Cardiac week

Question 1

Which are the ‘inferior’ 12 lead ECG leads?

Answer 1

II, III, aVF

Question 2

Which are the ‘lateral’ 12 lead ECG leads?

Answer 2

I, aVL, V5, V6

Question 3

Which are the ‘anterior’ 12 lead ECG leads?

Answer 3

V1-6 (particularly V3), I, aVL

Question 4

If someone is having an acute anterior STEMI, where would you expect ST elevation and where would you expect reciprocal ST depression?

Answer 4

ST elevation in V1-6, I, aVL

ST depression in III, aVF

Question 5

How do you identify a RBBB on ECG?

Answer 5

Late wave moves towards the side of the block: + Late wave in V1, - late wave in V6

Question 6

How do you identify a LBBB on ECG?

Answer 6

Late wave moves towards the side of the block: + Late wave in V6, - late wave in V1

Question 7

Which kind of BBB can be pathological or non-pathological?

Answer 7

RBBB

Question 8

Any kind of myocardial injury can result in a troponin rise. What are some non-cardiac causes of troponin rise?

Answer 8

Renal failure
Pulmonary embolism
Severe pulmonary hypertension
Sepsis
Burns
Extreme exertion
Amyloidosis or other infiltrative diseases
Stroke
Subarachnoid hemorrhage

Question 9

What is the normal range of troponin?

Answer 9

≥15 ng/L

Question 10

What are the precipitants of heart failure?

Answer 10

HEART FAILED
Hypertension (common)
Endocarditis/environment (e.g. heat wave)
Anemia
Rheumatic heart disease and other valvular disease
Thyrotoxicosis

Failure to take meds (very common) Arrhythmia (common) Infection/Ischemia/Infarction (common) 
Lung problems (PE, pneumonia, COPD) 
Endocrine (pheochromocytoma, hyperaldosteronism)
Dietary indiscretions (common)

Question 11

What is the acute treatment for pulmonary oedema?

Answer 11

Acute Treatment of Pulmonary Edema
• treat acute precipitating factors (e.g. ischemia, arrhythmias)
• L – Lasix® (furosemide) 40-500 mg IV
• M – morphine 2-4 mg IV: decreases anxiety and preload (venodilation)
• N – nitroglycerin: topical/IV/SL
• O – oxygen: in hypoxemic patients
• P – positive airway pressure (CPAP/BiPAP): decreases preload and need for ventilation when
appropriate
• P– position: sit patient up with legs hanging down unless patient is hypotensive

Question 12

What is the clinical triad of acute pericarditis?

Answer 12

Acute Pericarditis Triad
• Chest Pain
• Friction Rub
• ECG Changes

Question 13

What are the ECG changes in pericarditis?

Answer 13

Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).
Reciprocal ST depression and PR elevation in lead aVR (± V1).
Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion.

Question 14

What is the most common virus to cause pericarditis?

Answer 14

Coxsackie

Question 15

What are the different Etiologies of pericarditis?

Answer 15

• idiopathic is most common: presumed to be viral
• infectiousƒ( viral: Coxsackie virus A, B (most common), echovirus ƒ bacterial: S. pneumoniae, S. aureus
ƒTB, fungal: histoplasmosis, blastomycosis)
• post-MI: acute (direct extension of myocardial inflammation, 1-7 d post-MI), Dressler’s syndrome (autoimmune reaction, 2-8 wk post-MI)
• Traumatic/ post-cardiac surgery (e.g. CABG)
• metabolic: uremia (common), hypothyroidism
• neoplasm: Hodgkin’s, breast, lung, renal cell carcinoma, melanoma
• collagen vascular disease: SLE, polyarteritis, RA, scleroderma
• vascular: dissecting aneurysm
• other: drugs (e.g. hydralazine), radiation, infiltrative disease (sarcoid)