Cardio Flashcards
What is the acute treatment for narrow complex tachycardias (other than AF)?
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
MI acute treatment
MONBASH
How does a posterior transmural infarct present
ST depression in leads v1, v2, v3, tall R waves. Dominant R wave in v1, to distinguish from LAD
Easy way to see BBB
Wide QRS and;
- Down in V1= LBBB
- Up in v1=RBBB
What is most common MI?
LAD>RCA>Circumflex
Draw the circle of the leads and angles
https://ecgwaves.com/topic/ekg-ecg-leads-electrodes-systems-limb-chest-precordial/
In MI, what does it mean if all chest leads are involved?
Anterolateral MI
What murmurs are louder on inspiration and which are louder on expiration?
Right on inspiration
Left on expiration
What causes 3rd heart sound?
Rapid ventricular filling in HF (better with bell). Blood against a distended ventricle.
4th heart sound
Blood against a stiff ventricle, late diastole. LVH
Austin-flint? Graham-Steele? Gibson? Carey-coombs?Barlow?
Notes
Draw hypertension management
Notes
Treatment of VT
HS; fix electrolytes, amiodarone. sync DC shock if unsuccessful
Pulseless; ALS
Unstable VT; synchronised cardioversion. Pulseless VT and VF need cardioversion. electrolytes and amiodarone
Hyperkalemia ECG
over 5.5=tented T waves
over 6.5=flattening of P waves
over 7.5=widening of QRS
JVP waves; cannon A, Large V, Kussmal, raised with absent pulsation, slow Y descent
See notes
Contraindication of verapamil
beta blockers
AF treatment algorithm
○ 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
AF prophylaxis
§ 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
When do you see pulsus altercans?
LV systolic failure
Causes of long QT
Congenital
Hypokalaemia. Hypomagnesaemia. Drugs.
Hypokalemia ECG
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
AVRT vs AVNRT
AVNRT is local circuit around AV node. AVRT is re-entry circuit due to accessory pathway, see delta waves.
Signs of HOCM
Jerky carotid pulse, double apex beat, ES murmur, family history
Normal axis, RAD, LAD and eRAD
normal; I+, aVF+
RAD; I-, aVf+
LAD; 1+, aVF-
eRAD; 1-, aVf-
Peaked P wave
right atrial strain. P-pulmonale
P wave looks like an M
P-mitrale. Left side
