Cardiology Flashcards
DDx for LBBB on ECG (4)
- Hypertensive heart disease
- CAD
- Valvular heart disease
- Dilated cardiomyopathy
What is the significance of Q wave in V1 with RBBB?
Q wave in V1 in presence of RBBB, be cautious as it may be indicative of acute anterior MI in setting of RBBB
In setting of inferior STEMI on ECG, what is the clue suggesting posterior wall STEMI?
- ST depression in V2 more than 2mm
Diagnostic ECG feature of RV myocardial infarction in acute inferior STEMI
Isolated ST elevation in V1 (present in 10% of inferior STEMI).
This needs to be followed up with right sided lead and look for ST elevation in V4R
Importance of RCA
Involved in arterial supply to multiple conduction pathways (sinoatrial branch, AV node artery)
Deep T waves throughout the ECG
Consider Takotsubo cardiomyopathy
Clues indicating AVRT in SVT (such as due to WPW)
- Electrical alternans (but with normal QRS amplitudes)
2. Buried P wave just after QRS (look for in lead II)
Criteria to use Ivabradine
HFrEF with EF <35%
Sinus rhythm with rate >70
Maximum tolerated BB/ACEI +/- MRA
Criteria for CRTD
Sinus rhythm
LVEF <35%
Prolonged QRS (benefit is greater with broader QRS, LBBB morphology and prolonged PR interval)
When should you consider ICD as a primary prevention?
In ischaemic cardiomyopathy with LVEF <35%
Weak evidence exist for ICD as a primary prevention for HFrEF associated with dilated cardiomyopathy with LVEF <35% to decrease mortality
How long to withhold prasugrel/ticagrelor/clopidogrel prior to surgeriess?
Clopidogrel/Ticagrelor - 5 days
Prasugrel - 7 days
Duration of DAPT for all ACS regardless of revascularisation strategy
Generally for 12 months.
If high ischaemic risk, >1 year can be considered
If high bleeding risk, 6 months
Two contraindications for ticagrelor
Asthma/COPD
Second/Third degree AV block
In comparison of prasugrel vs clopidogrel, what were the three factors associated with more harm when using prasugrel?
Age >75 years
Low body weight
Prior cerebrovascular disease
