Cardiology Flashcards
ECG shows ST elevation in leads V2, V3, V4. Which artery is likely to be effected?
LAD - Anterior MI
Man with chest pain worse on lying down and better on sitting upright, had coryzal symptoms last week. Diffuse ST elevation is noted on ECG.
Acute pericarditis
Man with chest pain at rest, there is no radiation and he has unremarkable ECG and cardiac enzymes. There is no history of trauma or viral infection
Unstable Angina
Lady with Marfan’s syndrome develops a sudden onset tearing chest pain from the chest to the back. She is found to have an increased BP with different values noted on each arm.
Aortic dissection
Man with Ehlers-Danlos syndrome who presents with dyspnoea is found to have an early diastolic murmur. His pulse is noted to be collapsing/bounding, and a wide pulse pressure is noted.
Aortic rergurgitation
80 year old man presents with a head injury following collapse while shopping. He recalls episodes of recent non-radiating chest pain and gradually increasing shortness of breath. A medical student finds a murmur all over the chest but is unable to characterise it.
AS
Young lady presents with neck swelling, sweating, diarrhoea and ocular signs. She’s found to have a soft ejection systolic murmur over the pulmonary area.
Flow Murmur
Young child presents to the GP for a routine check-up and is found to have an ejection systolic murmur over the pulmonary area. There is also noted wide splitting of the S2.
ASD
Baby is routinely examined at 6 weeks and is found to have a continuous murmur over the pulmonary area. There is also a wide pulse pressure noted.
PDA
Man with history of acute rheumatic heart disease is found to have a mid-diastolic murmur that has an associated opening snap and loud S1. There is a tapping apex beat.
MS
Man with a history of pancarditis is reviewed in clinic. He is found to have muffled heart sounds and pulsus paradoxus. There is dullness to percussion at the lower angle of the left scapula. His ECG displays electrical alternans, which excites all the keen medical students.
Percardial effusion
Man is notably bradycardic and his JVP displays cannon a-waves.
Complete heart block
Man has severe hypoparathyroidism for which he only accepts homeopathic remedies. He is found to have severe confusion and tetany. A medical student is keen to take a history when suddenly this patient dies with little warning.
Torsades de Pointes due to hypocalcaemia
A young adult with a history of Kartagener’s syndrome is reviewed in resp clinic. He is found to be producing copious amounts of sputum and has clubbing on his fingers. His HRCT displays signet rings.
Bronchiectasis
In a patient with AF, when do you Rate control and when do you Rhythm Control…
Rate control when they’re stable - if haemodynamically unstable then rhythm control
How do you rate control in AF?
- Atenolol or Metoprolol
- Diltiazem or Verapamil (Central CCB)
- Digoxin
How do you rhythm control in AF?
- Amiodarone or Flecainide
How do you cardiovert a patient?
If unstable then cardiovert immediately
If stable then transoesophageal cardiogram to check for thrombus. If clear then cardiovert.
If it is not performed or shows a thrombus then the patient must be anticoagulated for three weeks prior with enoxaparin or dalteparin or enoxaparin (only for short term)
How do you maintain rhythm control after cardioversion?
- Flecainide
- Sotalol (watch for excessive QT prolongation)
- Amiodarone
How do you manage paroxysmal SVT?
Adenosine
- Verapamil
How do you manage Torsade’s?
If Bradycardic - atropine
- temporary Iv pacing
- MgSo4
- Isoprenaline
- Lignocaine
How do you manage premature ventricular ectopics?
- Atenolol or Metoprolol
How do you manage sustained Vent Tachy in an acute setting?
- Amiodarone
- Sotalol
- Lignocaine
What are Type B sAortic dissections?
Those involving the descending aorta - distal to the left subclavian
Surgical Vs conservative Mx for Type A dissection or Type B?
Type A - Surgical Mx - but control BP first.
Type B: Conservative - reduce blood pressure with labetalol to prevent progression. Consider endovascular repair
large volume, bounding, collapsing pulse
Patent Ductus arteriosus
Narrow pulse pressure, slow rising pulse
Aortic Stenosis
The absence of a carotid pulse in the presence of sinus tachycardia indicates that this is a ______
non-shockable rhythm
What is the mechanism of action of aspirin to achieve an antiplatelet effect?
Inhibits the production of thromboxane A2
_______ is one of the reasons for urgent Cardioversion in AF
Heart failure
ECG Changes from V1 -V4.
What infarct and what vessel does it involve?
Anteroseptal infarct - involving the Left Anterior descending
ECG changes in II, III and aVF. What infarct and what vessel does it involve?
Inferior infarct involving the Right Coronary artery
ECG changes in V4-V6, I, aVL. What infarct and what vessel does it involve?
Left anterior descending or left circumflex - Anterolateral infarct
ECG Changes in I, aVL +/- V5-V6
Lateral infarct involving the left circumflex artery
ECG changes show Tall R waves in V1-V2
Posterior infarct - Usually left circumflex artery and also right coronary
Young man, collapses at school. Ejection systolic murmur
HOCM
Tall, slender male. Capillary pulsations + volume loaded and displaced apex beat. Early diastolic murmur
Aortic regurgitation
Rheumatic fever, tapping apex beat. Mid diastolic murmur with opening snap.
Mitral Stenosis
Acyanotic premature infant with a heavy machinery murmur at left sternal border
PDA
Raised JVP with ___ waves. Pulsatile liver and pansystolic murmur?
Tricuspid regurgitation
Diastolic murmur that sounds like a “Pop” with some weakness of the left arm
Atrial Myxoma
Infant with a harsh pansystolic murmur at left sternal border
VSD
Syncope, chest pain, shortness of breath. ______ pulse pressure. Crescendo-Decrescendo Ejection systolic murmur
Aortic Stenosis
Pansystolic murmur that radiates to the axilla - related to infective endocarditis
Mitral Regurg
Down syndrome, with widely split S2 and ejection systolic murmur
ASD
Late systolic murmur with mid-systolic click. Lanky man
Mitra Valve Prolapse
Young lady + fatigue + anaemic + ejection systolic murmur that does not radiate
Flow murmur
Turner’s syndrome + Radiofemoral delay + continuous murmur over thoracic spine
Coarctation of aorta
