Cardiology Flashcards
1
Q
What drug is contraindicated when on a beta blocker?
A
Verapamil and Diltiazem
2
Q
What is your drug of choice for fast AF in a patient with heart failure?
A
Digoxin
Drug of choice when there is a reduced ejection fraction, ideally PO.
3
Q
When is cardioversion indicated for fast AF?
A
Onset >48 hours or haemodynamic compromise
4
Q
What are some contraindications of warfarin?
A
- Haemorrhagic stroke
- Clinically significant bleeding
- Pregnancy
- Renal or liver impairment
5
Q
What affect do NSAIDs have on warfarin?
A
Increases the risk of bleeding
Other drugs that affect it: fluconazole and amiodarone
6
Q
What drug may exacerbate long QT syndrome?
A
Sotalol
7
Q
How do you treat long QT syndrome?
A
- Avoid QT-prolonging drugs (amiodarone, sotalol, TCA, SSRI, haloperidol, ondansetron, erythromycin, methadone, chloroquine)
- Beta-blockers
- implantable cardioverter defibrillators
8
Q
What may cause long QT syndrome?
A
Congenital deformities
Electrolyte - low calcium, potassium and magnesium
Drugs - (amiodarone, sotalol, TCA, SSRI, haloperidol, ondansetron, erythromycin, methadone, chloroquine),
9
Q
What are the four classic ECG changes in hyperkalaemia?
A
Peaked T-waves
Small or indiscernible P-waves
Wide QRS
Prolonged PR Interval (when
10
Q
On ECG what areas of the heart correspond to which leads?
A
Anterior - V2-4
Lateral - V5-6
Inferior - avF, I and II
Septal - avR, V1
11
Q
What is the difference between Mobitz Type 1 and 2?
A
Second Degree Heart Block
Type 1 - PR prolongation and QRS drop
Type 2 - PR constant, QRS drop
12
Q
What is the maximum that the AVN conducts to?
A
The AV node cannot conduct above 200bpm.
13
Q
What are the two methods of calculating HR on an ECG?
A
- Large squares between QRS complexes, divided into 300
- over 10 seconds, record number of R-waves and multiple by 6
14
Q
What is a normal QRS duration?
PR Interval?
A
QRS: 0.06-0.10s
PR:0.12-0.2s
15
Q
What is the normal range of the QRS axis?
A
-30 degrees to +90 degrees
16
Q
What are the ECG changes associated with Wolff-Parkinson White?
A
Short PR interval
Wide QRS with slurred upstroke ‘delta wave’
17
Q
What are the main ECG findings of hypercalcaemia?
A
Shortening of the QT interval.
Occurs secondary to malignancy
18
Q
What arteries supply the different parts of the heart?
A
Anterior - LAD, V1-4 Inferior - right coronary, II, III, avF Anterolateral - LAD, LC, V4-6, I, aVL Lateral - left circumflex, I, aVL, V4, V5, V6 Posterior - LC, RC, V1-2
19
Q
What is a normal PR interval?
A
0.12-0.2 (3 small squares to 5)
20
Q
What are the different types of heart block?
A
1st degree - increased PR interval, no dropped QRS
2nd degree - Mobitz 1 - PR gradually prolongs and then QRS drops
2nd degree - Mobitz 2 - fixed PR, but drops QRS every few beats
3rd degree - complete - no association between P-waves and QRS
21
Q
What is Brugada syndrome?
A
An arrythmia associated with a problem with the calcium/sodium channels.
ST elevation in V1-3, wide QRS, incomplete RBBB
22
Q
What is a saw-tooth ECG indicative of?
A
Atrial Flutter
23
Q
What ischaemic features may be seen on ECG?
A
T-wave flattening or inversion
ST-depression or elevation
Q-waves
24
Q
What ECG finding is associated with hypothermia?
A
A J-waves (osbourne wave)
25
What does S1Q3T3 refer to and what is the most common ECG finding for this condition?
PE - most common is sinus tachy
| Deep s-wave in lead 1, q-wave in lead III, inverted T-wave in lead 3
26
What long-term ECG changes signify previous ischaemia?
T-wave inversion, ST depression
27
What leads would you expect to see ECG changes in an anterolateral STEMI? Which arteries are affected?
LAD – circumflex for lateral
| V3-V4 – anterior, V5-6 – lateral
28
A fast HR and broad complex QRS indicates...?
Ventricular tachycardia
29
What are some potential causes of sinus tachycardia?
- PE
- salbutamol
- anaemia
- CO2 retention
- anxiety
- exercise
- pregnancy
- sepsis
30
What do you see on ECG in hypothermia?
- J-wave
- 1st degree HB
- bradycardia
- long QT interval
- atrial and ventricular arrythmias
31
What is your pharmacological management for postural hypotension?
Fludricortisone
32
Give the name of some drugs that cause QTc prolongation
Antipsychotics (risperidone, haloperidol, clozapine), antidepressants (tricyclics), antiarrhythmics (sotalol, amiodarone, quinidine), fluconazole, azithromycin, clarithromycin, methadone
33
What are some non-cardiac causes of chest pain?
Respiratory - PE, pneumothorax, pneumonia
MSK - costochondritis
GI - GORD, peptic ulcer
Anxiety
Gallstones, pancreatitis
34
What are the five cardiac related symptoms to enquire about?
Chest pain, syncope, dyspnoea, oedema and palpitations
35
What is the scale used to quantify breathlessness?
```
MRC Dyspnoea Scale
1 - not troubled
2 - on a hill
3 - stop
4 -stop frequently on flat
5 - interferes with ADL
```
36
What are some differentials of palpitations?
AF (hypo/hyperthyroidism)
Caffeine
MI
Anxiety
37
What organisms commonly cause bacterial endocarditis when in association with prosthetic valves?
Staph. epidermidis (coagulase negative staph)
38
Most common cause of bacterial endocarditis?
Strep viridins in non IVDU
| Staph aureus in IVDU
39
How does the gram stain influence choice of initial antibiotic in infective endocarditis?
Gram +ve cocci - Penicillins (fluclox, penicillin), macrolides (erythromycin), glycopeptides (vancomycin, gent)
Gram -ve rods - cephalosporins, penicillins with anti-beta lactamase (co-amox, piperacillin-tazobactam), gent, meropenem
40
What are the 2 major criteria in the Modified Duke's Criteria?
2 separate positive blood cultures
| Endocardium involvement
41
How do you differentiate between VT and SVT?
```
VT = broad QRS (>120ms)
SVT = narrow complex QRS (<120ms)
```
42
What is the Levine Scale?
Grading of how to describe heart murmurs
43
What are the associations with coarctation of the aorta?
Turner's Syndrome, systolic murmur, non-cyanotic, radio-femoral delay
44
What is the acute management of VT?
Synchronised cardioversion.
45
What is the first and second line treatment for fast AF?
Beta Blocker
| Digoxin or Diltiazep (CCB)
46
What are the clinical features associated with aortic regurgitation?
Early diastolic murmur, high-pitches, aortic area, radiating to 4th intercostal space, AF, LVF (pulmonary oedema), loudest on expiration,
47
What dose of adrenaline do you give in anaphylaxis in a child and adult respectively?
Child - 300mcg
Adult - 500mcg
Repeated every 5 minutes as necessary
48
What are two ectopic beats called?
Bigeminy
49
What is your management for VT?
```
Acute defibrillation (if unstable)
Pharmacological - BB, amiodarone
```
50
What is Torsades De Pointes?
A form of VT with long QT intervals. Can develop into VF, result in haemodynamic compromise or death
51
Give five causes of AF?
PE, Ischaemia (MI), Alcohol, Thyrotoxicosis, Sepsis
52
What is your acute management drug of choice for AF?
A beta-blocker, bisoprolol or metoprolol
53
What are patients usually on for chronic AF?
Beta blocker
Sometimes digoxin
Anticoagulation - rivaroxiban
54
What is Wolff-Parkinson White Syndrome?
Increased wiring around the AV node resulting in abnormal re-entry, HR200-300, short PR interval
Treat with adenosine and BB
Aberrant pathway that skips the AV nodes, bundle of kent is the muscle structure it pierces
Ablation is first line (radiofrequency, then chemical)
55
Give some causes of bradycardia?
Drugs -BB
Hypothermia, hypothyroidism
Sick sinus syndrome
Treat with PPM
56
How is acute Ventricular Fibrillation treated?
One shock followed by 2 minutes of CPR
| If original rhythm known (VF/VT) give up to 3 shocks
57
Give three causes of postural hypotension?
Hypovolaemia
Autonomic dysfunction - diabetes, parkinson's
Drugs - diuretics, antihypertensives
58
What can cause a long QT and why is this worrying?
Antipsychotics, Low K, Ca2+, Mg2+, acute MI
| Can lead to VT and Torsades de Pointes
59
What is your acute management of an NSTEMI?
Aspirin 300mg
Nitrates or morphine if chest pain
Antithrombin (fondaparinux)
2nd platelet inhibitor (ticagrelor or prasugrel)
60
What is the site of action of bendroflumethiazine?
Proximal part of the distal convoluted tubule
61
What is symptomatic bradycardia treated with?
Atropine
| If no improvement external pacing
62
A patient with uncrontrolled HTN is already on 10mg ramipril. What is the next step?
Add either a CCB or a diuretic
63
What is the PERC score?
PE rule-out critera
Includes aspects like Age>50, HR>100, SpO2 <95%, unilateral leg swelling, haemoptysis, recent surgery or trauma, previous PE/DVT, exogenous oestrogen
64
Give 4 differentials for a PE
Acute coronary syndrome
Pleuritic chest pain (pneumonia)
Anxiety
MSK
65
What clotting disorder increases your risk of PE/DVT?
Factor V Leiden
| Thrombophilia
66
What is your acute management of a severe PE and what constitutes severe?
Thrombolysis
| Haemodynamically unstable
67
How long do you treat a patient with warfarin post-PE and what is your target INR?
3 months for provoked, 6 months for unprovoked, aim INR 2-3
| Treat with LMWH until INR >2
68
What are the different base pathologies for IHD?
Embolism, stenosis, occlusion, aneurysm, thrombosis
69
What are some precipitates of angina?
Exercise, cold weather, heavy metals, stress
70
What are your medical managements in an acute NSTEMI?
```
Aspirin 300mg
Fondeparinux IV
Morphine
Nitroglycerin
Ticagrelor
```
Later - beta blocker, ACE-inhibitor, statin
71
What are some differentials for chest pain?
```
Pericarditis
PE
Infection
GORD
MSK
Anxiety
```
72
What is your acute management for a STEMI
PCI
73
What cardiac enzymes are used in investigation for chest pain?
Troponin T - repeated after 6 hours, peaks at 24 hours
| CK-MB
74
ST elevation in leads II, III and aVF and depression in leads V1-4 indicates a blockage in which artery?
Right Coronary Artery
75
What complications occur over 24 hours post MI?
1-3 days - Pericarditis, VSD
3-14 days - myocardial rupture, cardiac tamponade
2 weeks - HF
Risks of cardiogenic shock, ischaemia mitral regurgitation, supraventricular arrythmias, heart block
76
What are two acute complications of an MI?
Cardiogenic shock
| Arrythmias
77
What is hydralazine?
An antihypertensive that is used in pregnancy or severe hypertension.
Increases cyclic GMP causing smooth muscle relaxation
SE: tachycardia, palpitations, flushing, fluid retention
78
What are some side effects of ACE inhibitors?
Ramipril - dry cough, rash, anaphylactoid reaction - this is the main antihypertensive at risk of causing these
Other - hypotension, renal impairment, hyperkalaemia
79
Do antihypertensives caused hyperkalaemia?
Yes
| Potassium is normally excreted in the kidney but most antihypertensives work by retaining potassium
80
Which CCBs are chronotropic?
Verapamil
| Diltiazem
81
What are dihydropyridines, their effect and common side effects?
A type of CCB (amlodipine, nifedipine), works by reducing systolic vascular resistance and arterial pressure
SE - flushing, headache, oedema
82
What are some uses of propanolol?
Anxiety, migraine prophylaxis, thyrotoxisis, pheochomocytoma, AF
83
What types of diuretics act on which part of the kidneys?
Thiazide - distal convoluted tubule (promote sodium and water loss)
Loop - loop of Henle (furosemide)
Potassium sparing/aldosterone agonists - spironolactone
84
What are some side effects of diuretics?
```
Hypovolaemia, hypotension
Low electrolytes (all except uric acid)
Erectile dysfunction
```
85
What dose of aspirin is given and what are the indications for each?
300mg following a TIA (3 weeks) or STEMI
| 75mg secondary prevention post-stroke or MI
86
What type of anti-platelet is clopidogrel and ticagrelor?
P2Y12 antagonist
87
What are some contraindications to DOACs?
Increased risk of GI bleeds
Avoid in pregnancy
Avoid in low GFR
(Less risk of ICH than warfarin)
88
How do you monitor LMWH?
Don't require monitoring unless unfractionated heparin in which case monitor APTT
89
How long is the half-life of warfarin and how can you counteract it?
36 hours
Vitamin K or Fresh Frozen Plasma
Beriplex (Factor VIII concentrate)
90
A high-pitched, early diastolic murmur is heard, radiating to the left sternal edge. What can cause this?
Aortic regurgitation
91
What kind of valve replacements exist and what are some pros and cons of each?
Mechanical - lasts longer but requires lifelong warfarin
Tissue/bioprosthetic - lasts about 10 years, but don't require anticoagulation
Complications - bleeding, thrombosis, stroke, IE
TAVI - less invasive - trans-catheter valve replacement
92
What causes rheumatic fever?
Beta-haemolytic strep (Lancefield Group A)
93
What are the 5 major criteria of rheumatic fever?
```
Carditis
Arhtritis
Subcut Nodules
Erythema Marginatum
Sydenham Chorea
```
94
What is your management for rheumatic fever?
Benpen IV then Penicillin (or erythromycin if allergic)
Aspirin
Rest, analgesia
95
What criteria is used to determine infective endocarditis and what are some criteria?
Duke's Criteria
Major - positive blood cultures, endocardium involvement on ECHO
Minor - Fever, risk factors present, vascular/immunological signs
96
What is the most likely cause of infective endocarditis in an IVDU?
In someone with native valve disease?
Staph aureus
Strep viridans
97
A patient presents with acute, tearing chest pain - what are you differential and what are risk factors for theses?
AAA - aortic aneurysm - ruptured - can result in collapse, expansile pulsatile mass, pain can be lower epigastri region, manage with surgery or stent
Aortic dissection - tearing pain spreading to shoulder or sternum, unequal pulses in both arms, Marfans increases your risk
98
What is a low grade fever and pansystolic murmur suggestive of?
Infective endocarditis
99
What is a precipitant of ventricular tachycardia (broad QRS)?
Hypokalaemia
100
How do you manage supra-ventricular tachycardia?
Vagal manoeuvres
Adenosine
(Atropine in bradycardia, amiodarone in VT)
101
What medication is used in angina?
GTN
Beta-blocker
CCB (verapamil or diltiazem but not with a BB)
Start on aspirin + statin
102
What is the feature of a ventricular septal defect?
Pansystolic murmur
Commonly associated with congenital chromosomal disorders (Down's, Edward's, Patau's)
103
How do you treat torsades de pointes?
Magnesium sulfate
104
How might a child with Eisenmenger's syndrome present?
Right ventricular hypertrophy
Harsh, blowing pansystolic murmur
Blue tinge to lips, loss of nail fold angle
105
What is a globular heart associated with?
Atrial septal defect
106
How do you treat acute pulmonary oedema?
IV diuretics
107
What are some adverse effects of thiazide diuretics?
```
Dehydration
Postural hypotension
Hyponatraemia, hypokalaemia, hypercalcaemia
Gout
Impaired glucose tolerance
Impotence
```
Thrombocytopaenia
Agranulocytosis
Photo-sensitivity rash
Pancreatitis
108
What do you do in a major bleed for patients on warfarin?
Stop warfarin
Give IV vit K 5mg
Give prothrombin complex concentrate IV
109
What medications usually used for heart failure should be stopped during a patient's respiratory illness?
If prescribe antibiotics stop statins (macrolide antibiotics), risk of rhabdomyolysis
110
What is Takayasu's arteritis and it's typical features?
Absent radial pulse
Large vessel vasculitis - malaise, headache, unequal blood pressure in upper limbs, carotid bruit, intermittent claudication, aortic regurg
111
What is Buerger's disease and some common features of it?
```
Smoking history
Male
Young age of onset
Upper limb involvement
Pain in hands and feet, getting progressively worse, pain worse at night and on walking
Ulcer
Absent foot and hand pulses
```
112
What might suggest an MSK cause of chest pain over cardiac?
Pain worse on movement or palpation
113
What features are typical in a history of aortic dissection?
Tearing chest pain
May have a aortic regurg murmur if it splits to the artery branches
Proximal lesions are treated surgically, B (distal) are managed non-operatively
CT angiography diagnosic, widened mediastinum on X-Ray
114
What are some association for coarctation of the aorta?
Turner's
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis
115
What medications improved PROGNOSIS and not just symptoms in HF?
ACE-i
BB
Spironolactone
Hydralazine with nitrates
Diuretics - symptoms only
116
What is the first and second line treatment for heart failure management?
ACE-i + BB
Aldosterone agonist (or ARB or hydralazine with nitrate)
If still symptomatic - cardiac resynchronisation therapy or digoxin
117
What is your exception in the >55 rule to hypertension management?
Diabetics - don't used CCB, give ACE-i
118
What dose of hydrocortisone should be given in acute anaphylaxis?
100mg
119
What dose of chlorphenamine should be given in acute anaphylaxis?
10mg
120
What are some acute complications of an MI?
Mitral regurgitation (systolic murmur)
Left ventricular aneurysm, arrythmias
121
In acute onset narrow complex tachycardia in a patient who is breathless with chest pain; what is your management?
Synchronised DC cardioversion
If signs of HF, shock or MI
122
What is the difference between atropine, adenosine and amiodarone?
Atropine - used in bradycardia
Adenosine - used 2nd line SVT
Amiodarone - VT
123
How might hypertrophic obstructive cardiomyopathy present?
Exertional dyspnoea, angina
Jerky pulse
Ejection systolic murmur
Left ventricular hypertrophy, decreased compliance, decreased cardiac output
124
Give some advantages of using a DOAC over Warfarin?
Less risk of ICH, don’t have to check INR, faster-onset and faster offset
BUT High GI bleed risk, non-reversible
125
What does CHADS2VASc stand for and what is it used for?
```
Congestive Heart Failure
Hypertension
Age >75, 64-74
Diabetes
Stroke - scores 2
Vascular Disease
Sex female
```
Used to determine anticoagulation use in AF patients
Moderate or high - warfarin
126
What does HASBLED stand for and what is it used for?
```
Hypertension
Abnormal kidney or liver function
Stroke - haemorrhagic
Bleeding history
Labile INR
Elderly >65
Drugs
```
1-3 moderate risk
>3 don't anticoagulate
127
What are the different types of AF?
Paroxysmal - self-limiting, usually spontaneously terminates within 7 days, normally 48hrs)
Persistent - not self-limiting, lasts over a week
Permanent - lasts over 1 year
128
What are some risk factors or causes of AF?
```
Post-MI
Idiopathic
Age
Male
Co-morbidity
Hyperthyroidism
PIRATES
```
129
What are some risk factors or causes of AF?
```
Post-MI
Idiopathic
Age
Male
Co-morbidity
Hyperthyroidism
PIRATES
Pulmonary
Ischaemia
Rheumatic Heart
Alcohol
Thyrotoxicosis
Electrolytes
Sepsis
```
130
If a patient is experiencing symptomatic AF what should be done?
Refer to DVLA
131
What are symptoms a patient with AF might experience? (3)
Palpitations
Breathlessness
Chest pain or 'discomfort'
Stroke or TIA may be first presentation
132
What are shockable rhythms?
Pulseless VT
| VF
133
What does a thiazide diuretic act on?
Thiazide – competitively inhibits the Na K 2Cl cotransporter in the thick ascending limb of the loop of Henle
134
What are some important questions to ask in heart failure?
Sleep flat? How far can you walk? Pink frothy sputum? Cough?
135
What other cardiac enzymes exist?
AST, Lactate dehydrogenase, CK and CK-MB
136
How does aspirin act?
Suppresses the production of prostaglandins and thromboxanes by irreversible inhibition of COX (cyclooxygenases)
137
What are the reversible causes of a cardiac arrest?
```
Hypoxia
Hypovolaemia
Hyperkalaemia
Hypothermia
Thrombosis
Tension Pneumothorax
Tamponade
Toxins
```
138
What are some risks of an angiogram?
bleeding and infection, perforation or trauma to adjacent structures, risk of infection, failure to work, MI, allergy to contrast
139
What else might cause a raised troponin?
Trop can be raised in myocarditis, pericarditis, trauma to the heart, endocarditis, PE, sepsis, aortic dissection, strenuous exercise
140
What is a capture beat?
A normal beat within an arrythmia
141
What do you see in a chest x-ray of a patient with heart failure?
What is your long-term management?
```
Alveolar oedema
Kerley-B lines
Pleural effusion
Increased vasculature
Cardiomegaly
```
Stop smoking, cardiopulmonary rehab, ACEi, BB
142
What signs would you see in a HF patient?
```
S3 gallop
Hypotension - narrow pulse pressure
Wheeze/crackles
Raised JVP
Hepatomegaly
```
143
What are indications for DC cardioversion?
<90 systolic BP
HR >150bpm
Dizziness, Chest pain, SOB
144
Fibrinolysis should be offered to who…?
If primary PCI cannot be delivered within 120 minutes
Onset of symptoms >12 hours
145
What does a double cardiac shadow on XR indicate?
Enlarged left atrium
146
What is considered cardiomegaly on XR?
A cardiothoracic ratio of over 0.5. heart over half width of chest
147
What are long-term consequences of untreated AS?
Sudden death, arrythmia such as AF or VT, left heart failure, angina, right heart failure
148
What is diagnostic of orthostatic hypotension?
BP 110/90 mmHg after 3 minutes of standing
149
How does Bendroflumethiazide work?
Thiazide diuretics work on the distal convoluted tubule by blocking the Na/Cl transporter causing water and sodium pretension
150
What do you see in investigations for Hypertrophic obstructive cardiomyopathy?
Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of the mitral valve
Asymmetric LV hypertrophy, signs on ECG
151
What are some causes of pericarditis?
```
Viral infection (adenovirus)
Bacterial infection (TB)
Recent MI
Chest trauma
Cancer
SLE
```
152
What is heard in pericarditis?
Pericardial friction rub
153
What is a common complication of pericarditis and signs you would see?
Cardiac tamponade
| Raised JVP, tachy, low BP (resistant to fluid therapy)
154
What are indications for urgent synchronised DC shocks?
Syncope, MI, Heart failure, shock (hypotension, pallor, sweating, cold extremities)
155
What does acute coronary syndrome refer to?
- STEMI
- NSTEMI
- Unstable angina
156
What are some non-modifiable risk factors for acute coronary syndrome?
- increasing age
- male gender
- family history of premature heart disease
157
What are some modifiable risk factors in cardiovascular disease?
- smoking
- diabetes
- hypertension
- obesity
- physical inactivity
158
What are some non-athersclerotic causes of ACS?
- vasculitits
- cocaine (causes coronary spasms)
- congenital cardiac abnormalities
- CHD
159
Who might present atypically with a heart attack or unstable angina?
- diabetics
- women
Abdominal discomfort
Jaw pain
Altered mental state in the elderly
160
A patient presents with chest pain. There is suspected cardiac involvement - what investigations should be done?
- 12 lead ECG
- troponin (6hr and 12hr post onset of chest pain)
- blood glucose
- ECHO
- CXR
- Coronary angiography
161
What are two causes for an irregular heartbeat?
- AF
| - Ventricular ectopics
162
What conditions are associated with AF?
- hyperthyroidism
- alcohol and caffeine
- MI
- sleep apnoea
- valvular disease
163
How can you classify AF?
- Acute: episode within previous 48 hours
- Paroxysmal AF: self limiting AF lasting <7 days
- Recurrent AF: 2+ episodes
- Persistent AF: >7day duration
- Permanent AF: fails to terminate following cardioversion, relapses within 24 hours
164
What are some complications of AF?
- stroke, TIA, VTE
| - heart failure
165
What is 3rd degree heart block?
Complete dissociation between the atria and the ventricles with no communication between them
166
What are some potential causes of 3rd degree heart block?
- ischaemia or infarction
- fibrosis or sclerosis of the conducting fibres
- heart surgery
- cardiomyopathy
167
What are some typical signs of heart failure?
- tachycardia
- tachypnoea
- rales (crackles)
- pleural effusion
- raised JVP
- peripheral oedema
- hepatomegaly
168
What leads cover the area of the heart provided for by the circumflex artery?
I, aVl, V4, V5, V6
169
What leads indicate a right coronary artery infarction? What should you avoid giving in these patients and what do you give instead?
Infarction of right ventricle = inferior = II, III, aVf
| GTN spray causes dilation of the inferior heart vessels, worsening the ischaemia, give fluids instead
170
Out of atropine and amiodarone - which do you give for what?
Atropine - used in bradycardia to increase HR
| Amiodarone - used for VT
171
If a patient presents with an ECG rate 150 regular, what is it until further investigation?
Atrial flutter 2:1 block
| if occurring at 100bpm then it is 3:1 block
172
Why does atrial flutter often present at 150bpm?
The AVN cannot conduct above 150bpm
173
Where do you measure PR- interval from?
Start of the P-wave to the end of the R-wave, it should be 3-5 small squares
174
What is your secondary prevention for a STEMI?
Aspirin
Clopidogrel
Statin
175
Can p-waves be present in AF?
They may be present, but usually not
176
What is a typical presentation of angina?
- increased SOB
- heaviness in the left arm
- increased pressure sensation on the chest
- do treadmill test (cardiac stress test) to confirm
177
An ECG sign for pericarditis is...?
- global saddle-shaped ST-elevation
178
What is a possible drug cause of VT?
Antipsychotic overdose e.g. tricyclics (give sodium bicarbonate)
Management of VT: pulseless - unsynchronised shock, pulse = synchronised shock
179
What is your target blood pressure for patients under 80?
<140/90mmHg
