cardio

Question 1

ECG shows and management

Answer 1

Regular broad complex tachycardia

May be pulseless or w/ pulse

Management : PULSELESS VT
a) shockable: unsynchronised shock
After 3rd shock
b) IV adrenaline 1(mg in 10ml, 1:10,000) + IV amiodarone )300mg)
c) Then give adrenaline every 3-5minutes thereafter

Management : PULSED VT + Adverse effects
a) SYNCHRONISED DC shocks (3 max) , sedation if conscious
b) EXPERT HELP
–> amiodarone (300mg IV over 10-20 mins followed by 900mg infusion over 24 hours)

Management : PULSED VT with NO adverse effects
a) Amiodarone 300mg IV over 10-60 mins
If ineffective
–> SYNCHRONISED DC SHOCKS (up to 3)

ECG features
- tachycardia (>100 bpm)
- absent P waves
- > 120 monomorphic regular broad QRS complexes

Adverse effects
- shock
- syncope
- MI
- Heart failure

Question 2

ECG shows:

Management

Answer 2

VENTRICULAR FIBRILLATION
- irregular broad complex tachycardia
- PULSELESS

Management
a) SHOCKABLE –> UNSYNCHRONISED shock
After 3rd shock
b) IV adrenaline (1mg of 1 in 10,000) + IV amiodarone (300mg)
c) Adrenaline 3-5 mins thereafter

Question 3

This ECG shows:

Answer 3

Torsades de pointes

polymorphic ventricular tachycardia, which is associated with QT prolongation

Question 4

Which valve is commonly affected in IV drug users:

Answer 4

Tricuspid valve
–> blood from venous circulation encounters the tricuspid valve first
–> bacterial load from repeated injections with contaminated drug paraphernalia –> more likely to lead to RHS endocarditis

Question 5

Management of narrow complex tachycardia’s

Answer 5

A-E Assessment

If adverse signs
1st Line: synchronised DC cardioversion +/- amiodarone

No adverse signs : Regular rhythm
1st Line: Vagal manouevres
2nd Line: IV adenosine (6 bolus, then 12mg then 18mg MAX)
3rd Line: Verapamil or BB
4th line: Synchronised DC cardioversion

No adverse signs: Irregular rhythm
–> AF —> BB (or CCB if asthmatic)
–> Heart failure signs : DIGOXIN
–> >48hr onset anticoagulate

Further management
- cardiac ablation

Question 6

this Is the only oral anticoagulant licenced for valvular AF

Answer 6

Warfarin

Question 7

Management of acute atrial fibrillation

Answer 7

If adverse signs
1st line: SYNCHRONISED DC CARDIOVERSION +/- AMIODARONE

Stable and AF onset <48 hours
1. Rate or rhythmm control
2. Rhythm control w/ DC cardioversion or pharmacological
–> Flecanide
–> OR amiodarone (if history of structural heart disease)
–> heparin if DCC delayed

Stable and >48 hours onset
–> RATE control only
–> BB, diltiazem or digoxin
–> AC for 3 weeks prior to cardioversion
–> TOE to exclude thrombus

Diltiazem: rate limiting CCB

Question 8

Bradycardia: management

Answer 8

1. A-E
2. Identify reversible causes

If adverse signs:
1st Line: 500 micrograms atropine IV
–> repeat up to 3mg until response

2nd Line: Transcutanoues pacing or isoprenaline or adrenaline

No adverse signs but RISK OF ASYSTOLE
1st line: 500micrograms atropine IV
2nd line: TCP or alternative drugs (isoprenaline, adrenaline or glucagon (in BB or CCB overdose))

No adverse signs NO risk of asystole
–> OBSERVE

Atropine: blocks vagal nerve which increases firing rate of SAN

Question 9

first-line treatment for haemodynamically stable ventricular tachycardia

Answer 9

Amiodarone

Question 10

clinical features of cardiac tamponade

Answer 10

BECKS TRIAD
- muffled heart sounds
- hypotension
- raised JVP

Mx: pericardiocentesis

Question 11

Infective endocarditis signs