Cardiology (3) Flashcards

Question

Summarise the prognosis of ventricular tachycardia

Answer 1

GOOD if treated RAPIDLY | Long-term prognosis depends on the underlying cause

Answer 2

A range of arterial syndromes caused by narrowing of vessels, resulting in reduced blood flow. This is most often due to atherosclerosis affecting the arteries of the leg.

Answer 3

The most common cause is ATHEROSCLEROSIS Types of peripheral vascular disease: Intermittent claudication - calf pain on exercise Critical limb ischaemia - pain at rest: the MOST SEVERE manifestation of PVD Acute limb ischaemia - a sudden decrease in arterial perfusion in a limb, due to thrombotic or embolic causes Arterial ulcers Gangrene ``` Risk factors: Hypertension Smoking Dyslipidaemia Diabetes Metabolic syndrome Age >60 years Obesity Physical inactivity ```

Answer 4

Incidence increases with age | More common in men

Answer 5

INTERMITTENT CLAUDICATION: Pain, tiredness, numbness of legs which is relieved by rest Calf claudication = femoral disease Buttock claudication = iliac disease ``` Critical limb ischaemia: Pain in legs at rest, worst when lying down Relieved by standing Ulcers Gangrene Night pain ``` Leriche Syndrome (aortoiliac occlusive disease): Buttock claudication Impotence Absent/weak distal pulses Progression from asymptomatic, intermittent claudication, rest pain, ulcers and gangrene

Answer 6

``` Hair loss Pallor Nail changes - loss, brittle, ridging Ulcers - dry, painful, punched out, non-healing Gangrene Dependent rubor - foot turns red when hanging down Elevation pallor Muscular atrophy ``` ``` Acute ischaemic limb = 6Ps: Pallor Parasthesia Paralysis Pain Perishingly cold Pulseless ```

Answer 7

Ankle brachial pressure index - systolic ankle/systolic arm <0.91 Toe-brachial index <0.6 Doppler ultrasound - FIRST LINE - shows site and degree of stenosis CT/MR arteriography Conventional arteriography - gold standard for vascular imaging DO NOT APPLY PRESSURE BAND - will worsen ischaemia

Answer 8

Uncoordinated muscle fibre contraction in the ventricles, resulting in an irregular broad-complex tachycardia that can cause cardiac arrest and sudden cardiac death and zero cardiac output. Ventricular fibrillation is a medical emergency and will result in death within minutes if it is not rapidly identified and managed appropriately.

Answer 9

The ventricular fibres contract randomly causing complete failure of ventricular function Most cases occur in patients with underlying heart disease Causes: Ischaemic Heart Disease/Coronary artery disease (most common) Idiopathic (progression from idiopathic ventricular tachycardia) Cardiomyopathy (hypertrophic, arrhythmogenic right ventricular) Long QT Syndrome Tissue heterogeneity Ischaemia Electrolyte disturbance - hypo or hyperkalaemia Drugs - methamphetamines, cocaine Scarring of heart causing anatomical reentrant

Answer 10

The MOST COMMON arrhythmia identified in cardiac arrest patients Incidence of VF parallels the incidence of ischaemic heart disease

Answer 11

Collapse, fainting and loss of consciousness are most common presentations ``` Preceding symptoms: Chest pain Nausea Vomiting Palpitations Dizziness SOB ``` ``` History of associated conditions: Coronary artery disease Cardiomyopathy Valvular heart disease Long QT syndrome Wolff-Parkinson-White syndrome Brugada syndrome ```

Answer 12

``` Tachycardia Hypotension Weak pulses Presyncope Syncope Airway compromise Diminished responsiveness Dyspnoea ```

Answer 13

ECG: No clear P, Q, R, S or T waves Rate 150-500bpm Chaotic irregular deflections of varying amplitude Cardiac enzymes (e.g. troponins) - check for recent ischaemic event Electrolytes - derangement can cause arrhythmias, including VF Drug levels and toxicology screen - anti-arrhythmics and cocaine can cause arrhythmia TFTs - hyperthyroidism can cause tachyarrhythmias Coronary angiography - if patient survives VF, to check the integrity of coronary arteries

Answer 14

Urgent defibrillation and CPR Cardioversion ICD implantation if VF is due to irreversible cause Patients who survive need full assessment of left ventricular function, myocardial perfusion and electrophysiological stability Empirical beta-blockers Some patients may be treated with radiofrequency ablation (RFA)

Answer 15

``` Ischaemic brain injury due to loss of cardiac output Myocardial injury Post-defibrillation arrhythmias Aspiration pneumonia Skin burns Death ```

Answer 16

Depends on the time between onset of VF and medical intervention Early defibrillation is essential (ideally within 4-6 mins) Anoxic encephalopathy is a major outcome of VF

Answer 17

A narrow-complex tachycardia with absent p waves which has a supraventricular origin. AF is a type of SVT Typically involves AVNRT and AVRT - regular narrow complex, paroxysmal SVT

Answer 18

AVRT - accessory pathway forms between atria and ventricles, allowing electrical impulse to pass back up from the ventricle to the atria, causing a re-entry circuit. Common type of this is Wolff-Parkinson-White syndrome with Bundle of Kent AVNRT - accessory pathway is in or around the AV node (localised re-entry circuit) ``` Risk factors: Nicotine Alcohol Caffeine Previous MI Digoxin toxicity ```

Answer 19

Twice as common in females | More common in younger patients

Answer 20

Paroxysmal Abrupt onset and termination of symptoms ``` Dyspnoea Dizziness Chest pain Syncope Pre-syncope Fatigue Palpitations ```

Answer 21

Tachycardia - 150-250bpm AVNRT - normal except tachycardia Wolff-Parkinson-White: Tachycardia Secondary cardiomyopathy (S3 gallop, RV heave, displaced apex beat)

Answer 22

ECG: Narrow complex tachycardia, absent p waves Differentiating between AVNRT and AVRT – once the SVT has been terminated and normal rate and rhythm are re-established: AVNRT – appears normal AVRT – delta-waves (slurred upstroke of the QRS complex) 24 hr ECG monitoring - will be required in patients with paroxysmal palpitations Cardiac Enzymes: Check for features of MI (especially if there is chest pain) Electrolytes: can cause arrhythmia TFTs: can cause arrhythmia Digoxin Level: for patients on digoxin Echocardiogram: check for structural heart disease

Answer 23

Haemodynamically unstable = DC cardioversion Haemodynamically stable = vagal manouvere and chemical cardioversion AVNRT: Vagal manouveres (blocks AV node) - carotid sinus massage, Valsalva manouvere (forced exhalation in acute attack If unresponsive to vagal manouveres: Adenosine AVRT: Acute: Same as AVNRT, avoid long acting AV nodal blockers e.g. digoxin, verapamil Medical: Procainamide and Flecainide Long term - radiofrequency ablation

Answer 24

``` Haemodynamic compromise Congestive heart failure Systemic embolism Cardiac tamponade DVT Syncope MI Tachycardia-induced angina ```

Answer 25

Dependent on the presence of underlying structural heart disease If structurally normal heart – GOOD PROGNOSIS People with pre-excitation have a small risk of sudden death

Answer 26

Characterised by decreased blood supply to the heart muscle resulting in chest pain (angina pectoris). May present as stable angina or acute coronary syndrome. ACS can be further subdivided into: Unstable angina - chest pain at rest due to ischaemia but without cardiac injury NSTEMI STEMI - ST elevation with transmural infarction

Answer 27

Angina pectoris occurs when myocardial oxygen demand exceeds oxygen supply, usually due to atherosclerosis Rare causes of angina pectoris: Coronary artery spasm (e.g. induced by cocaine), arteritis and emboli ``` Risk Factors: Male Diabetes mellitus Family history Hypertension Hyperlipidaemia Smoking ```

Answer 28

Common | More common in males

Answer 29

``` Crushing central chest pain Pain radiates to jaw and down left arm Develops during exercise and relieved with rest - stable angina Nausea Sweating Fatigue Dyspnoea ```

Answer 30

ACS: There may be NO CLINICAL SIGNS Pale Sweating Restless Low-grade pyrexia Check both radial pulses to rule out aortic dissection Arrhythmias, disturbances of BP and new heart murmurs Signs of complications (e.g. acute heart failure, cardiogenic shock)

Answer 31

Troponin - elevated if STEMI or NSTEMI AST - raised 24 hours post-MI LDH - raised 48 hours post-MI ECG: ST depression - NSTEMI New onset LBBB - STEMI ST elevation in leads V1-V4 - anterior - left anterior descending artery ST elevation in leads II, III, aVF - inferior - right coronary artery ST elevation in leads V5, V6, aVL, I - lateral - left circumflex artery Posterior MI - ST depression V1-V3, tall R wave

Answer 32

``` Stable angina: Symptomatic - GTN spray Anti-anginals - beta blockers, CCB Risk factor control Aspirin 75mg/day ``` ``` ACS management: Morphine Oxygen Anticoagulants - aspirin, clopidogrel Nitrates ``` Beta blockers ACEi Statins Heparin STEMI: If <12 hours since symptom onset - urgent PCI If >12 hours, coronary angiography followed by PCI if necessary ``` STEMI = aspirin, clopidogrel, PCI NSTEMI = aspirin, clopidogrel, LMWH ```

Answer 33

``` Death Arrhythmia - VT Rupture Tamponade Heart failure Valve disease Aneurysm Dressler's syndrome Embolism Reinfarction ```