Cardiology

Question 1

What are 10 findings to look for on ECG in a patient with syncope?

Answer 1

1. Tachydysrhythmias
2. Bradydysrhythmias
3. Long QT
4. Short QT
5. ST changes in MI
6. PE - sinus tachycardia, RBBB, RVH, S1Q3T3
7. Brugada syndrome
8. ARVD - epsilon wave
9. HOCM - dagger Q waves in lateral leads, LVH, LV strain
10. WPW/re-entry pathways

Question 2

What is Wellen’s syndrome?

Answer 2

Wellens’ syndrome is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery

Question 3

What are the diagnostic criteria for Wellen’s syndrome (Rhinehart 2002)

Answer 3

Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6)
Isoelectric or minimally-elevated ST segment (< 1mm)
No precordial Q waves
Preserved precordial R wave progression
Recent history of angina
ECG pattern present in pain-free state
Normal or slightly elevated serum cardiac markers

Question 4

What is the DDx of Wellen’s syndrome changes on ECG

Answer 4

Pulmonary embolism
Right bundle branch block
Right ventricular hypertrophy
Left ventricular hypertrophy
Hypertrophic cardiomyopathy
Raised intracranial pressure
Normal paediatric ECG
Persistent juvenile T wave pattern
Brugada syndrome
Hypokalaemia

Question 5

What is the Type A Wellen’s pattern

Answer 5

1. Biphasic precordial T waves with terminal negativity, most prominent in V2-3.
2. Minor precordial ST elevation.
3. Preserved R wave progression (R wave in V3 > 3mm)

Question 6

What is the Type B Wellen’s pattern

Answer 6

Biphasic T waves in V2-3

Question 7

What is an Impella?

Answer 7

Percutaneous left ventricular assist device placed from the femoral artery, tip sits in the LV
Temporary
Works to create forward flow out the LV to the aorta
Only increased cardiac output by 0.25

Question 8

What are 3 complications of pericarditis

Answer 8

1. heart failure
2. pericardial effusion leading to tamponade
3. dysrhythmias