Cardio

Question 1

What is the initial management of MI?

Answer 1

Attach ECG monitor
IV access - take bloods - FBC, U and E, glucose, lipids, troponin
Brief assessment - history and examination, contraindications to PCI
MOAN
Morphine 5-10mg IV + antiemetic e.g. metoclopramide
Oxygen if sats low
Asprin 200mg PO + ticagrelor 180mg
Nitrates no longer recommended

Question 2

What is the definitive management of STEMI?

Answer 2

If STEMI on ECG and PCI available in 120mins then PCI, if not the fibrinolysis followed by transfer to PCI centre

Question 3

What is the management of an NSTEMI?

Answer 3

This is managed with anti-ischaemic and antiplatelet therapy. Give asprin 300mg and ticagrelor. Fondaparinux is then given as an anticoagulant. IV nitrate is the pain continues. High risk patients need angiography.

Question 4

What are the causes of severe pulmonary oedema?

Answer 4

Cardiovascular - left ventricular failure, also valvular disease
ARDS from any cause e.g. trauma, malaria, drugs (asprin overdose)
Fluid overload
Neurogenic e.g. head injury

Question 5

What are the investigations for severe pulmonary oedema?

Answer 5

CXR - look for cardiomegaly, kerley B lines, effusions at the costophrenic angles
ECG for signs of MI
U and E, troponin, ABG
BNP may be helpful

Question 6

What is the management of severe pulmonary oedema?

Answer 6

Begin treatment before investigations
Sit patient upright
High flow oxygen if saturations are low
IV access and monitor ECG, treat any arrhythmias
Diamorphine slowly - caution in liver failure and COPD
Furosemide 40-80mg IV slowly
GTN spray 2 puffs

Question 7

When is GTN spray contraindicated?

Answer 7

In BP less than 90

Question 8

How do you manage cardiogenic shock?

Answer 8

Oxygen needs to be tirated to maintain saturations of 94-98%
Diamorphine
Investigations and close monitoring
Correct arrhythmias, U and E abnormalities or acid-base disturbance
Optimise filling pressure by either using plasma expanders or inotropic support if overfilled

Question 9

What are the differentials for cardiogenic shock?

Answer 9

MI
Arrhythmias
PE
Tension pneumothorax
Cardiac tamponade
Myocarditis
Valve destruction
Aortic dissection

Question 10

What is beck’s triad for cardiac tamponade?

Answer 10

Raised JVP
Decreased BP
Muffled heart sounds

Question 11

What is the appearance of broad complex tachycardia on ECG?

Answer 11

Rate of greater than 100bpm with qrs complexes of greater than 3 small squares (120ms)

Question 12

What are the main differentials for broad complex tachycardia?

Answer 12

Ventricular Tachycardia (VT) - single ventricular ectopics
SVT - Supraventricular tachycardia e.g. AF or atrial flutter

Question 13

What is the management of broad complex tachycardia?

Answer 13

A-E
IV acess and ECG
Identify the underlying arrhythmia, if in doubt treat as VT
Correct any electrolyte problems
For VT give amiodarone 300mg IV over more than 20 mins