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To Revise > Cardio > Flashcards

Cardio Flashcards

1
Q

What can cause a false positive elevation of TropI

A

Advanced renal failure
Large PE

Aortic stenosis
HOCM
Severe sepsis
Stroke

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2
Q

What can new LBBB inidcate

A

STEMI

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3
Q

When do you take trop levels (timings)

A

On admission and then 1 hr after
If sx longer than 3 hrs then only take trop on admission

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4
Q

Which leads can be added to see posterior stemi

A

V7-9

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5
Q

Spotting a posterior stemi on an ecg

A

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)

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6
Q

In which stemi territories should you be also checking for posterior infarct

A

Lateral or inferior stemi

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7
Q

In which stemi territories should you also check for posterior infarct and how

A

Inferior and lateral
Leads V7-9

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8
Q

In which stemi territories should you have high suspiscion of posterior infarct?
How would you confirm

A

Lateral and inferior

Add leads v7-9

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9
Q

In which stemi territories should you have jigh suspiscion of posterior infarct?
How would you confirm

A

Lateral and inferior

Add leads v7-9

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10
Q

ECG territories leads and arteries

A

Inferior - II, III, aVF. RCA
Lateral - I, aVL, V5, V6 LCx or LAD
Anterior - V3, V4 LAD
Septal - V1, V2 LAD

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11
Q

ECG territories and arteries

A

Inferior - II,III, aVF RCA
Lateral - I, aVL, V5,V6 LCx
Anterior - V3, V4 LAD
Septal - V1, V2 LAD

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12
Q

Calculating rate on ecg

A

300/number of big squares
OR if irregular count number of QRS in 50 squares and x6

(50 large squares = 10s)

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13
Q

Axis deviation interpretation

A

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

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14
Q

Causes of right axis deviation

A

Anterolateral MI
RVH
PE

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15
Q

Causes of LAD

A

Inferior MI
LVH

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16
Q

Normal PR interval

A

120-200ms from start of P to start of QRS
3-5 little squares

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17
Q

Normal QTc

A

380-440 from start of QRS to end of T wave

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18
Q

Drug Causes of a long QTc

A

Antipsychotics -
TCAs
Citalopram
Macrolides - erythro, clarithro

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19
Q

Mobitz Type 1 vs type 2 HB

A

1 - Progressive lengthening of PR interval then dropped QRS

2 - constant PR then dropped QRS

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20
Q

RBBB vs LBBB Ecg

A

R - MaRRoW - wide QRS, positive V1!! (Normally negative)
L - WiLLiaM - V6 M

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21
Q

Beck’s triad

A

For cardiac tamponade

Raised JVP
Muffled heart sounds
Low BP

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22
Q

What is bifascicular block
What is trifascicular block

A

RBBB + R/L Axis deviation

RBBB + R/L Axis deviation + 1st degree HB

23
Q

WPW on ECG

A

Delta waves

24
Q

What can long Qt lead to

A

Torsades de pointes

25
Q

What is torsades de pointes

A

Polymorphic VT

26
Q

What is p mitrale and what is it indicative of

A

Bifid P waves

Mitral stenosis

27
Q

Hyperkalaemia ECG

A

Tall tented t waves
Broad qrs
Absent p waves

‘Pulled up image’

28
Q

Side effects of adenosine

A

Teansient chest tightness
Dyspnoea
Flushing
Headache
Bronchospasm (CI in asthmatics)

29
Q

Causes of VT (Im QVICK)

A

Infarction
Myocarditis
QTc
Valve abnormalities
Iatrogenic - digoxin, antiarrythmics
Cardiomyopathy
Kaleami - HYPOKALAEMIA most important!!

30
Q

Causes of AF

A

IHD
Rheumatic heart disease
Throtoxicosis
HTN

Alcohol
PE
Pneumonia
Hypokalaemia
Post op

31
Q

Rx of AF

A

If any life threatening features or haemodynamically unstable - synchronised DC

Otherwise beta blocker
Or digoxin/amiodarone if heart failure
Consider anti coag

32
Q

CHA2DS2VASc

A

CCF
HTN
Age >75
DM
Stroke/TIA
Vascular disease
Age 65-75
Sex: female

33
Q

What does the HAS BLED score predict

A

Likelihood of haemorrhage and anti coag bleeding risk

34
Q

How can a silent MI present and who is it more likely in

A

Reflux like symptoms in an older female diabetic

35
Q

Management of a STEMI nice algorithm

A

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

36
Q

NSTEMI rx NICE guidelines

A

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)

37
Q

stemi + bradycardia.
what artery is affected

A

right coronary artery

38
Q

rx of STEMI

A

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)

39
Q

Next step in rx if ECG still shows STEMI despite fibrinolysis

A

PCI immediately

40
Q

what drugs are offered alongside PCI if
- pt is not on oral anticoags
- pt is on oral anticoags

A

Prasugrel and aspirin (dual therapy)
if on oral anticoagulants

if not on anticoags, give clopidogrel with aspirin instead

41
Q

complications of MI

A

DREAD
Death
Rupture of papillary muscles/ventricle
oEdema (heart failure)
Arrythmias
Dresslers - pericarditis

42
Q

first line imaging for stable angina

A

CT coronary angiogram

43
Q

rx of stable angina

A

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

44
Q

when are Nitrates CI

A

in hypotensive patients

45
Q

drugs which may be used to pharmacologically cardiovert patients with paroxysmal atrial fibrillation

A

flecainide or amiodarone

46
Q

what drug should not be used in VT

A

verapamil

47
Q

how long must pt be orally anti coagulated for before electrical cardio version

A

3 weeks

48
Q

rx of unstable bradycardia

A

atropine 500micrograms up to 3mg
then transcutaneous pacing

49
Q

rx of dresslers

A

nsaids
and course of colchicine or steroids

50
Q

other features of cardiac tamponade apart from becks triad

A

dyspnoea
pulses paradoxus
electrical alternans
tachycardia

51
Q

ix for acute pericarditis

A

transthoracic echocardiogram

52
Q

difference between nstemi and unstable angina

A

nstemi has raised trop

53
Q

moa of alteplase

A

Activates plasminogen to form plasmin

54
Q
A

To Revise (29 decks)

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