Cardio Flashcards
Give 2 shockable cardiac arrest rhyhms
Ventricular tachycardia
Ventricular fibrilation
Give 2 non-shockable caridac arrest rhthms
Asystole
Pulseless electrical activity
Unstable tachycardia patient- treatment options?
consider 3 synchronised shocks
consider amiodarone infusion
Give 3 examples of narrow complex tachycardias in a stable patient?
Atrial Fibrilation
Atrial Flutter
SVT
Give 2 examples of broad complex tachycardias in a stable patient?
Ventricular tachycardia
SVT with bundle branch block
Atrial flutter causes a narrow or broad QRS complex tachycardia?
Atrial flutter= Narrow complex tachycardia
What is the pathophysiology behind atrial flutter?
Re-entrant rhythm
Extra electrical pathway causing self-perpetuating electrical signal loop
ECG shows “Saw Tooth Appearance”- likely diagnosis and management?
Atrial Flutter
Rate/rhythm control- BB / Cardioversion
Tx underlying cause e.g HTN / Thyrotoxicosis
Anti-coagulate if CHA2DS2VASc high risk
Radio-frequency ablation
What is the most definitive treatment of Atrial Flutter?
Radio-frequency ablation
Potential causes/ associations with atrial flutter
Ischaemic heart disease
Hypertension
Thyrotoxicosis
Three types of AF
Paroxysmal <48hrs
Persistent > 7 days
Permanent (cannot restore to normal)
Which is the commonest arrhythmia
AF (10% over 80yos)
What is the pathophysiology of AF?
single re-entrant circuit or ectopic foci
What clinical picture may indicate AF?
Palpitations, SOB, fatigue
Increased HR, Decreased BP,
Irregularly irregular pulse
Patient has absent P waves and an irregularly irregular RR interval on ECG. Likely diagnosis? They are stable, how would you acutely manage this patient?
Rhythm- electrical/chemical cardioversion
Rate- BB/CCB/Digoxin
Derek is an 82 year old gentleman with a history of AF. What is the long term management plan for derek?
Rhythm control- amiodarone
Rate control- BB/CCB/Digoxin
Anti-coagulation if CHA2DS2VASc high risk
Consider catheter ablation
What is the definitive management of AF?
Catheter ablation
Patient presents to A&E with SOB, palpitations and an irregularly irregular pulse. It is uncertain from the history how long the patient has been like this. Your colleague is about to cardiovert the patient, what should you do?
Warn them that if it has been >48hrs since onset they may have clot formation in atria, cardioversion will dislodge this and cause stroke.
Perform transthoracic/transoesophageal echo or anti-coagulate for 4 weeks before cardioverting
What are the causes of AF?
PIRATES Pulmonary= PE , COPD, Lung CA Ischaemia= IHD, MI, HTN, HF Rheumatic valve disease Alcohol Thyrotoxicosis Electrolytes (low K+/Mg2+) Sugar (DM) / Sepsis
patient has stable angina, what should you prescribe them?
Bisoprolol (lower rate)
Aspirin or Clopidogrel (give single antiplatelet in stable angina)
Statin (lower cholesterol)
GTN spray (reliever)
What is metaclopromide? When might you give it?
anti-emetic
ACS, when giving morphine (prevent sickness from morphine)
What is the purpose and what are the components of CHA2DS2-VASc Score?
Risk of stroke in patients with AF
Congestive heart failure Hypertension Age (>65, >75) Diabetes Stroke/TIA/VTE hx (2) Vascular disease hx e.g. MI, PAD Sex (female)
Mangement of ventricular tachycardia
DC cardioversion
Name 3 cardio drugs which can increase serum potassium
ACEi
BB
Spironolactone
Describe the coronary arteries involved in.... Anterior MI Inferior MI Posterior MI Lateral MI
Anterior= LAD Inferior= Right coronary Posterior= Circumflex / Right coronary Lateral= circumflex / diagonal branch LAD
CPAP is given to patients in LVF, how does CPAP help these patients?
Improves oxygenation by recruiting lung units, improved V/Q mismatch
Improves lung compliance, decreases work of breathing therefore decreases myocardial demand
Increased intrathoracic pressure decreases venous return (preload), this decreases LV systolic pressure and therefore decreased afterload
What are the 3 diagnostic features of stable angina?
Number of features needed for stable angina? for atypical angina? for non-cardiac/anginal pain?
1) Chest pain/dicomfort
2) Exacerbated by exercise / emotion / big meals
3) Relieved by rest / GTN
All 3= stable angina
Any 2/3= atypical angina
=1= non-anginal pain
Gary, a 62 year old male, suffered a heart attack 3 days ago. On cardiovascular examination you auscultate a loud pansystolic murmur at the base of the left sternal edge. What has occured and what other sign might you elicit in your CV exam?
Ventricular Septal Defect (post-MI complication)
Other sign= check for ankle oedema
Patients with suspected MI presents to A&E, a number of investigations are ordered including a troponin. When should the troponin levels be re-tested?
12 hours after symptoms started (more reliable result at 12 hours than initial)
What cardiovascular presentation would warrant a carotid sinus massage/table tilt test? Describe the test, what equipment is needed and what constitutes a positive result?
Vasovagal syncope
Massage one carotid sinus then the other for ~5 seconds
First with patient lying flat then on table 30 degrees up
Need beat to beat BP measurement, need continuous ECG and print strip
Positive test if systolic BP drops >50mmHg with symptoms or asystole >5 seconds
Atrio-ventricular nodal reentrant tachycardia is a common arrhythmia in what patient group?
young women (~5%)
What are the 3 Ps indicative of uncomplicated syncope e.g vasovagal?
Posture/prolonged standing
Provoked
Prodromal sx
