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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
Q

Constrictive Pericarditis

A

Fibrosis of pericardium e.g. TB. Raised JVP, hepatomegaly, calcification of pericardium on CXR

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26
Q

PE Risk Factors

A

Immobility, malignancy, smoking, birth control, pregnancy, prior DVT

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27
Q

Postural Hypotension Investigations

A

Lying/Standing BP

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28
Q 
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

A

Heart Failure

Sit her up and 60-100% O2

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29
Q

S1

A

Closure of Mitral Valve

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30
Q 
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
A

Tachyarrhythmia - Ventricular Tachycardia

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31
Q

Common cause of gastritis

A

Excessive Alcohol intake

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32
Q

VT Management

A

IV Amiodarone

Cause and Complications
Think about ICD (implantable cardiac defibrillator)
Pulseless VT -> Defibrillate

33
Q

Outflow Obstruction O/E and Investigations

A 
(L: Aortic Stenosis, HOCM
R: PE)
Low Volume/Slow rising pulse
Ejection Systolic Murmur
Echocardiogram
34
Q

Fixed wide splitting of S2

A

Atrial Septal Defect

35
Q

Oesophageal Infection during immunosuppression

A

Oesophageal Candidiasis

36
Q

Long QT Syndrome

A

Abnormal Ventricular Repolarisation
Congenital e.g. mutations in K+ channels
Acquired: Low K+/Mg2+, drugs
FH of sudden death

37
Q

2nd Degree Heart Block

A

P not followed by QRS

38
Q

Delta waves

A

AVRT ECG finding in sinus rhythm

39
Q

Coronary Artery and ECG changes in Anterior MI

A

LAD artery

V1-V4

40
Q

ALS algorithm

A 
VF/Pulseless VT:
Shock
CPR 2mins
Assess rhythm
Adrenaline every 3-5mins
Correct reversible causes

Asystole/Pulseless electrical activity:
CPR
Correct reversible causes

41
Q

Pericarditis characteristic pain

A

Pleuritic Chest Pain (worse on inspiration) - better by leaning forward.
Also maybe preceding flu-like illness

42
Q

Chest Pain Investigations

A
  1. ECG
  2. Troponin
    +ve: coronary angiography and PCI
    -ve: Exercise Tolerance Test
  3. Echocardiography
43
Q

SVT, BP 120/80 Management

A

Valsava Manoeuvre

Adenosine

44
Q

Systolic Murmur DDx

A

Aortic Stenosis
Mitral regurgitation
Tricuspid Regurgitation
VSD

Differentiate by where loudest, radiation, associated features

45
Q

Displaced apex beat in which cardiac condition

A

Mitral regurgitation

46
Q

Prolonged PR interval

>0.2s

A

1st Degree Heart Block

47
Q

Acute Heart Failure Managment

A 
Sit up
Oxygen
Furosemide (IV)
GTN infusion
Diamorphine

(all venodilators - reduce preload of heart)

Treat underlying cause

48
Q

S4

A

Associated with ventricular filling

Caused by atria contracting forcefully to overcome stiff/hypertrophic ventricle

49
Q

Sinus Tachycardia DDx

A

Sepsis, Hypovolaemia, Endocrine (thyrotoxicosis, phaeochromocytoma)
Anxiety

50
Q

Tricuspid regurgitation causes

A

Valve leaflet defects

R ventricle dilatation

51
Q

PE timing

A

Sudden onset pain

52
Q 
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?

A

ECG (STEMI/NSTEMI?)

Then serial Troponin, then Echocardiogram

53
Q

SVT subtypes

A

AVNRT

AVRT
-> ECG in sinus rhythm has short PR and Delta wave

54
Q

Chest Pain DDx

A

Cardiac: IHD, Aortic Dissection, Pericarditis
Resp: PE, Pneumonia, Pneumothorax
GI: Oesophageal spasm, Oesophagitis, Gastritis
Musc: Costochondritis, Rib Fracture

55
Q

R heart failure causes

A 
Secondary to L failure
Pulmonary HTN (PE, COPD etc)
56
Q

Collapse DDx

A
  1. Hypoglycaemia
  2. Cardiac:
    Vasovagal
    Arrhythmia
    Outflow obstruction
    Postural Hypotension
  3. Neurological - Seizure
57
Q

1st Degree Heart Block

A

Prolonged PR interval

>0.2s

58
Q

Ventricular Tachycardia DDx

A

Ischaemia, Electrolyte abnormality, long QT

59
Q 
45 yr old man
Fever
Malaise
IV drug use
Temp 38
Raised JVP to earlobes
S1+S2+PSM louder on inspiration
Hepatomegaly
A

Tricuspid Regurgitation

PSM louder inspiration due to increased venous return
Hepatomegaly due to back pressure - hepatic congestion.

60
Q

Risk Factors Aortic Dissection

A

HTN

61
Q

NSTEMI treatment?

A

Aspirin, Clopidogrel, Fondaparinux

62
Q

Why need to take serial troponins?

A

Rapid increase to peak after MI, then slower decrease after peak is reached - need to know where on graph you are for timing.

63
Q

S2

A

Closure of Aortic Valve

64
Q

LVH DDx

A

Aortic Stenosis

HTN

65
Q

Bundle of Kent

A

Accessory pathway in AVRT (SVT)

66
Q

Arrhythmia O/E and Investigations

A

(Tachycardia/Bradycardia)
ECG (?Long QT - predisposes to VT)
Cardiac Monitor
24hr tape

67
Q

LVH by VC

A

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
Q

Risk Factors IHD

A

Smoking
HTN
Diabetic

69
Q

Pathologies suggested by ECG

A

Ischaemia:
ST elevation
T inversion
Q waves

Arrhythmia/Conduction Defects:
Rate/Rhythm
PR long
Broad QRS
QT

Ventricular Strain/Hypertrophy:
Axis

70
Q 
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
A

Atrial Fibrillation

Caused by Pneumonia

71
Q

Features Aortic Dissection

A

Pain radiating to back;

Sudden onset

72
Q

Complete Dissociation P/QRS

A

3rd Degree Heart Block

73
Q

SVT and BP 60/30 Management

A

Cardioversion

Adenosine

74
Q

Constrictive pericarditis causes

A

Infection e.g. TB
Inflammation e.g. CTD
Malignancy

75
Q

Features IHD

A

Tight
Nausea
Sweating
etc

76
Q

Atrial Fibrillation DDx

A

Thyrotoxicosis, Alcohol
Heart: Pericariditis, IHD, Rheumatic Heart disease, Endocarditis
(Remember layers: Heart, Valve, Pericardium)
Lungs: Pneumonia, PE, cancer

77
Q

Pleuritic Chest Pain DDx

A 
Pericarditis
Pneumothorax
PE
Pneumonia
Pleural Pathology

Sub-diaphragmatic pathology

78
Q

Coronary Artery and ECG changes in Lateral MI

A

Circumflex artery

V5, V6, I, aVL

DPD Amir Sam GK (5 decks)

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