Cardiology Flashcards
Varenicline
Is an oral selective nicotine receptor partial agonist.
Start 1wk before target stop date and gradually increase the dose
SEs: appetite change; dry mouth; taste disturbance; headache; drowsiness; dizziness; sleep disorders; abnormal dreams; depression; suicidal thoughts; panic; dysarthria
Bupropion (amfebutamone)
Increases quit rate to 30% at 1yr
SEs: seizures (risk < 1:1000), insomnia, headache
Constricting chest pain suggests:
Angina
Oesophageal spasm
Anxiety
Sharp chest pain suggests:
Involvement of the pleura, pericardium or chest wall
Prolonged chest pain suggests:
> 1/2h, dull, central crushing pain or pressure suggests MI
Causes of angina:
Coronary artery disease Aortic stenosis Hypertrophic cardiomyopathy Paroxysmal supraventricular tachycardia Exacerbated by anaemia
Chest pain with tenderness suggests:
Self-limiting Tietze’s syndrome
Chest pain and acutely unwell - management
1 - Admit 2 - Check pulse, BP in both arms (unequal in aortic dissection), JVP, heart sounds, examine legs for DVT 3 - Give O2 4 - IV line 5 - Relieve pain (eg 5-10mg IV morphine) 6 - Cardiac monitor 7 - 12-lead ECG 8 - CXR 9 - Arterial blood gas
Famous traps: Aortic dissection; zoster; ruptured oesophagus; cardiac tamponade; opiate addiction
AF x Atrial Flutter x Ventriculsr rhythm
AF: has no discernible P waves and QRS complexes are irregularly irregular
Atrial Flutter: has a sawtooth baseline of atrial depolarization (~ 300/min) and regular QRS complexes
Ventricular rhythm: has QRS complexes > 0.12s with P waves following them or absent
Left axis deviation in ECG - causes:
Left anterior hemiblock Inferior MI VT from a left ventricular focus WPW LVH
Right axis deviation can result from:
RVH PE Anterolateral MI WPW Left posterior hemiblock
P wave - describe:
Upright in II, III & aVF
Inverted in aVR
Absent P wave: AF, P hidden due to junctional or ventricular rhythm
P mitrale: bifid P wave, indicates left atrial hypertrophy
P pulmonale: peaked P wave, indicates right atrial hypertrophy
Pseudo P pulmonale: seen in hyperkalemia
P-R interval: features
Normal range: 0,12-0,2s (3-5 small squares)
Prolonged PR interval implies delayed AV conduction
Short PR interval implies unusually fast AV conduction down an accessory pathway (eg WPW)
QRS complex: features
Normal duration: < 0.12s
> 0.12s = suggests ventricular conduction defects (bundle branch block / Metabolic disturbance or ventricular origin)
Normal Q waves < 0,04s wide and < 2mm deep
* Seen in leads I, aVL, V5 and V6 - reflect normal septal depolarization
Pathological Q waves (deep and wide) may occur within a few hours of an acute MI
QT interval: features
Measure from start of QRS to end pf T wave
Normal: 0.38-0.42s
Long QT can lead to VT and sudden death
T wave: features
Normally inverted in aVR, V1 and V2 Normal if inverted in isolation in lead III Abnormal if inverted in I, II and V4-V6 Peaked in hyperkalaemia Flattened in hypokalaemia
J wave: features
The J point is where the S wave finishes and ST segment starts
Seen in hypothermia, SAH, and hypercalcemja
Uk standard ECG speed:
25mm/s
ECG - axis
Normal (-30° to +90°) Left deviated (< -30°) Right deviated (> +90°)
If the QRS in lead I (0°) is predominantly positive (R wave is taller than the S wave is deep), the axis must be between -90° and + 90°
If lead II (+ 60°) is mostly positive, the axis must be between -30° and +150°
If both I and II are positive, the axis must be between -30° and +90° (the normal range)
When II is negative, the axis is likely to be left-deviated
When I is negative, the axis is likely to be right-deviatef
LOVERS LEAVING - LEFT AXIS DEVIATION (the QRs complexes in I and II point away from each other)
LOVERS RETURNING - RIGHT AXIS DEVIATION (the QRS complexes in I and III +/- II points towards each other)
