CASE 1 - HEART FAILURE Flashcards
List 5 DDx for a patient presenting with pink, frothy sputum
- PE
- CHF
- Lung cancer
- Tuberculosis
- Bronchiectasis
List 3 DDx for acute dyspnoea presenting at 2am
- PND
- Orthopnoea
- Sleep apnoea
TRUE OR FALSE? Most episodes of haemoptysis are non-life threatening
TRUE
List 2 chronic causes of haemoptysis
- Lung cancer
- Chronic bronchiectasis
These are the 2 most common causes of haemoptysis
TRUE OR FALSE? Haemoptysis is rare during the chronic phase of bronchitis.
TRUE
‘Streaky’ phlegm with minor amounts of blood mixed in suggests which condition?
Chronic bronchiectasis
Name 2 non-cardiac and non-pulmonary causes of dyspnoea
- Panic attack and/or anxiety disorder
- Anaphylaxis
insert clinical reasoning question
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Cardiac elevations in potassium become problematic beyond…?
5mmol/L
List the ECG / EKG changes in hyperkalemia (in ascending order)
- Tented T waves
- Loss of P waves
- Wide QRS
The SA Node fires off impulses at ___bpm?
60-100bpm
The AV Node fires off impulses at___bpm?
40-55bpm
The Purkinje fibres fire off impulses at ___bpm?
25-40bpm
The heart will beat at the rate of which pacemaker?
The heart will beat at the rate of the fastest pacemaker
Name the 2 causes of tachyarrhythmias
- Increased automaticity
2. Re-entry circuits
Give 2 examples of things that may cause the aforementioned tachyarrhythmias
- INCREASED AUTOMATICITY: myocardial ischaemia, hypokalemia, digoxin - changes the resting membrane potential of the cell and brings it closer to the threshold for depolarisation)
- RE-ENTRY CIRCUITS: e.g. AVNR, AFib, VT, VF
How does a re-entry circuit manifest?
Continuous repetitive propagation of an excitatory wave traveling in a circular path, returning to its site of origin to reactivate that site.
List 3 predisposing factors for tachyarrhythmias
IHD (e.g. acute MI) Hypertension (dilated atria) Cardiomyopathy Drugs (e.g. digoxin) Metabolic Genetic
Why is CO usually maintained in arrhythmias that start above the AV node?
For arrhythmias that start above the AV node, the ventricles are limited by the AV node because it will stop the conduction of rapid pulses above the AV node.
Therefore, CO is maintained and ventricular rate is usually <150bpm
Why is the origin of the tachyarrhythmia important?
It affects ECG appearance and treatment
What does the QRS complex look like when tachyarrhythmias occur ABOVE the AV Node?
Usually normal: ventricles are activated via the usual pathway
Describe the appearance of atrial flutter on an ECG
Multiple P waves before each QRS (saw-tooth pattern)
Narrow QRS
Describe the clinical
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Describe the ECG appearance of atrial fibrillation.
P waves usually absent
Irregular rhythm
Narrow QRS
Why are ventricular arrhythmias more lethal?
There is no delay at the AV node, so the rate isn’t being controlled by anything
How are supraventricular tachyarrhythmias treated?
- Slow AV Node conduction / RATE CONTROL –> reduces ventricular rate, e.g. beta-blockers
- Revert to sinus rhythm / RHYTHM CONTROL: (if possible) by suppressing abnormal automaticity or altering conduction, e.g. amiodarone
Describe the appearance of ventricular TACHYCARDIA on an ECG
P Wave Hidden
Broad QRS
Looks like villi or something
Describe the appearance of ventricular FIBRILLATION on an ECG
P waves absent
Broad, disorganised QRS
Looks like lazy grass drawing
5 anti-arrhythmic drugs
CLASS I: Fast (Na+ channel blockers), e.g. lignocaine, phenytoin
CLASS II: beta-blockers, e.g. metoprolol, bisoprolol
CLASS III: (K+ channel blockers), e.g. Sotalol, amiodarone
CLASS IV: Slow (Ca++ channel blockers), e.g. verapamil
CLASS V: variable mechanisms (e.g. digoxin)
How are supraventricular tachyarrhythmias treated?
- Slow AV Node conduction –> reduces the ventricular rate, e.g. beta-blocker
- Revert to sinus rhythm (if possible) by suppressing abnormal automaticity or altering conduction, e.g. amiodarone
RATE & RHYTHM CONTROL
Name 2 drugs for ventricular arrhythmias
- Amiodarone (the best one for ventricular arrhythmias - but lots of adverse events if used long-term lol, e.g. ILD)
- Sotalol
For fast VT or VF, what is the immediate treatment?
Defibrillation
For fast VT or VF, what is the treatment once sinus rhythm has been restored?
Prevent recurrence: amiodarone, sotalol
something about ventricular ectopics???
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something about ventricular ectopics???
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