CV Flashcards
Explain what the different parts of an ECG represent
P wave - atrial depolarisation
QRS complex - ventricular depolarisation
T wave - ventricular repolarisation
How long does each part of the ECG last?
P-R interval - 0.12-0.2s
QRS -
Quick way of calculating heart rate from ECG
300 divided by number of big squares between each QRS
In what condition would you see absent P waves?
Atrial fibrillation
What is classed as tachyarrhythmia? and how are they further classified?
Heart rate >100bpm
Narrow or broad (QRS120ms)
Supraventricular or ventricular
4 symptoms of atrial fibrillation
Breathlessness, chest pain, palpitations, fatigue
Main risk of atrial fibrillation
Embolic stroke
Who is most at risk for AF
Elderly
What will an ECG in AF look like
Absent P waves, irregular QRS
Some causes for AF
Heart failure, ischaemic heart disease, hypertension, caffeine, MI, PE, pneumonia
Treatment for acute AF (
Cardioversion, drug cardioversion (IV amiodarone)
What score is used to measure the risk of stroke in patients with AF?
CHADS-VASc (CHA2DS2VASc) Congestive heart failure Hypertension Age >75 (2) Diabetes Stroke or TIA in past (2) Vascular disease Age 65-74 Sex
2 main goals in AF?
Rate control and anticoagulation
B-blocker/CCB first line, add digoxin, then amiodarone
What is atrial flutter
Activity 300bpm, sawtooth appearance on ECG - macro reentry around right atrium
What is cor pulmonale?
Right sided heart failure secondary to lung disease - pulmonary hypertension, COPD, fibrosis, asthma, sickle cell, PE
Signs and symptoms of cor pulmonale
Dyspnoea, fatigue, syncope, cyanosis, tachycardia
When does ischaemic heart disease occur?
Increased demand of blood supply or blood supply itself is impaired
4 symptoms of acute MI
Crushing band like chest pain may radiate to jaw/back/arm, nausea, vomiting, sweating
Treatment of an acute MI
Morphine Oxygen Nitrates Anticoagulants Beta blockers if no contraindication
5 differences between STEMI and NSTEMI
STEMI - full thickness damage, ST elevation, pathological Q waves, more elevated markers (troponin, CK-MB), PCI to treat, Thrombolysis.
NSTEMI - partial thickness damage, markers only mildly elevated, ST depression, no Q waves, T wave inversion, PCI/CABG, thrombolysis can be harmful
What should patients be prescribed on discharge?
ACEI, BB/CCB, statin
Complications of MI
(C PEAR DRoP) Cardiac arrhythmia/cardiogenic shock Pericarditis Emboli Aneurysm Rupture of ventricle Dresslers syndrome Rupture of free wall o Papillary muscle rupture
When does angina occur?
Imbalance between oxygen supply and demand
8 risk factors for angina
Hypertension, obesity, smoking, diabetes, physical inactivity, family history, stress, age
3 exacerbating factors
Excitement, cold weather, exertion, heavy meal
4 components of Tetralogy of Fallot
Pulmonary stenosis, ventricular septal defect, over riding aorta, right ventricle hypertrophy
Treatment of angina
GTN as required, aspirin, beta blockers - contraindicated in asthma and COPD, CABG/PTCA
Findings on a CXR of heart failure
Alveolar oedema Kerly B lines Cardiomegaly Dilated prominent upper lobe vessels pleural Effusion
Which classification systems are used for heart failure?
New York - symptoms
(1-asymptomatic, 2-dyspnoea on activity, 3-dyspnoea on less than normal activity, 4-dyspnoea present at rest) or Framingham for congestive cardiac failure diagnosis
5 symptoms of left sided heart failure
Dyspnoea, orthopnoea, fatigue, low exercise tolerance, nocturnal cough, wheeze, +/- pink frothy sputum, weight loss, muscle wasting
5 symptoms of right sided heart failure
Peripheral oedema, nausea, anorexia, facial engorgement, epistaxis
What is the key investigation in heart failure?
Echocardiography. Do if either ECG or BNP (b type natriuretic protein) abnormal. Can show dilated cardiomyopathy, systolic/diastolic dysfunction
Treatment for chronic heart failure
Diuretics (furosemide)
ACEI - ramipril
(if cough is a problem ARB - losartan)
Beta blockers, spiranolactone, digoxin
3 causes of aortic stenosis
Calcification, congenital bicuspid valve, rheumatic heart disease
3 symptoms of aortic stenosis
Dyspnoea, syncope, angina
Describe the murmur heard in aortic stenosis
Crescendo decrescendo ejection systolic murmur radiating to the carotid arteries
Possible complications of aortic stenosis
Arrhythmias, sudden death infective endocarditis
2 features of the pulse in aortic stenosis
Narrow pulse pressure, slow rising pulse
6 causes of aortic regurgitation
Acute - cusp rupture, connective tissue disorders (marfans), aortic dissection
Chronic - Rheumatoid arthritis, ankylosing spondylitis, syphilis
3 symptoms of aortic regurgitation
Dyspnoea, angina, heart failure
2 features of the pulse in aortic regurgitation
Waterhammer pulse, wide pulse pressure
3 complications of aortic regurgitation
Arrhythmias, heart failure, infective endocarditis
3 signs of aortic regurgitation
De Musset’s sign - head bobbing
Traube’s sign - pistol sound heard over femoral artery
Quincke’s sign - pulse felt in nail
Describe the murmur heard in aortic regurgitation
Decrescendo early diastolic murmur
How is aortic regurgitation treated?
Underlying conditions treated, heart failure treated, valve replacement is treatment of choice
Which imaging technique is used to confirm a diagnosis of valve disease?
ECHO
5 causes of mitral stenosis
Calcification, rheumatic heart disease, rheumatoid arthritis, ankylosing spondylitis, SLE
4 symptoms of mitral stenosis
Dyspnoea, palpitations if in AF, heart failure, haemoptysis
Describe the murmur heard in mitral stenosis
Mid diastolic murmur with opening snap
4 signs of mitral stenosis
Malar flush, irregularly irregular pulse if in AF, Ortner’s syndrome - hoarse voice, tapping apex beat
3 complications of mitral stenosis
Atrial fibrillation, heart failure, infective endocarditis
Treatment of mitral stenosis
Manage AF and heart failure, valve replacement
4 causes of mitral regurgitation
Rheumatic heart disease, papillary muscle rupture, infective endocarditis, prolapse
4 symptoms of mitral regurgitation
Palpitations if in AF, symptoms of infective endocarditis, heart failure
2 signs of mitral regurgitation
Irregularly irregular pulse if in AF, displaced apex beat
Describe the murmur heard in mitral regurgitation
Harsh pansystolic murmur radiating to the axilla
4 complications of mitral regurgitation
Infective endocarditis, atrial fibrillation, heart failure, pulmonary hypertension
Treatment of mitral regurgitation
Treat heart failure and atrial fibrillation, valve repair is preferred because valve replacement might damage papillary muscles
What are the two layers of the peridcardium?
Outer fibrous and inner serous
6 causes of acute pericarditis?
Viral (cocsackie A+B, herpes simples, influenza), post MI, uraemia, bacterial, tuberculosis, fungal
2 causes of chronic pericarditis
Connective tissue disease, rheumatoid arthritis
How does pericarditis present?
Sharp central chest pain, exacerbated by movement, respirating and lying down. Relieved by sitting forward. Fever and dyspnoea.
What would be seen on an ECG in a patient with pericarditis?
Saddle shaped ST elevation
How is pericarditis treated?
Cause treated if known, oral NSAIDs, aspirin, colchicine