Cardiac

Question 1

When should troponin levels be checked in stable angina?

Answer 1

If there has been recent ECG changes or the history is suggestive

Question 2

In right axis deviation what lead will show negative deflection on an ECG?

Answer 2

lead I

Usually die to right ventricle hypertrophy

Question 3

What would you see on an ECG displaying Mobitz type II heart block?

Answer 3

Consistent PR interval with missed QRS complexes

Question 4

What is a possible cause of a shortened PR interval?

Answer 4

WPW syndrome - a faster conducting alternative pathway from SA node to the AV node

Will also have a delta wave (kinked R wave)

Question 5

In which leads is inverted T wave a normal finding?

Answer 5

V1 and Lead III

Question 6

Cause of Tall tented T waves?

Answer 6

If universal = hyperkalemia

If specific leads = hyperacute STEMI

Question 7

In which BBB would you see an ‘M’ shape in V1?

Answer 7

RBBB
Will also have T inversion V1-3
‘W’ shape in I and aVL

Question 8

In which BBB would you see a tall R wave and deeply inverted T wave in V6?

Answer 8

LBBB

Can look like ST elevation in V1

Question 9

Management for NSTEMI?

Answer 9

ABCDE
O2 if required (<94% sats)
Diamorphine (2.5-10mg PRN)
Nitrates - GTN
Aspirin 300mg and Ticagrelor (180mg)
B-blocker (aim for HR 50-60)
Ace-i (aim for SBP <120)
Atorvastatin 

Calculate GRACE score and consider PCI and glycoprotein IIb/IIIa

Question 10

Management for STEMI?

Answer 10

ABCDE
O2 if required (<94% sats)
Diamorphine (2.5-10mg PRN)
Nitrates - GTN
Aspirin 300mg and Ticagrelor (180mg)

+ PCI within 12 hours or within 2 hours of fibrinolysis
(fibrinolysis if PCI not available quickly)
CABG if failed PCI

Question 11

Risk factors for aortic dissection?

Answer 11

male
Age (60-80)
HTN
Genetic - marfans, turners, ehlers danlos
Pregnancy

Question 12

Presentation of aortic dissection?

Answer 12

Sudden and severe chest pain - anterior (can radiate to scapular)
Dyspnoea
Sudden death or shock
Dizzy and sweaty
Possible neuro deficit

Question 13

O/E what would you find in aortic dissection?

Answer 13

aortic regurgitation
Unequal pulses and BP in arms
Pleural effusion

Question 14

Investigations in aortic dissection?

Answer 14

ECG - look for MI
CXR - widened mediastinum, abnormal aortic contour, pleural effusion

Echocardiogram - transoesophageal is more sensitive
MRI angiography = gold standard

Question 15

management of aortic dissection?

Answer 15

ABCDE
if hypotensive treat as shock
Venous access with 2 wide-bore cannulas and get to ICU

Correct BP:
B-blockers (unless cardiac tamponade or congestive HF)
then nitrates (GTN)

Type B (descending aorta) –> surgery

Question 16

Immediate management for cardiac arrest?

Answer 16

Call 2222
Begin CPR (30:2) at 100-120bpm
Get assistant to attach a defibrillator and use this to assess the rhythm

Establish IV access when possible

Question 17

When would you use a defibrillator to shock a patient in cardiac arrest? What drugs will you use in this instance?

Answer 17

In VF or pulseless VT

After the 3rd shock give 1mg adrenaline and 300mg amiodarone IV every 3-5 mins

NB. amiodarone can lead to hypotension so give a fluid bolus

Question 18

When do you not shock a patient in cardiac arrest? what drugs will you use in this instance?

Answer 18

Asystole or PEA

Adrenaline as soon as IV access is achieved

Question 19

What are the reversible causes of cardiac arrest?

Answer 19

4 H's:
Hypoxia
Hypovolemia
Hypothermia
Hyperkalaemia

4T's:
Tension pneumothorax
Tamponade
Toxins
Thromboembolism

Question 20

Presentation of pericarditis?

Answer 20

Retrosternal chest pain radiates to neck:
Worse on lying down, inspiration, swallowing and movement
Relieved by sitting forward

Pericardial friction rub
fever, cough, SOB, arthralgia, rash

pericardial effusion may develop –> rise in venous pressure

Question 21

What may an ECG show for pericarditis?

Answer 21

Sinus tachycardia
Saddle ST elevation in 2+ limb leads or all chest leads
Prominent peaked T waves (flatten/invert after few days)
PR depression

If pericardial effusion - all QRS amplitude will be decreased

Question 22

What investigation should be done if tamponade or pericardial effusion is suspected?

Answer 22

Echocardiogram

Question 23

What bloods should be sent for in pericarditis?

Answer 23

Routine (FBC, U+E, LFT, CRP, ESR) + troponin + cardiac markers