Cardio Flashcards
3 Causes of LBBB
hypertension, aortic stenosis, acute MI, coronary artery disease primary conducting system disease, infection
Primary heart block findings
fixed prolonged PR interval (>200 ms)
Seen in LAD
Lead I has the most positive deflection
Leads II and III are negative
[Seen in conduction defects]
RAD?
Lead III has the most positive deflection
Lead I should be negative
[This is commonly seen in individuals with right ventricular hypertrophy]
PR interval length?
120-200ms [3-5 small squares]
2nd degree heart block type 1 findings?
PR interval slowly increases then there is a dropped QRS
2nd degree type 2 heart block findings
PR interval is fixed but there are dropped beats
[Make sure you clarify that by the frequency of dropped beats e.g 2:1, 3:1, 4:1]
3rd degree heart block
P waves and QRS complexes are completely unrelated
Where do the pathologies causing heart block types occur?
1: between the SA node and the AV node (i.e. within the atrium)
2: Mobitz I (Wenckebach) – occurs IN the AV node.
[This is the only piece of conductive tissue in the heart which exhibits the ability to conduct at different speeds]
Mobitz II – occurs AFTER the AV node in the bundle of His or Purkinje fibres
3:Occurs anywhere from the AV node down
2 reasons for a shortened PR?
Seen in the pathological cause on ECG?
SA node location can vary / people have small atria
Accessory pathway
Slurred upstroke o= delta wave
2 reasons for a shortened PR?
Seen in the pathological cause on ECG?
SA node location can vary / people have small atria
Accessory pathway
Slurred upstroke o= delta wave
What is a narrow / broad QRS
NARROW (< 0.12 seconds)
BROAD (> 0.12 seconds)
Why do you get broad QRSs
BBB
Ventricular ectopic
Conduction system defects
What should be seen in Anterior chest lead R waves?
R wave pregression
small in V1 to large in V6
What is the J pount
where S wave joins ST
When is ST elevaiton significant ?
greater than 1 mm (1 small square) in 2 or more limb leads
or >2mm in 2 or more chest leads.
When is ST depression significant
≥ 0.5 mm in ≥ 2 leads
2 times you get tall T waves
Hyperkalaemia (“Tall tented T waves”)
Hyperacute STEMI
Where are T waves normally inverted
V1
lead 3
3 causes of T wave inversion
Ischaemia
Bundle branch blocks (V4 – 6 in LBBB and V1 – V3 in RBBB)
Pulmonary embolism
Left ventricular hypertrophy (in the lateral leads)
Hypertrophic cardiomyopathy (widespread)
General illness
Biphasic T wave seen in ?
Ischaemia and hypokalaemia
When might you see U waves/
electrolyte imbalances
hypothermia
antiarrhythmic therapy (such as digoxin, procainamide or amiodarone).
RBBB where is the RsR wave?
v6 [2 peaks]
Drugs for rate control of AF
β-blockers and calcium-channel antagonists.
[Digoxin]
Prescribe with AF rate control
anticoagulation eg Warfarin
name 3 ways/drugs for rhythm control
amiodarone, flecainide, dronedarone
and/or DC cardioversion and/or ablation therapy
Name 2 causes of raised troponin T
a. Cardiac ischaemia
b. Cardiac arrhythmia
c. Pneumonia
d. Pulmonary embolism.
Drugs used for HTN that can cause heart block
beta-blockers and
the non-dihydropyridine calcium-channel antagonists, EG verapamil
3rd-degree heart block - what drug might you use? more permanent fix?
Atropine
transcutaneous pacing via a defibrillator
2nd degree heart block causes? name 3
Mx if no reversible cause found?
ischaemic heart disease, sarcoidosis, Lyme
disease, thyroid disease, strong parasympathetic response,
drugs such as digoxin and verapamil.
Pacemaker
Treatment options for SVT
Vagal manoeuvres (blowing hard against closed lips, cold water splashed into face, carotid massage)
adenosine
BB/CCB/ flecanide/amiodarone (not digoxin)
direct current (DC) cardioversion.
What medication is contraindicated in WPW ?
Mx of WPW
Digoxin – this drug will slow AV (atrioventricular)
node conduction exclusively and therefore encourage conduction along the accessory
pathway.
accessory pathway ablation
Which leads meaure inferior?
II, III, aVF
Which leads are lateral
I, aVL, v5, v6
Inferior STEMI - what is likely artery? What else does it supply?
2 other Comps?
Right coronary artery
AV node -> complete heart block
Other comps:
ventricular arrhythmia, reduced left ventricular
function leading to acute left ventricular failure,
right ventricular failure, ischaemic ventricular septal defect
acute mitral regurgitation due to papillary muscle
rupture.
Why might you get a ‘cannon wave’ raised JVP in compete heart block?
RA contacts against closed tricusid valve [due to heart block]
->blood shoots up jugular vein
Mx of severe AS
TAVI -transcatheter valve implant
Open valve repair
[Balloon valvuloplasty - usually for palliative / awaiting definitive treatment]
2 reasons for a shortened PR?
Seen in the pathological cause on ECG?
SA node location can vary / people have small atria
Accessory pathway
Slurred upstroke o= delta wave
What is a narrow / broad QRS
NARROW (< 0.12 seconds)
BROAD (> 0.12 seconds)
Why do you get broad QRSs
BBB
Ventricular ectopic
Conduction system defects
What should be seen in Anterior chest lead R waves?
R wave pregression
small in V1 to large in V6
What is the J pount
where S wave joins ST
When is ST elevaiton significant ?
greater than 1 mm (1 small square) in 2 or more limb leads
or >2mm in 2 or more chest leads.
When is ST depression significant
≥ 0.5 mm in ≥ 2 leads
2 times you get tall T waves
Hyperkalaemia (“Tall tented T waves”)
Hyperacute STEMI
Where are T waves normally inverted
V1
lead 3
3 causes of T wave inversion
Ischaemia
Bundle branch blocks (V4 – 6 in LBBB and V1 – V3 in RBBB)
Pulmonary embolism
Left ventricular hypertrophy (in the lateral leads)
Hypertrophic cardiomyopathy (widespread)
General illness
Biphasic T wave seen in ?
Ischaemia and hypokalaemia
When might you see U waves/
electrolyte imbalances
hypothermia
antiarrhythmic therapy (such as digoxin, procainamide or amiodarone).
RBBB where is the RsR wave?
v6 [2 peaks]
Drugs for rate control of AF
β-blockers and calcium-channel antagonists.
[Digoxin]
Prescribe with AF rate control
anticoagulation eg Warfarin
name 3 ways/drugs for rhythm control
amiodarone, flecainide, dronedarone
and/or DC cardioversion and/or ablation therapy
Name 2 causes of raised troponin T
a. Cardiac ischaemia
b. Cardiac arrhythmia
c. Pneumonia
d. Pulmonary embolism.
Drugs used for HTN that can cause heart block
beta-blockers and
the non-dihydropyridine calcium-channel antagonists, EG verapamil
3rd-degree heart block - what drug might you use? more permanent fix?
Atropine
transcutaneous pacing via a defibrillator
2nd degree heart block causes? name 3
Mx if no reversible cause found?
ischaemic heart disease, sarcoidosis, Lyme
disease, thyroid disease, strong parasympathetic response,
drugs such as digoxin and verapamil.
Pacemaker
Treatment options for SVT
Vagal manoeuvres (blowing hard against closed lips, cold water splashed into face, carotid massage)
adenosine
BB/CCB/ flecanide/amiodarone (not digoxin)
direct current (DC) cardioversion.
What medication is contraindicated in WPW ?
Mx of WPW
Digoxin – this drug will slow AV (atrioventricular)
node conduction exclusively and therefore encourage conduction along the accessory
pathway.
accessory pathway ablation
Which leads meaure inferior?
II, III, aVF
Which leads are lateral
I, aVL, v5, v6
Inferior STEMI - what is likely artery? What else does it supply?
2 other Comps?
Right coronary artery
AV node -> complete heart block
Other comps:
ventricular arrhythmia, reduced left ventricular
function leading to acute left ventricular failure,
right ventricular failure, ischaemic ventricular septal defect
acute mitral regurgitation due to papillary muscle
rupture.
Why might you get a ‘cannon wave’ raised JVP in compete heart block?
RA contacts against closed tricusid valve [due to heart block]
->blood shoots up jugular vein
Mx of severe AS
TAVI -transcatheter valve implant
Open valve repair
[Balloon valvuloplasty - usually for palliative / awaiting definitive treatment]
Pt comes in with central crushing chest pain…Hx HTN
XR shows mediastinal widening …. what is it?
Aortic dissection
Type A vs B dissection? Mx?
type A
(involves ascending aorta/arch proximal to the origin of the left subclavian artery)
REQUIRES SURGERY
type B
(where the dissection involves the aorta distal to the left subclavian artery origin).
Can be managed conservatively
In VT what is usual Mx option?
What if they are stable?
DC cardiovert
correct electrolytes, amiodarone, beta-blockers
[this is uncommon]
3 most common bugs for IE
a. Staphylococcus aureus
b. Streptococcus viridans
c. Enterococcus spp.
PE ECG findings
S wave in lead I
Q wave in lead III,
Inverted T wave in lead III.
Becks triad
Muffled heart sounds with hypotension + raised JVP
Atrial flutter Mx
DC cardiovert
radiofrequency ablation - for long term
Name 3 causes of pericarditis
a. Viral – in particular coxsackie, cytomegalovirus, herpes virus and HIV
b. Immune conditions, such as systemic lupus erythematosus
c. Myocardial infarction (MI) (Dressler’s syndrome – usually occurring 2 weeks
post-MI)
d. Trauma to the heart
e. Uraemia
f. Malignancy (as a paraneoplastic phenomenon)
Pericarditis - what positions make it better/worse
The worsening of pain when lying down,
alleviated on sitting forward
