Cardio Flashcards
What can cause a false positive elevation of TropI
Advanced renal failure
Large PE
Aortic stenosis
HOCM
Severe sepsis
Stroke
What can new LBBB inidcate
STEMI
When do you take trop levels (timings)
On admission and then 1 hr after
If sx longer than 3 hrs then only take trop on admission
Which leads can be added to see posterior stemi
V7-9
Spotting a posterior stemi on an ecg
Suspicion if following in V1-3 :
- ST depression -(horizontal)
- upright T waves
(Bc reciprocal changes so basically opposite of what you see in a stemi)
In which stemi territories should you be also checking for posterior infarct
Lateral or inferior stemi
In which stemi territories should you also check for posterior infarct and how
Inferior and lateral
Leads V7-9
In which stemi territories should you have high suspiscion of posterior infarct?
How would you confirm
Lateral and inferior
Add leads v7-9
In which stemi territories should you have jigh suspiscion of posterior infarct?
How would you confirm
Lateral and inferior
Add leads v7-9
ECG territories leads and arteries
Inferior - II, III, aVF. RCA
Lateral - I, aVL, V5, V6 LCx or LAD
Anterior - V3, V4 LAD
Septal - V1, V2 LAD
ECG territories and arteries
Inferior - II,III, aVF RCA
Lateral - I, aVL, V5,V6 LCx
Anterior - V3, V4 LAD
Septal - V1, V2 LAD
Calculating rate on ecg
300/number of big squares
OR if irregular count number of QRS in 50 squares and x6
(50 large squares = 10s)
Axis deviation interpretation
If I and II are pointing away from each other they are LEAVING - Left deviation
If I and II are pointing towards each other they are RETURNING - Right deviation
Causes of right axis deviation
Anterolateral MI
RVH
PE
Causes of LAD
Inferior MI
LVH
Normal PR interval
120-200ms from start of P to start of QRS
3-5 little squares
Normal QTc
380-440 from start of QRS to end of T wave
Drug Causes of a long QTc
Antipsychotics -
TCAs
Citalopram
Macrolides - erythro, clarithro
Mobitz Type 1 vs type 2 HB
1 - Progressive lengthening of PR interval then dropped QRS
2 - constant PR then dropped QRS
RBBB vs LBBB Ecg
R - MaRRoW - wide QRS, positive V1!! (Normally negative)
L - WiLLiaM - V6 M
Beck’s triad
For cardiac tamponade
Raised JVP
Muffled heart sounds
Low BP
What is bifascicular block
What is trifascicular block
RBBB + R/L Axis deviation
RBBB + R/L Axis deviation + 1st degree HB
WPW on ECG
Delta waves
What can long Qt lead to
Torsades de pointes
What is torsades de pointes
Polymorphic VT
What is p mitrale and what is it indicative of
Bifid P waves
Mitral stenosis
Hyperkalaemia ECG
Tall tented t waves
Broad qrs
Absent p waves
‘Pulled up image’
Side effects of adenosine
Teansient chest tightness
Dyspnoea
Flushing
Headache
Bronchospasm (CI in asthmatics)
Causes of VT (Im QVICK)
Infarction
Myocarditis
QTc
Valve abnormalities
Iatrogenic - digoxin, antiarrythmics
Cardiomyopathy
Kaleami - HYPOKALAEMIA most important!!
Causes of AF
IHD
Rheumatic heart disease
Throtoxicosis
HTN
Alcohol
PE
Pneumonia
Hypokalaemia
Post op
Rx of AF
If any life threatening features or haemodynamically unstable - synchronised DC
Otherwise beta blocker
Or digoxin/amiodarone if heart failure
Consider anti coag
CHA2DS2VASc
CCF
HTN
Age >75
DM
Stroke/TIA
Vascular disease
Age 65-75
Sex: female
What does the HAS BLED score predict
Likelihood of haemorrhage and anti coag bleeding risk
How can a silent MI present and who is it more likely in
Reflux like symptoms in an older female diabetic
Management of a STEMI nice algorithm
MONA
If present within 12hrs and PCI possible in next 120 mins, offer PCI and then prasugrel with aspirin (or ticagrelor if high bleeding risk)
If present within 12 hrs but PCI not possible in 120mins then give fibrinolysis and give ticagrelor with aspirin
if>12 - dual antiplatelet therapy
NSTEMI rx NICE guidelines
Mona
give 300mg aspirin + fondaparinux
calculate grace score
if score >3% consider PCI within 72hrs if stable or immediately if unstable
if score <3% offer aspirin and ticagrelor (or aspirin and clopidogrel if high risk of bleeding)
stemi + bradycardia.
what artery is affected
right coronary artery
rx of STEMI
MONA
300mg aspirin
offer PCI if presenting <12hrs and PCI available in <120 mins
offer fibrinolysis if presenting in 12hrs but no PCI available in <120 mins
otherwise medical management with ticagrelor (or clopidogrel if high bleed risk)
Next step in rx if ECG still shows STEMI despite fibrinolysis
PCI immediately
what drugs are offered alongside PCI if
- pt is not on oral anticoags
- pt is on oral anticoags
Prasugrel and aspirin (dual therapy)
if on oral anticoagulants
if not on anticoags, give clopidogrel with aspirin instead
complications of MI
DREAD
Death
Rupture of papillary muscles/ventricle
oEdema (heart failure)
Arrythmias
Dresslers - pericarditis
first line imaging for stable angina
CT coronary angiogram
rx of stable angina
aspirin, statin and GTN
+ either beta blocker or CCB
if not controlled on one add the other but must be amlodipine, nifedipine etc. NOT verapamil
when are Nitrates CI
in hypotensive patients
drugs which may be used to pharmacologically cardiovert patients with paroxysmal atrial fibrillation
flecainide or amiodarone
what drug should not be used in VT
verapamil
how long must pt be orally anti coagulated for before electrical cardio version
3 weeks
rx of unstable bradycardia
atropine 500micrograms up to 3mg
then transcutaneous pacing
rx of dresslers
nsaids
and course of colchicine or steroids
other features of cardiac tamponade apart from becks triad
dyspnoea
pulses paradoxus
electrical alternans
tachycardia
ix for acute pericarditis
transthoracic echocardiogram
difference between nstemi and unstable angina
nstemi has raised trop
moa of alteplase
Activates plasminogen to form plasmin
