Cardiac Flashcards
When should troponin levels be checked in stable angina?
If there has been recent ECG changes or the history is suggestive
In right axis deviation what lead will show negative deflection on an ECG?
lead I
Usually die to right ventricle hypertrophy
What would you see on an ECG displaying Mobitz type II heart block?
Consistent PR interval with missed QRS complexes
What is a possible cause of a shortened PR interval?
WPW syndrome - a faster conducting alternative pathway from SA node to the AV node
Will also have a delta wave (kinked R wave)
In which leads is inverted T wave a normal finding?
V1 and Lead III
Cause of Tall tented T waves?
If universal = hyperkalemia
If specific leads = hyperacute STEMI
In which BBB would you see an ‘M’ shape in V1?
RBBB
Will also have T inversion V1-3
‘W’ shape in I and aVL
In which BBB would you see a tall R wave and deeply inverted T wave in V6?
LBBB
Can look like ST elevation in V1
Management for NSTEMI?
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
Management for STEMI?
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
Risk factors for aortic dissection?
male Age (60-80) HTN Genetic - marfans, turners, ehlers danlos Pregnancy
Presentation of aortic dissection?
Sudden and severe chest pain - anterior (can radiate to scapular) Dyspnoea Sudden death or shock Dizzy and sweaty Possible neuro deficit
O/E what would you find in aortic dissection?
aortic regurgitation
Unequal pulses and BP in arms
Pleural effusion
Investigations in aortic dissection?
ECG - look for MI
CXR - widened mediastinum, abnormal aortic contour, pleural effusion
Echocardiogram - transoesophageal is more sensitive
MRI angiography = gold standard
management of aortic dissection?
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
Immediate management for cardiac arrest?
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
When would you use a defibrillator to shock a patient in cardiac arrest? What drugs will you use in this instance?
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
When do you not shock a patient in cardiac arrest? what drugs will you use in this instance?
Asystole or PEA
Adrenaline as soon as IV access is achieved
What are the reversible causes of cardiac arrest?
4 H's: Hypoxia Hypovolemia Hypothermia Hyperkalaemia
4T's: Tension pneumothorax Tamponade Toxins Thromboembolism
Presentation of pericarditis?
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
What may an ECG show for pericarditis?
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
What investigation should be done if tamponade or pericardial effusion is suspected?
Echocardiogram
What bloods should be sent for in pericarditis?
Routine (FBC, U+E, LFT, CRP, ESR) + troponin + cardiac markers
