Cardio Flashcards
What three investigations would you perform for chest pain?
1) ECG
2) Troponin (+ive - angio) (-ive -> ETT)
3) Echo (regional wall abnormalities
What are the top Ddx for chest pain?
Cardiac:
- ACS
- aortic dissection
- pericarditis
Respiratory:
- PE
- pneumonia
- pneumothorax
Gastro:
- oesophageal spasm
- oesophagitis
- GORD
MSK
- costochondritis
What are the cardiac causes of collapse?
1) vasovagal
2) arrhythmia
3) outflow obstruction
- left sided = aortic stenosis, HOCM
- right sided = PE
4) postural hypotension
Pan-Systolic Murmur (louder on inspiration)
JVP to earlobes
What is it ?
Tricuspid regurgitation
What are the DDx of Raised JVP?
1) right sided heart failure
2) tricuspid regurgitation
3) constrictive pericarditis
An ECG reveals ST elevation in leads 1 aVL, V5 and V6. Which coronary artery is affected.
Lateral MI - Left circumflex
What parameters make up the CHA2D2-VASc score? and what score should be offered anti coagulation
Congestive Heart Failure Hypertension Age >75 (x2 points) Diabetes Mellitus Stroke/TIA symptoms (x 2 point) Vascular disease Age 65-74 (1 point) Sex (1 point for female)
Anticoagulate > 2
What is Decubitus angina?
symptoms occur when lying down
What is Prinzmetal angina?
– symptoms caused by coronary vasospasm
What are the ECG criteria for STEMI?
≥ 1mm elevation in consecutive limb leads, ≥2 mm of ST segment elevation in 2 contiguous precordial leads in men (1.5 mm for women)
new or presumably new left bundle branch block
What conditions can you not use ECG criteria to diagnose a STEMI ?
LBBB or Left ventricular hypertrophy
Because these conditions may mask or simulate ischaemic ST changes
Outline the management of NSETMI
Aspirin + other antiplatelet (e.g. clopidogrel, ticagrelor)
Fondaparinux – if low bleeding risk unless coronary angiography planned within 24 hrs of admission
LMWH – if coronary angiography is planned
What is a GRACE score?
Estimates admission-6 month mortality for patients with acute coronary syndrome.
Why must heparin be administered with warfarin initially?
warfarin causes an initial pro-thrombotic phase because it blocks protein C and protein S.
What are the Beck’s triad features of tamponade?
Muffled heart sounds
Raised JVP
Low blood pressure
What is Dressler Syndrome?
Pericarditis 2-10 weeks post MI
AF management: What re the guidelines?
If < 48 hrs since onset of AF
DC OR chemical cardioversion (flecainide or amiodarone)
If > 48 hrs since onset of AF anticoagulate for 3-4 weeks before attempting cardioversion
What is a Delta wave?
slurred upstroke on QRS complex
What is the management of an SVT if the patient is not haemodynamically stable?
Synchronised DC cardioversion
Name 4 clinical features of HOCM
Jerky carotid pulse
Double apex beat
Ejection systolic murmur
Family history of sudden death at a relatively young age (< 65 yrs)
What features might you see on ECG in salicylate overdose?
Signs of hypokalaemia -‐ flattened/inverted T waves, U waves, prolonged PR interval, ST depression
In hypertensive retinopathy what signs indicate grade one hypertension
Silver wiring
In hypertensive retinopathy what signs indicate grade two hypertension
AV nipping
In hypertensive retinopathy what signs indicate grade three hypertension
Flame haemorrhages
