Cardiovascular & ECGs Flashcards
Example Exam Question: The following table represents a 12 lead ECG. Match each lead to the view of the heart it represents. Lead I and aVR are completed for you. (10 marks)
Example Exam Questions: List the possible causes for the presentation of sinus bradycardia on an ECG. (10 marks)
- Cardiac diseases eg. Myocardial Infarctions, Cardiomyopathies
- Medications eg. Digoxin, Beta Blockers,
- Poisons/Toxins eg. Organophosphates
- Obstructive jaundice
- Raised intracranial pressure
- Sick sinus syndrome Hypothermia
- Hypothyroidism
- Hypoxia
- Electrolyte Disturbance eg. Hyperkalaemia
- Other Physiological Causes eg. Athletes, Vagal Stimuli
Example Exam Question: You are called to attend a 59 year old male complaining of central chest pain and difficulty in breathing. On arrival the patient is GCS 15 and tells you that he has been feeling nauseous since coming home from work an hour ago. The pain started when he got home while he was at rest and he describes the pain as a crushing sensation that radiates into his jaw and left arm. You obtain the following ECG (see photo) as well as the vital signs.
Respiratory Rate = 20, Oxygen Saturations = 95%, Pulse rate = 64, Blood Pressure 137/80, Blood Glucose = 6.6, Temperature of 36.5, pain score =8/10.
Diagnose the ECG and discuss your management of this patient as per the UK Ambulance Service Clinical Practice Guidelines 2019. (20 marks)
- Sinus Rhythm Global ST depression leads – II, III, aVF, V2-V6
- Isolated ST elevation – aVL
- ?LMCA occlusion/NSTEMI/Unstable Angina/Posterior Myocardial Infarction.
- Consent & capacity
- DR©ABCDE
- Oxygen if Sp02 <94%
- Record a posterior ECG
- Asprin Clopidogrel – If Posterior STEMI confirmed GTN
- Entonox/Penthrox
- IV/IO Morphine
- IV/IO Ondansetron
- Priority/Blue call/rapid transfer to ED
- PPCI/Cath lab if posterior ECG shows a STEMI
Example Exam Question: . Match the type of heart block with the characteristics provided in the table below.
Example Exam Question: You have been called to a 45 year old male complaining of central chest pain. On arrival he appears breathless and clammy. A thorough investigation of this patient’s history reveals that the patient has central chest pain radiating into his left arm which has gradually increased over the last 20 minutes. (pain score is now 7/10).
a) Identify 10 possible causes of this patient’s condition.
- Angina
- Myocardial infarction
- Chest infection
- Indigestion
- Pleurisy
- Pulmonary Embolism
- Asthma
- Anaphylaxis
- Aortic aneurysm
- Hyperventilation.
Example Exam Question: You have been called to a 67 year old male complaining of chest pain. On arrival he appears breathless clammy and grey. Your initial history taking reveals that the patient was shovelling some sand and developed a sudden onset of central chest pain radiating into his left arm, which was enough to stop him working, the pain has remained constant over the last 15 minutes. (Pain score is now 7/10).
You assist the patient into the back of the ambulance and make him comfortable; you perform a 12 lead ECG on the patient.
a) Interpret the ECG using the 10 rules (You can look at the 10 ECG rules). (20 marks)
b) What is your diagnosis?
a)
- All waves are predominantly negative in lead AVR – Yes
- The ST segment starts isoelectric except in V1 & V2 – ST segment elevated in leads V1, V2, V3, and depression in leads 11, 111, aVF, V5 and V6
- The PR interval should be 120-200msec – 182 secs
- The QRS complex should not exceed 120 msec (3 small squares)- It does not
- The QRS and T waves tend to have the same general direction in standard leads (1, 11 ,111, aVR ,aVL, aVF) – QRS & T waves are positive in leads 1,11 and aVL, and negative in leads aVR, 111 and aVF.
- The R wave in the precordial leads grows V1 to at least V4 – No R wave progression
- The QRS is mainly upright in 1 & 11 – Yes
- The P wave is upright in 1, 11, & V2 – V6 – V2 is difficult to determine P wave upright leads V3 – V6
- There is no Q wave or only a small q <0.04(1 small square in width in 1, 11 & V2- V6 – Deep Q wave in lead V2
- The T wave is upright in 1, 11 & V2 – V6 – All upright
b) Anterior Myocardial Infarction
Example Exam Question: You have been called to a 67 year old male complaining of chest pain. On arrival he appears breathless clammy and grey. Your initial history taking reveals that the patient was shovelling some sand and developed a sudden onset of central chest pain radiating into his left arm, which was enough to stop him working, the pain has remained constant over the last 15 minutes. (Pain score is now 7/10). He has an anterior myocardial infarction.
c) Discuss your assessment and management of this patient including clinical interventions, drugs and clinical pathways you have available to you as a Paramedic. (5 marks)
- Privacy & dignity
- Reassurance
- Consent
- History including PMH/DH & Allergies
- Patient position
- Clopidigrol
- Morphine
- GTN 400-800 mcg I
- V access 300mg
- Aspirin
- Anti-emetic
- Saline Flush
- PCi Pathway/ Thrombolyisis
- Entonox
Example Exam Question: Compile a list of the therapeutic interventions provided by a paramedic for the management of a patient suffering a myocardial infarction. (8 marks)
- Oxygen if Sp02 under 94%
- Aspirin
- Clopidogrel/Ticagrelor/Thrombolysis
- GTN
- Entonox/Penthrox
- IV/IO Paracetamol
- IV/IO Morphine Ondansetron
Example Exam Question: a) Interpret the ECG (see below) using the 10 rules of a normal ECG (You can use the 10 rules). (10 marks)
b) What is your diagnosis? (4 marks)
a)
- Yes
- V1 = 1mm st elevation V2 = Isolectric
- No
- Widened QRS in V1 to V3
- Yes
- No
- Yes
- No
- Yes
- No
b)
- Sinus Rhythm
- Inferior STEMI
- Right Bundle Branch Block
- 3 rd degree AV heart block
Example Exam Question: List the types of regular narrow complex tachycardias that originate in the Atria. (5 marks)
- Sinus Tachycardia
- Atrial Tachycardia
- Atrial Flutter
- Atrioventricular Nodal Re-entrant Tachycardia
- Atrioventricular Re-entrant Tachycardia
Example Exam Question: Elaborate on the reasons not to give Glyceryl Trinitrate to a patient? (10 marks)
- Hypotension
- Hypovolaemia
- Head Trauma
- Cerebral Haemorrhage
- Patient who have taken sildenafil (Viagra) in the past 24 hours
