Cardio

Question 1

What is the acute treatment for narrow complex tachycardias (other than AF)?

Answer 1

Hamedynamically stable; Vagal manoeuvres and adenosine (verapamil if asthmatic if unsuccessful). Then if unsuccessful; sedate and synchronised DC cardioversion, or amiodarone

Haemodynamically unstable: DC cardioversion

Question 2

MI acute treatment

Answer 2

MONBASH

Question 3

How does a posterior transmural infarct present

Answer 3

ST depression in leads v1, v2, v3, tall R waves. Dominant R wave in v1, to distinguish from LAD

Question 4

Easy way to see BBB

Answer 4

Wide QRS and;

• Down in V1= LBBB
• Up in v1=RBBB

Question 5

What is most common MI?

Answer 5

LAD>RCA>Circumflex

Question 6

Draw the circle of the leads and angles

Answer 6

https://ecgwaves.com/topic/ekg-ecg-leads-electrodes-systems-limb-chest-precordial/

Question 7

In MI, what does it mean if all chest leads are involved?

Answer 7

Anterolateral MI

Question 8

What murmurs are louder on inspiration and which are louder on expiration?

Answer 8

Right on inspiration

Left on expiration

Question 9

What causes 3rd heart sound?

Answer 9

Rapid ventricular filling in HF (better with bell). Blood against a distended ventricle.

Question 10

4th heart sound

Answer 10

Blood against a stiff ventricle, late diastole. LVH

Question 11

Austin-flint? Graham-Steele? Gibson? Carey-coombs?Barlow?

Answer 11

Notes

Question 12

Draw hypertension management

Answer 12

Notes

Question 13

Treatment of VT

Answer 13

HS; fix electrolytes, amiodarone. sync DC shock if unsuccessful
Pulseless; ALS
Unstable VT; synchronised cardioversion. Pulseless VT and VF need cardioversion. electrolytes and amiodarone

Question 14

Hyperkalemia ECG

Answer 14

over 5.5=tented T waves
over 6.5=flattening of P waves
over 7.5=widening of QRS

Question 15

JVP waves; cannon A, Large V, Kussmal, raised with absent pulsation, slow Y descent

Answer 15

See notes

Question 16

Contraindication of verapamil

Answer 16

beta blockers

Question 17

AF treatment algorithm

Answer 17

○ If > 48 hrs since onset of AF
§ Anticoagulate for 3-4 weeks before attempting cardioversion
○ If < 48 hrs since onset of AF
§ DC cardioversion (2 x 100 J, 1 x 200 J)
§ Chemical cardioversion: flecainide or amiodarone

NOTE: flecainide is contraindicated if there is a history of ischaemic heart disease

Question 18

AF prophylaxis

Answer 18

§ Sotalol
§ Amiodarone
§ Flecainide
§ Consider pill-in-the-pocket (single dose of a cardioverting drug (e.g. flecainide) for patients with paroxysmal AF) strategy for suitable patients

Question 19

When do you see pulsus altercans?

Answer 19

LV systolic failure

Question 20

Causes of long QT

Answer 20

Congenital

Hypokalaemia. Hypomagnesaemia. Drugs.

Question 21

Hypokalemia ECG

Answer 21

Flattening and inversion of T waves in mild hypokalemia, followed by Q-T interval prolongation, visible U wave and mild ST depression in more severe hypokalemia.
Severe hypokalemia can also result in arrhythmias such as Torsades de points and ventricular tachycardia

Question 22

AVRT vs AVNRT

Answer 22

AVNRT is local circuit around AV node. AVRT is re-entry circuit due to accessory pathway, see delta waves.

Question 23

Signs of HOCM

Answer 23

Jerky carotid pulse, double apex beat, ES murmur, family history

Question 24

Normal axis, RAD, LAD and eRAD

Answer 24

normal; I+, aVF+
RAD; I-, aVf+
LAD; 1+, aVF-
eRAD; 1-, aVf-

Question 25

Peaked P wave

Answer 25

right atrial strain. P-pulmonale

Question 26

P wave looks like an M

Answer 26

P-mitrale. Left side