Cardiac emergencies

Question 1

Clinical features of aortic dissection x4

Answer 1

1. Sudden onset of chest pains
2. Syncope
3. Anxiety and prenomination of death
4. Altered mental state
5. Flank pain if renal artery is involved

Question 2

Congenital causes of aortic dissection x2

Answer 2

1. Bicuspid aortic valve
2. CT disease eg Marfan syndrome

Question 3

4 Acquired causes of aortic dissection

Answer 3

1. HTN
2. Vasculitis
3. Trauma
4. Drugs- amphetamine or cocaine

Question 4

Management of aortic dissection x2

Answer 4

Pain relief
Beta blockers to low systolic BP<100mmHg
Surgical repair and replaced of tear

Question 5

Management of severe arrhythmia x4

Answer 5

Medical cardioversion ie shocking

Vagal stimulants
Beta and Ca channel blockers
Amiodarone- antiarrhythmia

Question 6

Indications of oxygen therapy x3

Answer 6

Hypoxia
Trapped gases
Anesthesia

Question 7

Hazard of oxygen therapy x 5

Answer 7

Oxygen toxicity
Drying of mucous membranes
Atelectasis due to absorption collapse
Depression of ventilation in COPD
Reversal of hypoxic pulmonary vasoconstriction

Question 8

Drugs used in heart failure x7

Answer 8

Diuretics
ACE inhibitors
Beta blockers
Vasodilators
Digoxin
Ionotropic agents
Anticoagulants
Angiotensin Il receptor blocker

Question 9

ECG characteristics of hyperkalemia x4

Answer 9

Peaked T waves
P wave flattening
PR prolongation
Wide QRS complex

Question 10

ECG characteristics of hypokalemia x3

Answer 10

T wave inversion
ST depression
Prominent U wave

Question 11

3 causes of acute coronary syndrome

Answer 11

Atherosclerosis
Coronary dissection
Coronary artery spasms

Question 12

S&S of acute coronary syndrome x5

Answer 12

Angina at rest radiating to left shoulder or jaw
Autonomic symptoms- nausea, sweating, heart palpitations
SOB, dizziness

Question 13

Management of acute chest syndrome x7

Answer 13

1.Oxygen therapy
2.Blood thinners
3.Thrombolytics
4.Morphine- relax spasms
5.Coronary Angioplasty
6.Coronary artery bypass graft
7.B- blockers reduce contractility of heart > decreased O2 requirement
8. Vasodilators eg nitrates > decreased venous return > decreased ventricular work

Question 14

Acute coronary syndrome spectrum x3

Answer 14

Unstable angina
STEMI- ST segment elevation myocardial infarction
NSTEMI- Non ST segment elevation myocardial infarction

Question 15

Becks triad

Answer 15

Muffled heart sounds
Low systolic BP
Raised JVP

Question 16

Management of cardiac tamponade x3

Answer 16

Pericardiocentesis
Percutaneous balloon pericardiotomy
Emergency subxiphoid percutaneous drainage

Question 17

Classification of aortic dissection - De Bakey (3)

Answer 17

I- involves both ascending and descending aorta
II- involves ascending aorta
III- involves descending aorta

Question 18

Classification of aortic dissection - Stanford (2)

Answer 18

A- Involves aorta proximal to origin of Left subclavian artery
B- Involves aorta distal to origin of Left subclavian artery

Question 19

Types of severe arrhythmias x4

Answer 19

1. Supraventricular tachycardia SVT
2. Atrial fibrillation
3. Atrial flutter
4. Paroxysmal SVT

Question 20

Management of aortic dissection x3

Answer 20

Surgical repair
Pain relief - morphine
Beta blockers to lower BP to <100

Question 21

Management for severe arrhythmias x4

Answer 21

Unstable- electrical cardioversion
Medical- Vagal maneuvers, B blockers, Ca channel blockers
Anti arrhythmias - amiodarone