Cardiology

Question 1

Varenicline

Answer 1

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

Question 2

Bupropion (amfebutamone)

Answer 2

Increases quit rate to 30% at 1yr

SEs: seizures (risk < 1:1000), insomnia, headache

Question 3

Constricting chest pain suggests:

Answer 3

Angina
Oesophageal spasm
Anxiety

Question 4

Sharp chest pain suggests:

Answer 4

Involvement of the pleura, pericardium or chest wall

Question 5

Prolonged chest pain suggests:

Answer 5

> 1/2h, dull, central crushing pain or pressure suggests MI

Question 6

Causes of angina:

Answer 6

Coronary artery disease 
Aortic stenosis
Hypertrophic cardiomyopathy 
Paroxysmal supraventricular tachycardia
Exacerbated by anaemia

Question 7

Chest pain with tenderness suggests:

Answer 7

Self-limiting Tietze’s syndrome

Question 8

Chest pain and acutely unwell - management

Answer 8

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

Question 9

AF x Atrial Flutter x Ventriculsr rhythm

Answer 9

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

Question 10

Left axis deviation in ECG - causes:

Answer 10

Left anterior hemiblock 
Inferior MI
VT from a left ventricular focus
WPW 
LVH

Question 11

Right axis deviation can result from:

Answer 11

RVH
PE
Anterolateral MI
WPW
Left posterior hemiblock

Question 12

P wave - describe:

Answer 12

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

Question 13

P-R interval: features

Answer 13

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)

Question 14

QRS complex: features

Answer 14

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

Question 15

QT interval: features

Answer 15

Measure from start of QRS to end pf T wave

Normal: 0.38-0.42s
Long QT can lead to VT and sudden death

Question 16

T wave: features

Answer 16

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

Question 17

J wave: features

Answer 17

The J point is where the S wave finishes and ST segment starts

Seen in hypothermia, SAH, and hypercalcemja

Question 18

Uk standard ECG speed:

Answer 18

25mm/s

Question 19

ECG - axis

Answer 19

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)