Cardiology ICM Flashcards
Besides bloods and initial ECG, what is the first line investigation for palpitations?
Holter Monitor
Name 3 components of a blood test that you want to check for palpitations
FBC
TFT - Thyrotoxicosis
U&E - low potassium
How does left ventricular hypertrophy present on an ECG and what PMHx would you be interested in as a cause?
R-waves (V5-6)
S waves (V1-V2)
ST elevation
HTN
What type of patient is it normal to find a Mobitz type 1 heart block?
A - Athlete
B - Construction worker
C - Obese
Athlete
Due to increased vagal tone
How would you manage an athlete with a mobitz type 1 heart block?
Discharge and monitor with ECG in primary care
What condition normally causes tall R waves in V1 & V2? A - RBBB B - Right ventricular hypertrophy C - Posterior MI D - Anterior MI
Posterior MI
What findings on an ECG would make you think of right ventricular hypertrophy?
A - Dominant R waves in V1
B - Dominant waves in V1 & Dominant S waves in V 6
C - Right Axis deviation
D - All of the above
D
How does hypokalaemia present on an ECG?
Prolong PR interval Small/absent T waves Long QT ST depression U waves
What would you see on an ECG for Wolff-Parkinson White syndome?
Delta waves
What would you see in RBBB?
A - W in V1 and M in V6
B - M in Vt and W in V 6
B
What % of occlusion does widespread ST elevation show?
A - 75%
B - 100%
B
What would you see on an ECG that shows hypokalaemia?
A - Delta waves
B - J waves
C - U waves
C - U waves
What can increase BNP? (2 marks)
Heart failure
CKD
What 3 medications can falsely lower BNP levels?
ACEi
B-blockers
Diuretics
What would you do if you suspected HF in a patient who has previously not had an MI?
A - BNP
B - Urgent referral, ECHO and assessment
A
Name 4 other causes of increased BNP levels apart from heart failure
LVH
AF
PE
Diabetes
In what two groups of people would you see naturally raised BNP?
Women
> 70
What does a posterior STEMI cause on an ECG?
A - ST Depression
B - ST Elevation
A
If you have an infarct in the RCA, what complication would a patient suffer from?
A - Left ventricular wall thrombus,
B - RBBB
C- Ventricular septal efect
D - 1st degree AV block
D - RCA supplies the AV node
What complication can happen from occlusion of the left anterior descending artery that supplies the majority of the left ventricle?
Left ventricular thrombus
Where are you more likely to find RBBB?
A LAD
B RCA
A - anterior MI lead to heart block below the level of the AV node
A patient has new LBBB on her ECG alongside SOB and fatigue. What next investigation should you do and what condition are you thinking about?
Troponin
ACS
What condition are J waves associated with on an ECG if severe?
Hypercalcaemia
After examination and ECG, what would be the next best step in investigation of someone presenting with typical/atypical angina and non-cardiac chest pain but positive changes on an ECG?
Contrast CT coronary angiogram
