Cardiology Flashcards
1
Q
Amiodarone drug monitoring:
Before tx.:
Monitoring:
A
TFT, LFT, U&E, CXR prior to initiating treatment
TFT, LFT every 6 months
2
Q
Angina pectoris Mx:
All patients should be started on a:
To abort acute attacks:
First line:
A
Statin for all pts. w/out contraindications
Sublingual glyceryl trinitrate
Beta-blocker or CCB
3
Q
CCB used in angina
as monotherapy
A
Verapamil or Diltiazem - rate limiting
4
Q
Angina: if CCB and BB are used in combination which CCB should be used
A
long acting dihydropiridine - NIFEDIPINE
5
Q
Can beta blockers be prescribed with Verapamil?
A
NO
6
Q
Angina: If pt. is on monotherapy and cannot tolerate addition of CCB/BB which drugs can be added?
A
Long-acting nitrate, ivabradine, nicorandil, ranolazine
7
Q
Nitrate tolerance: How long are pts. advised to maintain a daily nitrate free time for?
A
10-14 hours
although this is not seen in pts. who take once daily modified release isosorbide mononitrate
8
Q
Anti-platelets: ACS - 1) and 2) PCI - 1) and 2) TIA - 1) and 2) Ischaemic stroke - 1) and 2) Peripheral arterial disease - 1) and 2)
A
ACS -
1) Aspirin and ticagrelor
2) asprin CI? - clopidogrel
PCI -
1) aspirin plus prasurgel or ticagrelor
2) asprin CI? - clopidogrel
TIA -
1) Clopidogrel
2) Aspirin and dipyridamole
Ischaemic stroke -
1) Clopidogrel
2) Aspirin and dipyridamole
Peripheral arterial disease -
1) Clopidogrel
2) Aspirin
9
Q
Investigation of choice in suspected aortic dissection:
stable pt?
unstable pt?
A
CT CAP angiography
suitable for stable pts.
a false lumen is a key finding
Transoesophageal echocardiography (TOE) - if too risky take to CT scanner
10
Q
Mx of aortic dissection
Type A;
Type B:
A
Type A: surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
Type B:
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression
11
Q
Features of Aortic regurgitation:
describe the murmur:
Pulse?:
Pulse pressure?:
A
Early diastolic
Collapsing pulse
Wide pulse pressure
12
Q
Features of aortic stenosis: Describe the murmur: Radiates to? Pulse? Pulse pressure
A
Ejection systolic murmur - reduced with valsalva
Carotids
slow rising pulse
Narrow pulse pressure
13
Q
Mx. Aortic stenosis:
Asymptomatic:
Symptomatic:
A
Asymptomatic: Observation
Symptomatic: valve replacement
14
Q
Arrhythmogenic right ventricular cardiomyopathy - second most common cause of SCD in young people after HOCM
mx. (BB)
mx. surgical
A
Mx: Drugs: Sotalol
Catheter ablation
ICD
15
Q
Arrhythmogenic right ventricular cardiomyopathy - ECG findings:
A
ECG V1-V3 = T-wave inversion
16
Q
Most common primary cardiac tumour:
Murmur:
most commonly attached to:
A
Atrial myxoma
mid diastolic - tumour plop
Fossa ovalis
17
Q
Two types of ASD:
A
Ostium secundum (70%) Ostium primum
18
Q
Effects of BNP
Vasodilation/constriction?
Diuretic/anti-diuretic
supress/enhances symapthetic tone and RAAS?
A
Vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and RAAS
19
Q
BNP value of?
Makes chronic heart failure unlikely
A
<100 pg/ml
20
Q
Contraindications of Beta blockers? (4)
A
Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent use of VERAPAMIL: may precipitate severe bradycardia
21
Q
Cardiac enzymes?protein markers:
First to rise:
Useful to look for reinfarction as it returns to normal 2-3 days
A
Myoglobin
CK-MB
22
Q
Cardiac tamponade Beck’s triad:
A
Hypotension
Raised JVP
Muffled heart sounds
23
Q
What is pulsus paradoxus
A
An abnormally large drop in BP during inspiration
24
Q
Takotsubo cardiomyopathy:
induced by?
Transient aplical balooning of ?
tx.
A
Stress
Myocardium
Supportive
25
Stable chest pain imaging investigations:
| for pts. who cannot be excluded to have stable angina, NICE recommends the following investigations:
1) CT coronary angiography
2) non-invasive functional imaging (looking for reversible myocardial ischaemia)
3) Invasive coronary angiography.
26
First line test for Chronic heart failure:
B-type natriuretic peptide (BNP)
27
If BNP (released by left ventricular myocardium in repsonse to strain) levels are
High:
Raised:
When should specialist assessment be arranged
High: 2 weeks
Raised: 6 weeks
28
Factors which increase BNP:
```
Left ventricular hypertrophy
ischaemia
tachycardia
right ventricular overload
hypoxaemia
GFR < 60
sepsis
COPD
Diabetes
age > 70
liver cirrhosis
```
29
Factors which decrease BNP:
| think cardio drugs plus one other
```
Obesity
Diuretics
ACEis
Beta-blockers
ARBs
Aldosterone antagonist
```
30
Chronic heart failure first line tx:
Second line tx:
Third line tx: (to be initiated by a specialist)
1) ACEi AND a beta blocker
2) Aldosterone antagonist
3) Ivabradine, sacubitril-valsartan, digoxin, hydralazine w/ nitrate
31
Additional vaccines for heart failure pts.
Offer annual influenza vaccine
| Offer one-off pneumococcal vaccine (usually one off but if splenic dysfunction or CKD, offer booster every 5 years )
32
concurrent use of clopidogrel and X may make clopidogrel less effective:
Proton pump inhibitors
33
Monoclonal antibody drug for reversal of DABIGATARAN
Idarucizumab
34
Antihypertensive used in diabetes regardless of age?
ACEi
35
Most common cardiomyopathy?
Dilated cardiomyopathy
36
```
DVLA cardiovascular disorders: how long off driving?
Angioplasty:
CABG:
ACS:
Angina:
Pacemaker insertion:
ICD
Aortic aneurysm diameter to disqualify from driving:
Heart transplant:
```
Angioplasty: 1 week
CABG: 4 weeks
ACS: 4 weeks
Angina: driving must cease if sx. occur at rest
Pacemaker insertion: 1 week off
ICD: 6 months, 1 month if inserted prophylactically
Aortic aneurysm diameter to disqualify from driving: 6.5 cm
Heart transplant: 6 weeks but do not need to inform DVLA
37
Describe Eisenmenger's syndrome:
| Management:
Left to right shunt in a congenital heart defect due to PULMONARY HYPERTENSION - eventually causes obstruction to pulmonary blood.
associations with: VSD, ASD, patent ductus arteriosus
Mx = Heart lung transplant required
38
```
Diagnostic work-up for acute heart failure:
Bloods tests:
CXR:
Echocardiogram:
BNP:
```
Bloods tests: look for underlying abnormality
CXR: pulmonary congestion, interstitial oedema, cardiomegaly
Echocardiogram: pericardial effusion and cardiac tamponade
BNP: raised levels >100mg/litre (indicates myocardial damage and are supportive of diagnosis)
39
Heart failure acute management:
IV loop diuretics (furosemide or bumetanide)
possible additional tx:
Oxygen
Vasodilators (nitrates) - not always, but have a role if concomitant MI , severe hypertension or regurgitant aortic or mitral valve disease.
40
Heart failure mx: patients with hypotension
Inotropic agents: Dobutamine
vasopressor agents: Norepinephrine
Mechanical circulatory assistance: Intra-aortic baloon counterpulsation or ventricular assist device
41
Should B-blockers be stopped in AHF?
Only if HR <50 bpm, 2nd or 3rd degree AV block or shock
42
Heart failure types:
HFpEF:
HFrEF:
What is the dysfunction of each with regards to the cardiac cycle (systolic or diastolic)
HFpEF: Diastolic dysfunction
HFrEF: systolic dysfunction
43
Causes of:
systolic dysfunction:
diastolic dysfunction:
Systolic dysfunction: Ischaemic heart disease,
dilated cardiomyopathy
myocarditis
arrhythmias
Diastolic dysfunction: HOCM
Restrictive CM
Cardiac tamponade
Constrictive pericarditis
44
Describe high-output heart failure:
| causes:
Normal heart is unable to pump enough blood to meet the metabolic needs of the body
Causes: anaemia, AVM, Paget's disease, pregnancy, thyrotoxicosis, thiamine deficiency (wet beri-beri)
45
What is an S3 heart sound:
Is it ever normal?
Heard in (conditions) ?
caused by diastolic filling of the ventricle
Yes if less than 30 y/o
Left ventricular failure, constrictive pericarditis and mitral regurgitation
46
What is an S4 heart sound:
```
Heard in (conditions) ?
Coincides with which wave on ECG:
```
Atrial contraction against a STIFF ventricle
Heard in aortic stenosis, HOCM, Hypertension
P wave
47
Hypercalcaemia effect on ECG QT interval?
SHORTENED QT
48
Newly diagnosed hypertension investigations (6):
```
Fundoscopy: hypertensive retinopathy
Urine dipstick: renal disease
ECG: LVH or ischaemic heart disease
U&Es:
HbA1c: check for co-existing diabetes
Lipids: hyperlipidaemia
```
49
Thiazide diuretics effect on Na and K
Both LOWERED: HYPOnatraemia, kalaemia
50
Clinical BP and HBPM
stage 1 HTN:
stage 2 HTN:
Severe HTN:
1) >140/90, 135/85
2)>160/100, 150/95
Severe: Clinic systolic BP>180 or diastolic BP >120
51
HBPM: regime
| Do you use the first day of readings in the average?
Each BP recording: two must be taken at least 1 minute apart
Should be recorded twice daily for at least 4 days (7 ideally)
NO
52
Drug causes of hypertension:
```
Steroids
MOAis
COCP
NSAIDS
Leflunomide
```
53
HOCM ECHO findings 'MR SAM ASH'
```
Mitral regurgitation (MR)
systolic anterior motion (SAM)
asymmetrical hypertrophy (ASH)
```
54
Management of HOCM: 'ABCDE'
| Drugs to avoid:
```
Amiodarone
Beta-blockers or Verapamil for symptoms
Cardioverter defibrillation
Dual chamber pacemaker
Endocarditis prophylaxis
```
Nitrates, ACEis, inotropes
55
```
Hypothermia investigations findings:
ECG:
FBC:
Blood glucose:
ABGs
Coagulation factors
CXR
```
ECG: 12 lead, as temperature approaches 32 degrees, acute ST elevation and J waves or Osborn waves may appear
FBC: serum electrolytes - Hb and haematocrit can be elevated due to haemoconcentration. Platelets and WBCs will be low due to sequestration in the spleen.
Blood glucose: Stress hormones are increased - body can have more peripheral resistance to insulin
56
Strongest risk factor for infective endocarditis?
Most common valve affected?
Previous episode of endocarditis
| Mitral valve
57
Most common BACTERIAL cause of infective ENDOCARDITIS
STAPH AUREUS - particularly common in acute px. and IVDU
58
Poor dental hygiene or dental procedure leading to endocarditis
What is the causative organism?
Strep VIRIDANS
| No longer most common cause (*except in developing countries)
59
Prosthetic valve endocarditis most common causative organism?
Staph EPIDERMIDIS
| usually the result of preoperative contamination
60
After how many months do they most common organisms of endocarditis return to normal?
2 Months
61
Bacterial cause of endocarditis associated with colorectal cancer
Strep BOVIS
62
Libman Sachs endocarditis is associated with which AI condition
SLE.
63
DUKES criteria (endocarditis) Major criteria (4)
2 positive blood cultures showing typical organisms (strep, HACEK) - 3 if less specific pathogen (staph aureus, epidermis etc.)
Persistent bacteraemia from 2 blood cultures taken 12 hours apart
Positive serology for Cox Burnetti, Bartonella, chlyamydia psttaci
Postive molecular assays for specific gene targets.
64
DUKES criteria (endocarditis) minor criteria (4)
predisposing heart condition or intravenous drug use
microbiological evidence does not meet major criteria
fever > 38ºC
vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots
65
Infective endocarditis: poor prognostic factors:
Staph aureus infection
Prosthetic valve
culture negative endocarditis
low complement levels
66
Endocarditis treatment
Initial blind therapy:
Native valve:
Pen allergic, MRSA or SEPSIS:
Prosthetic valve:
Amoxicillin, consider adding low-dose gentamicin
Vancomycin + low-dose gentamicin
Vancomycin + rifampicin + low-dose gentamicin
67
Native valve endocarditis tx: Staphylococci
FLUCLOXACILLIN
If penicillin allergic or MRSA
vancomycin + rifampicin
68
Prosthetic valve endocarditis caused by staphylococci tx.
Flucloxacillin + Rifampicin + low-dose gentamicin
If penicillin allergic or MRSA
Vancomycin + Rifampicin + low-dose Gentamicin
69
Endocarditis caused by fully-sensitive streptococci (e.g. viridans) tx.
Endocarditis caused by less sensitive streptococci tx:
Benzylpenicillin
If penicillin allergic
Vancomycin + low-dose Gentamicin
Benzylpenicillin + low-dose gentamicin
If penicillin allergic
vancomycin + low-dose gentamicin
70
Endocarditis indications for surgery:
Severe valvular incompetence
Aortic abscess (often indicated by a lengthening PR interval)
Infections resistant to antibiotics/fungal infections
Cardiac failure refractory to standard medical treatment
Recurrent emboli after antibiotic therapy
71
Procedures which may require prophylactic ABs for endocarditis:
GI or GU procedure at site where there is a suspected infection
72
Palpitations investigations (4):
Investigation for capturing episodic arrhythmias:
12-lead ECG
TFT
U&Es
FBC
HOLTER monitoring
73
IVABRADINE adverse effects:
| "eyevabradycardiene"
Visual effects (luminous phenomena)
Headache
Bradycardia, heart block
74
What is Kussmauls sign (JVP)
paradoxical rise in JVP during inspiration seen in CONSTRICTIVE PERICARDITIS
75
Long QT syndrome: drug causes:
1) cardiac drugs
2) antidepressants
3) misc.
1) Amiodarone, Sotalol, class 1a anti arrhythmic drugs
2) TCA, SSRIs (CITALOPRAM ++)
3) Methadone, chloroquine, ERYTHROMYCIN, Haloperidol, Ondansetron
76
Long QT causes:
Electrolytes:
hypo/hyperthermia?
Cardiac/neuro conditions?
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hypothermia
Acute MI, myocarditis, subarachnoid haemorrhage
77
Management of Long QT syndrome:
Avoid drugs which cause
Beta-blockers (NOT SOTALOL)
ICD
78
Loop diuretics adverse effects:
Electrolytes:
blood sugar?
HYPO EVERYTHING,
Hypochloaraemic alkalosis
May cause hyperglycaemia (less common than with thiazides)
79
Mitral regurgitation:
signs: murmur? radiation?
ECG:
Signs: pansystolic 'blowing' murmur
ECG - may cause P wave broadening
80
MR treatment options:
TO INCREASE CO:
medical:
TO INCREASE CO: Acute cases: nitrates, diuretics, positive inotropes, intra-aortic balloon pump
For pts. in heart failure ACEis, BBs and spironolactone
81
Mitral stenosis MAIN CAUSE:
Fx:
Rheumatic fever, rheumatic fever, rheumatic fever
```
Mid-late diastolic murmur (best heard in expiration).
Loud S1, opening snap
Low volume pulse
Malar flush
ATRIAL FIBRILLATION
```
82
Mitral stenosis: Mx:
Patients w/ assoc. AF require WARFARIN
asymptomatic pts: monitor with regular echocardiograms
symptomatic pts.:
Percutaneous mitral balloon valvotomy
mitral valve surgery
83
Features of mitral valve prolapse:
Main complaint:
Murmur:
Complications
Atypical chest pain or palpitations
mid systolic click (occurs if pt. squatting),
late systolic murmur (longer if pt. standing)
Complications:
Mitral regurgitation, arrhythmias, emboli, sudden death
84
Ejection systolic murmurs:
Louder on expiration:
Louder on inspiration:
Aortic stenosis, HOCM
Pulmonary stenosis, ASD
85
Late systolic murmurs
mitral valve prolapse
| coarctation of aorta
86
Holosystolic murmurs:
| Mitral/tricuspid regurgitation: which gets LOUDER during inspiration?
TRICUSPID
think during inspiration, the venous blood flow into the right atrium and ventricle are increased which increases the stroke volume of right ventricle during systole.
87
All pts. should be offered which drugs after a MI: (4)
Statin
Dual anti platelet therapy (Aspirin plus one other usually)
BB
ACEi
88
Patients with acute MI who have symptoms or signs of heart failure and LVSD should also be treated with what, post MI...
Aldosterone antagonist (Eplerenone)
89
Glycaemic control in MI for diabetics
What BM should be aimed for
how is this achieved?
11.0 mmol/L
| dose-adjusted insulin infusion
90
```
With which demographic is myocarditis associated with
Can myocarditis increase
inflammatory markers?
cardiac enzymes?
BNP?
```
Management:
Young pts. who px. with chest pain
Yes.
Supportive, treat underlying cause (antibiotics if required)
91
Side effects of Nicorandil:
Contraindication:
Headache, flushing, skin, mucosal and eye ulceration,
GI ulcers incl. anal ulceration
contraindicated in Left Ventricular Failure
92
Orthostatic hypotension diagnostic fx:
A drop in BP (usually >20/10 mm Hg) within three minutes of standing
presyncope, syncope
93
Examples of direct thrombin inhibitors: (2)
Bivalirudin
| Dabigataran
94
Bradycardia acute tx.
1)
2)
3)
Risk factors for asystole:
ATROPINE 500 mcg IV repeat (X6) up to 3 mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response
complete heart block with broad QRS.
recent asystole
Mobitz type II AV block
Ventricular pause > 3 seconds
95
Peri-arrest tachycardia if unstable tx:
Synchronised DC shocks should be given
| Up to 3 can be given. after this, get extra help
96
Broad complex tachycardia mx:
Regular:
irregular:
assume ventricular tachycardia:
Loading dose of AMIODARONE followed by 24 hour infusion
seek expert help
97
Orthostatic hypertension drug causes (1)
| possible treatment options:
Cause: ALPHA BLOCKERS
Tx. options: Midodrine, Fludrocortisone
98
Long term anti-coagulation requirement:
biological valves: (bovine/porcine)
Mechanical valves:
```
biological valves (bovine/porcine): NO
Mechanical valves: YES (warfarin)
```
99
Normal pulmonary artery occlusion pressure:
| High:
8-12 mmHg
| >18 mmHg (overload)
100
If PE is 'likely' i.e >4 points scored on Wells, what is the immediate management:
Should anti-coagulation be given if there is a delay in getting a CTPA? What should be given if so?
Immediate CTPA
YES -
DOAC now preferred (Rivaroxaban, Apixaban)
101
If CTPA is negative but Wells >4 what scan should you consider:
Proximal leg vein ultrasound.
102
If PE is 'unlikely' (<4 points on Wells) what should be arranged?
If this is positive, what should then be arranged? - should AC be given while awaiting this?
if negative, then PE unlikely, what should you do with AC?
D-dimer
CTPA - Yes
Stop anti-coagulation
103
PE: Ix of choice IN RENAL IMPAIRMENT:
V/Q scan
104
PE: mx of VTE:
cancer patients:
If DOAC (Apix, Rivarox) CI:
Severe renal disease (15/min):
DOACs
DOACs
LMWH followed by Dabigataran or LMWH followed by Vit K antagonist: WARFARIN
LMWH or LMWH followed by Warfarin
105
Length of anticoagulation:
Provoked:
Non-provoked:
Scoring tool to assess risk of bleeding
Provoked: 3 months
Non-provoked: 6 months
HAS-BLED
106
Massive PE with Haemodynamic instability (circulatory failure) 1st line tx.
Thrombolysis
107
Collapsing pulse causes (3)
Aortic regurgitation
Patent ductus arteriosus
Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
108
Rheumatic fever:
Develops after infection with which organism.
Outline Mx:
Strep Pyogenes (2-6 weeks ago)
Antibiotics: Oral Pen V
Anti-inflammatories: NSAIDs
Tx. any complications that may develop (heart failure)
109
```
Scoring systems:
ABCD2:
Child Pugh classification:
HAD:
PHQ-9
GAD-7
SCOFF:
Epworth:
Waterlow:
Frax:
Ranson:
```
ABCD2: prognostic risk stratification in TIA
Child Pugh classification: Severity of liver cirrhosis
HAD: Hospital anxiety and depression scale
PHQ-9: Patient health questionnaire
GAD-7: Screening tool for GAD
SCOFF: eating disorders
IPSS: international prostate symptom score
Epworth: obstructive sleep apnoea
Waterlow: pressure sores risk
Frax: 10 year fracture risk for pts. with osteoporosis
Ranson: acute pancreatitis
110
Statins side effects:
contraindications (2): antibiotic class?
```
MYOPATHY
Liver impariment (LFTs at 3 and 12 months)
```
Macrolides
Pregnancy
111
When should statins be taken:
At night - as this is when cholesterol synthesis takes place
112
Statin doses:
Recommended regimen
Primary prevention:
Secondary prevention:
ATORVASTATIN
Primary prevention: 20mg
Secondary prevention: 80mg
113
SVT: prevention of episodes management:
B-blockers
| Radiofrequency ablation
114
Thiazide diuretics main difference from loop diuretics in terms of electrolyte disturbance?
Loop = HYPOcalcaemia
| Thiazide may cause HYPERcalcaemia
115
Thiazide diuretics main S/Es
dehydration,hyponatraemia-kalaemia, HYPERCALCAEMIA GOUT, impaired GLUCOSE TOLERANCE
116
Torsades de pointes: Management:
| assoc. with long or short QT?
IV MAGNESIUM SULPHATE
Long
117
Tricuspid regurgitation causes:
```
Pulmonary hypertension (COPD)
Rheumatic heart disease
Infective endocarditis
Ebsteins anomaly
Carcinoid syndrome
```
118
```
Ventricular tachycardia mx:
if pt. haemodynamically unstable:
if not:
medical:
if these fail:
```
Immediate cardioversion
Medical: Amiodarone, lidocaine or procainamide
electrophysiological study -> ICD
119
Warfarin: managing high INR:
Major bleeding:
INR > 8.0
Minor bleeding:
INR > 8.0
No bleeding
INR 5.0-8.0
Minor bleeding
INR 5.0-8.0
No bleeding
Major bleeding: Stop warfarin -> IV VIT K 5mg, prothrombin complex concentrate
INR > 8.0
Minor bleeding: Stop warfarin, IV Vit K 1-3mg
restart at INR 5.0
INR > 8.0
No bleeding:
Stop warfarin, IV vit K (1-5mg) restart at INR 5.0
INR 5.0-8.0
Minor bleeding: Stop warfarin, IV vit K (1-3mg) restart at INR 5.0
INR 5.0-8.0
No bleeding: withhold 1 or 2 doses of warfarin -> reduce subsequent maintenance dose
120
ECG: causes of left axis deviation:
```
Left anterior hemiblock
LBBB
Inferior MI
WPW syndrome with RIGHT sided accessory pathway
Hyperkalaemia
Ostium primum
```
minor LAD in obese people
121
ECG: causes of right axis deviation:
```
Right ventricular hypertrophy
Left posterior hemiblock
Lateral MI
Chronic lung disease (cor pulmonale)
Pulmonary embolism
WPW with LEFT sided accessory pathway
ostium secundum
```
minor RAD in tall people
122
bifasicular block combo?
trifasicular block combo?
Combination of RBBB with left anterior or posterior hemiblock
bifasicular plus 1st degree heart block
123
ECG coronary territories: Anteroseptal
ECG changes:
Coronary artery affected:
ECG changes: V1-V4
| Coronary artery affected: Left anterior descending (LAD)
124
ECG coronary territories: Inferior
ECG changes:
Coronary artery affected:
II,III,aVF
Right coronary artery
125
ECG coronary territories: Anterolateral
ECG changes:
Coronary artery affected:
V4-V6, I, aVL
LAD or Left circumflex
126
ECG coronary territories: Lateral
ECG changes:
Coronary artery affected:
I, aVL +/- V5-V6
Left circumflex
127
ECG coronary territories: Posterior
ECG changes:
Coronary artery affected:
Confirmed by?
Changes in V1-V3
Reciprocal changes of STEMI typically seen:
- horizontal ST depression
- tall broad R waves
- upright T waves
- dominant R wave in V2
Left circumflex also right coronary
Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-V9)
128
A new diagnosis of what may point towards a diagnosis of ACS?
New LBBB
129
ECG features: Digoxin
down-sloping ST depression ('reverse tick', 'scooped out')
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia
130
ECG features: Hypokalaemia
'U have no Pot and no T, but a long PR and a long QT'
```
U waves
small or absent T waves
Prolonged PR interval
ST depression
Long QT
```
131
ECG features: Hypothermia
```
Bradycardia
J wave - small hump at the end of QRS complexes
First degree heart block
Long QT interval
Atrial and ventricular arrhythmias
```
132
Causes of LBBB (5)
```
Myocardial infarction
Hypertension
Aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, Hyperkalaemia
```
133
Posterior MI causes ST elevation/depression?
Depression
134
Cause of increased P wave amplitude?
Think increased atrial pressure..
COR PULMONALE
135
Causes of RBBB
```
NORMAL VARIANT in old people (in contast to LBBB which is always pathological)
RVH
Cor Pulmmonale
Pulmonary embolism
MI
```
136
```
Causes of ST depression:
2 cardiac muscle issues
1 ECG feature
1 electrolyte imbalance
1 cardiac drug
```
Posterior MI
ischaemia
secondary to abnormal QRS complex (LVH, L/R -BBB, Digoxin, hypokalaemia)
137
Causes of ST elevation:
+1 rare cause (neuro)
```
MI
Pericarditis/myocarditis
Normal variant
left ventricular aneurysm (persistent ST elevation)
rare: subarachnoid haemorrhage
```
138
T wave changes:
Peaked (2):
inverted (6):
Peaked: Hyperkalaemia
MI
```
Inverted:
MI,
Digoxin toxicity
Subarachnoid haemorrhage
Pulmonary embolism S1Q3T3
Brugada syndrome
```
139
ECG Wellens syndrome
Cause:
ECG features
high-grade stenosis in the LAD coronary artery
```
ECG:
Biphasic or deep
T wave inversion V2-V3
Minimal ST elevation
NO Q waves
```
140
As well as heart failure, which other condition can increase BNP:
Chronic renal failure
141
Is LBBB more assoc. w/ NSTEMI or STEMI
STEMI
