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FACEM > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pericardial ECG stages

A

Hrs: diffuse concave STE, PR depression
Days: normalisation
Weeks: TWI
Months: normalisation 3/12 or ongoing TWI

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2
Q

Pericarditis Management

A

Ibuprofen 2/52 (viral)
Aspirin (post-MI)
Colchicine 0.5mg BD 3/12 (acute)
Colchicine 0.5mg BD 6/12 (chronic)

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3
Q

BER vs Pericarditis

A

BER:

  • ST/T <0.25
  • Precordial leads only (V1-4)
  • ECG stable (stages in pericarditis)
  • J wave in V4 in BER
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4
Q

STEMI DDX

A 
MI
Dissection
BER
Myocarditis
Vasospasm
SAH
Ventricular Aneurysm
LBBB/PPM
PE
Hyperkalaemia
Post-cardio version
Brugada
Takotsubo cardiomyopathy
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5
Q

VT ECG

A 
Extreme NW axis
QRS >160ms
AV dissociation
Capture & Fusion beats
Concordance
RSR taller left rabbit ear
Notched S wave (Josephson sign)
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6
Q

VT more likely in what patients compared to SVT

A 
Age >35 yrs 
Structural Heart Disease
IHD or MI
CCF
Cardiomyopathy
Family Hx of SADS
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7
Q

Electrical Alternans

A 
Pericardial Effusion (low voltage, tachy)
WPW
Prolonged QTc
Hypothermia
Cor pulmonale 
RHD
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8
Q

RAD DDX

A

(Think big RV causes)

Pulm HTN
RVH
COPD
Na blocking drugs
Hyperkalaemia
Sinus inversus 
Newborn
Misplaced leads
Old lateral MI
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9
Q

Pericardial Tamponade ECHO

A

Anechoic stripe around heart
RV collapse on diastole
RA & LA collapse in systole
Dilated non-collapsing IVC

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10
Q

PCI vs Thrombolysis timings

A

Onset within 1hr: PCI within 1hr
Onset 1-3 hours: PCI within 90mins
Onset 3-12 hours: on-site PCI 90mins, off-site PCI 120mins

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11
Q

Brugada Syndrome diagnosis

A

Coved STE >2mm in V1-3 w/ TWI or saddleback STE 2mm

AND

Clinical criteria:

  • hx of VF or polymorphic VT
  • family hx SADS
  • family members with same ECG
  • syncope
  • nocturnal atonal respiration
  • Inducible VT
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12
Q

Management Brugada

A

ICD

Quinidine in neonates or asymptomatic

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13
Q

Wellens dx

A

Deeply inverted or biphasic T waves V2/3
Painfree
No Q waves
Recent angina

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14
Q

Triggers for Brugada

A 
Fever
Ischaemia
Cocaine or booze
Bblockers or CCB
low K
Hypothermia
Post-DCR
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15
Q

External Pacing indications

A 
3rd degree HB
Mobitz II HB
Unstable bradycardia with medication failure
Overdrive pacing 
? Asystole
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16
Q

Describe how to externally pace

A

Resus, setup, AP pads
Consent & sedation
Connect ECG pads for sensing
Demand pacing mode >30bpm above rate
Start and increase amp until capture (add 10)
If >120mA then resite electrodes and go again
Assess capture by palpating pulse

17
Q

Reasons for PPM failure

A 
Fractured lead
PPM Malfunction
Oversensing
Lead displacement
Fibrosis at lead tip
Ischaemia
Change to underlying rhythm
18
Q

HOCM clinical features

A 
Exertional syncope
Exertional dyspnoea (pulm congestion)
Sharp rising pulse
Chest pain & palpitations
Systolic murmur
19
Q

HOCM ECG

A 
LVH
Deep dagger Q waves lateral & inferior leads
LAE 
Tachyarrythmias (WPW, AF, SVT)
Giant TWI precordial leads (apical HOCM)
20
Q

HOCM SADS RF

A 
VF or VT
Family hx SADS
Syncope
LV wall >3cm
LVOT
non-sustained VT
21
Q

HOCM murmur

A

Increases with decreased preload (valsalva, standing)

Decreased with increased preload (leg raise, hand grip, squat)

22
Q

HOCM vs AS murmur

A

HOCM opposite of preload
AS increases/decreased with preload

Increase preload: squatting, leg raise, handgrip
Decrease preload: valsalva, standing

AS: slow rising pulse, displaced apex, aortic thrill, S4 (dilated LV), splitting 2nd HS

23
Q

Murmurs:
Mid-systolic
Pan-systolic
Diastolic

A

Mid-systolic: AS, PS, HOCM, ASD

Pan-systolic: MR, TR, VSD

Diastolic: MS, TS, AR, atrial myxoma, ARf

24
Q

Sgarbossa

A

Concordance STD 2mm V1-3
Concordance STE 1mm any lead
Discordance STE 5mm any lead

25
Q

DeWinter

A

Up-sloping ST depression 1mm with peaked T waves

STE 0.5mm aVR

26
Q

Hypokalaemia ECG

A 
Peaked P wave
1st HB
Prolonged QTc
U waves
TWI or flattening
ST depression
27
Q

STEMI Fibrinolysis Dose

Tenectaplase & Alteplase

A

Tenectaplase: 0.5mg/kg (to nearest 10kg)

Alteplase:
<65kg: 15mg bolus, 0.75mg/kg 30mins, then 0.5mg/kg 60mins
>65kg: 15mg bolus, 50mg 30mins, then 35mg 60mins

28
Q

Pericarditis causes

A 
Viral (CMV, EBV, HIV, coxsackie B)
Bacterial (Staph, Strep, TB, GNB)
Parasitic (Entamoeba, toxoplasma)
Malignant (sarcoma, mesothelioma, mets)
Autoimmune (SLE, RA, Sarcoidosis, IBD)
MI (acute or desslers)
Uraemia/myxoedema 
Other: trauma, radiation, drugs (penicillin)
29
Q

Successful thrombolysis STEMI

A 
Pain resolution
STE reduced 70%
Improved haemodynamics
Accelerated idioventricular rhythm
TWI 4 hours post MI
30
Q

VT in pregnancy tx

A

DCR: safe, effective, sedation risk
Amio: sig failure to reverse, fetal thyroid disease
Lignocaine: safe, 1st Med line, increased failure than DCR
Mg: safe, better in polymorphic
Metoprolol: effective, no fetal risk, hypotension

FACEM (8 decks)

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