CCC - Cardiology Flashcards
What investigations do you do for a MI?
- ECG
- Troponin
- Echocardiography
What do you do if the troponin is positive?
coronary angiography
What do you do if the troponin is negative?
ETT
What are the cardiac differential diagnosis of chest pain?
- IHD
- Aortic dissection: sudden onset
- Pericarditis: worse on breathing in and leaning forward
What are the respiratory differential diagnosis of chest pain?
- PE
- Pneumonia: temp recently?
- Pneumothorax: sudden onset, SOB, sharp pain, pain worse breathing in
What are GI differential diagnosis of chest pain?
- oesophageal spasm
2. oesophagitis, gastritis
What are the musculoskeletal differential diagnosis of chest pain?
costochrondritis: pain on movement
What is first line investigation for chest pain?
ECG - if ST elevation or not
If it is an anterior MI which coronary artery is affected and in which leads will there be ECG changes?
- LAD
2. V1-V4
If it is a lateral MI which coronary artery is affected and in which leads will there be ECG changes?
- circumflex
2. V5, V6, I, aVL
If it is an inferior MI which coronary artery is affected and in which leads will there be ECG changes?
- RCA
2. II, III, aVF
What does the different in BP need to be for postural hypotension?
20mmHg
If there is a FHx of sudden cardiac collapse should vasovagal be high sus?
no
What are the 3 categories for differential diagnosis of collapse?
- hypoglycaemia
- cardio
- brain
What are the different cardio reasons for collapse?
- Vasovagal
- Arrhythmia
- Outflow obstruction
- Postural hypotension
Which arrhythmia can cause collapse and how would you manage?
- tachycardia, bradycardia
2. ECG (long QT predisposes you to VT), cardiac monitor, 24hr tape
What could a left outflow obstruction lead to collapse be due to?
- HOCM
2. Aortic stenosis
What could a right outflow obstruction lead to collapse be due to?
PE - low volume/slow rising pulse, ESM (ejection systolic murmur), echocardiogram
How do you determine if postural hypotension causes collapse?
lying/standing BP
What are the brain causes of sudden collapse?
seizure
What does a long QT mean?
abnormal ventricular reporlarization
What are the congenital causes of long QT syndrome?
- mutations in K+ channels
- FH of sudden death
What are the acquired causes of long QT syndrome?
low K+/Mg2+, drugs
How do you know if it is a long QT?
red line in between QRS and T waves should have finished by red line
Which valves are affected in infective endocarditis?
right sided valves get affected (as inject into veins) and right sided murmurs are louder on inspiration
When would mitral regurgitations have a high JVP?
only with heart failure
What is tricuspid regurgitation associated with?
raised JVP and hepatomegaly
Which type of murmurs are louder on inspiration?
right
What are the differential diagnosis of a raised JVP?
- Right sided heart failure
- Tricuspid regurgitation
- Constrictive pericarditis
What is right sided heart failure caused by?
- Secondary to L heart failure (CCF)
- Caused by pulmonary HTN (secondary to PE, COPD etc) leads to
- Left parasternal heave is a sign of right ventricular hypertrophy
What is tricuspid regurgitation caused by?
- Valve leaflets
2. Right ventricle dilation
What is constrictive pericarditis caused by?
- Infection e.g. TB
- Inflammation: Connective tissue disease
- Malignancy
What are the DDx for a systolic murmur?
- aortic stenosis
- mitral regurg
- tricuspid regu
- VSD
How can you tell if the systolic murmur is aortic stenosis?
loudest is aortic area and radiates to neck - associated with slow rising pulse
How can you tell if the systolic murmur is mitral regurgitation?
loudest in apex and radiates to axilla - associated with displaced apex beat
How can you tell if the systolic murmur is tricuspid regurgitation?
loudest in tricuspid area and loudest on inspiration and associated with high JVP
How can you tell if systolic murmur is due to VSD?
systolic murmur not associated with anything - hole between two ventricles
What does SVT stand for?
supraventircular tachycardia
What are the DDx for sinus tachycardia on an ECG?
- sepsis
- hypovolemia
- endocrine (thyrotoixosis, phaemochromocytoma)
- Anxious, stressed
What are the DDx for SVT on an ECG?
re-entry cirucit: AVNRT and AVRT (after treatment would have a delta wave AVRT)
Which ECGs have absent p waves?
- SVT
2. AF
What are the differential diagnosis for Atrial Fibrillation on ECCG?
- thyrotoxicosis
- alcohol
- Heart: muscles, valve, pericardium
- Lungs: pneumonia, PE, cancer
What are the DDx for ventricular tachycardia on ECG?
- ischaemia
- electrolyte abnormality
- Long QT (congenital)
- Broad complexes
How do you treat a patient with SVT and BP of 120/80?
- vagal maneuvers
- adenosine (cardiac monitor)
- DC cardioversion if evidence of haemodynamic compromise
How do you treat a patient with acute fast AF and BP 120/80?
- Rhythm control
If onset >48hours, anticoagulate for 3-4 weeks before cardioversion - Rate control:
-beta blocker
-digoxin - Think of underlying cause
- Think of complications (anticoagulation)
What is the management of VT?
- If no haemodynamic compromise: IV amidarone
- Look for and treat underlying cause
- ICD
What is the management of pulseless VT?
defibrillate
How can you tell left ventricular hypertrophy by voltage criteria?
- Deep S waves and tall R waves
2. S in V1 + R in V5 or V6 (whichever is larger) > 7 large squares
How is ischaemia suggested on an ECG?
ST, T, Q waves
How is arrhythmia or conduction defects suggested by ECG?
- Rate, rhythm
2. PR, QRS, QT
How is ventricular strain or hypertrophy suggested by ECG?
- Axis
- R
- S
What is the S3 sound associated with?
ventricular filling
What is the S4 sounds associated with?
ventricular hypertrophy
How could you tell atrial septal defect in a heart sound?
fixed wide splitting of S2
When do you give BiPaP?
if COPD with high CO2 and low pH
When do you give CPAP?
improve oxygen
What is the management of acute heart failure?
- Sit up
- Oxygen
- Furosemide (IV)
- GTN infusion
- Treat underlying cause
When do you not give adrenaline in Vfib?
temp below 30 degrees
What is the ALS algorithim for VF/pulseless VT?
- Shock
- CPR (2min)
- Assess rhythm
- Adrenaline every 3-5min
- Amiodarone after 3 shocks
- Treat reversible causes
What is the ALS algorithm for asystole/PEA?
- CPR (2min)
- Adrenaline every 3-5min
- Correct reversible causes
What are the DDx of pleuritic chest pain?
- Pericarditis
- PE
- Pneumonia
- Pnuermothroax
- Plueral pathology
- Sub diaphragmatic pathology
