CVS Flashcards
1
Q
How would you calculate the heart rate from an ECG strip?
A
Each strip is 10 seconds long
Count the amount of QRS and then multiply by 6
2
Q
What lead is normally the most positive? What would be the most positive in LBBB and RBBB respectively?
A
Lead II is normally the most positive
LBBB - Lead aVL
RBBB- Lead III
3
Q
State the normal parameters for the PR interval, the QRS interval and the QT interval
A
PR - 120-200ms
QRS - <120ms
QT - 2 large squares
4
Q
RBBB can be present without heart disease, however name three common causes of LBBB
A
Anterior MI
CHF
Left Ventricular Hypertrophy
5
Q
Describe the diagnostic features of a STEMI
A
Cardiac Chest Pain
ECG changes (persistent ST elevation or new LBBB)
Raised Troponin I (greater than 100 nanograms)
6
Q
What are the parameters for ECG changes in a STEMI?
A
ST elevation in atleast 2 leads
Elevation greater than 1mm in limb leads and 2mm in chest leads
7
Q
Describe the ECG changes in an NSTEMI
A
ST segment depression
T wave inversion
8
Q
When might an STEMI be mistaken for an NSTEMI?
A
If you have ST segment depression in V1-V4, it may be the reciprocal changes of a posterior STEMI
9
Q
Describe the pathophysiology of ACS
A
Plaque rupture
Thrombosis to varying degrees
Inflammation
Artery occlusion and reduced blood supply to myocardium
10
Q
What layer of the heart do the coronary arteries lie in?
A
Epicardium
11
Q
Describe 5 of the classical presentations of ACS
A
Central crushing chest pain lasting >20 mins Nausea Sweating Breathlessness Palpitations
12
Q
Some ACS can be ‘Silent’, what groups of people can this occur in? How would they present?
A
Elderly and Diabetics
Syncope
Epigastric Pain
13
Q
What is the S4 heart sound?
A
Blood striking against a non compliant ventricle
14
Q
What happens to Troponin I in an MI
A
Begin to rise 3-4hrs post MI
Remain elevated for up to two weeks
15
Q
When should Troponin I be sampled?
A
One sample on admission
If onset of the symptoms was less than 3 hours ago, take another sample one hour after the original
16
Q
Give 4 false positives of Troponin I
A
Advanced renal failure
Large PE
Severe CCF
Aortic Dissection
17
Q
Give 3 possible features of an MI on a CXR
A
Cardiomegaly
Pulmonary Oedema
Widened Mediastinum
18
Q
In four steps describe the initial medical management of suspected ACS
A
1) Morphine and Antiemetic (Metacloperamide)
2) Oxygen (Sats>94% or <88% if CO
3) Nitrates (GTN Spray)
4) Asparin 300mg Loading Dose
19
Q
What are the four requirements for Prasugrel in an MI?
A
Undergoing PCI
Less than 75 y/o
Weight >60kg
No prior TIA/Stroke
20
Q
Describe the approach to an MI discharge (ABCD)
A
A - Asparin 75mg, Atorvastatin 80mg, ACEI
B- Bisoprolol
C- Cardiac Rehab, Cut out smoking
D- Diet and Alcohol, ?Dyspepsia (provide PPI with Asparin), DVLA advice (able to drive after one week, if a bus/lorry driver can’t for 6 weeks)
21
Q
Describe the 4 step management of NSTEMI
A
Initial ACS management GRACE score (6 month mortality) and Heart Score (6 week mortality) Add Clopidogrel and UFH/Fondaparinux
PCI/CABG is definitive, time frame that this occurs is dependent on the level of risk derived from these scores
22
Q
What is the Grace Score?
A
Used on ACS patients to estimate their inpatient and 3 year mortality
23
Q
Describe the complications of an MI
A
Pericarditis
Cardiac Tamponade
Cardiac Arrest
24
Q
Name four STEMI mimics
A
Early repolarisation in young & fit
Pericarditis (saddle shaped)
Brugada Syndrome (Sodium Channelopathy)
Takotsubo Cardiomyopathy (temporary and brought on by stress - broken heart syndrome)
25
What is stable angina?
Chest discomfort provoked by effort/emotion and relieved by rest
26
Describe four potential symptoms of Stable Angina
Chest Pain
Throat tightness
Arm Heaviness
Exertional Breathlessness
27
What features would make Angina unlikely?
Continuous/Very prolonged pain
Unrelated to activity level
Associated with other symptoms such as dizziness/dysphagia
28
Describe two methods of functional imaging
Stress Echo
| Cardiac MRI
29
Describe four main pharmacological managements of Stable Angina
Asparin (75mg)
GTN Spray
Beta Blockers
Long term nitrates (Isosorbide Mononitrate)
30
When would you prescribe Ivabradine?
As an alternative to a Beta Blocker, for example if the patient is Hypotensive
31
When would you prescribe Ranolazine in Stable Angina?
If intolerant to all the other drugs
Commenced by consultants
eGFR>30
(reduces sodium and hence calcium - relaxes muscle)
32
Other than Stable/Unstable, describe two other types of Angina
Decubitus Angina - precipitated by lying flat
| Vasospastic Angina - spasm of coronary artery
33
How would you educate a patient in how to use GTN spray in Stable Angina?
Repeat dose after 5 minutes if required
If still persisting after 5 minutes of the second dose, call an ambulance
SE: Headache, Hypotension
34
Describe the classes of HTN in terms of clinic readings
Class 1 - 140/90
Class 2 - 160/100
Severe - 180/110
35
Describe the classes of HTN in terms of home readings
Class 1 - 135/85
| Class 2 - 150/95
36
Give 4 broad causes of Secondary HTN
Renal (Renal Artery Stenosis, PCKD)
Pregnancy
Drugs (Steroids, COCP, Cocaine)
Endocrine (Cushings, Conns)
37
What is Malignant Hypertension?
Rapid rise in blood pressure to over 200/130, leading to vascular and organ damage
Can causes bilateral retinal haemorrhages, headache, visual disturbances
38
How does Hypertension present?
Generally asymptomatic
If sweating/palpitations - Phaeochromocytoma
If muscle tetany/weakness - Hyperaldosteronism
39
Describe 5 investigations (apart from BP) necessary for HTN
```
Full range of bloods (inc cholesterol)
Urinalysis (A:Cr, Protienuria, Haematuria)
ECG
Fundoscopy
Cardiac Echo
```
40
You should aim to reduce blood pressure slowly in Hypertensive patients. What is the BP goal in treated patients?
Normal <140/90
| Diabetic <130/80
41
Describe the four step (up) management of Hypertension
```
1) Under 55 - ACEI/ARB
Over 55/AfroCaribbean - CCB
2) ACEI/ARB + CCB
3) ACEI/ARB + CCB + Thiazide
4) Measure K+
If K+>4.5 add Alpha/Beta Blocker
If K+<4.5 add Spironolactone
```
42
Describe the 3 classes of CCBs, an example of each and their actions
Dihydropyridine - acts on peripheral vasculature (eg Amlodipine, Nifedipine)
Phenylalkamine - acts on cardiac vasculature (eg Verapamil)
Benzothiazepine - acts on cardiac and peripheral vasculature (eg Diltiazem)
43
Describe the difference between a Hypertensive Emergency and a Hypertensive Urgency
Emergency - High BP with critical illness (AKI,MI, Encephalopathy)
Urgency - High BP without critical illness at the moment, often accompanied by retinal damage
44
Describe the management of a Hypertensive EMERGENCY
Reduce diastolic to 110mmHg in 3-12hrs
| Use IV Sodium Nitroprusside/Labetolol/GTN/Esmolol (acts in 30s)
45
Describe the management of a Hypertensive URGENCY
Reduce diastolic to 100mmHg in 48-72hrs
| Usually use Nifedipine AND Amlodipine for 3 days and then continue Amlodipine alone
46
Heart Failure is when cardiac output fails to meet the body's requirements. Using the mnemonic HEART MAy DIE, give some causes.
Hypertension, Embolism, Anaemia, Rheumatic fever, Thyrotoxicosis, MI, Arrhythmia, Diet, Infection, Endocarditis
47
Describe the features of SYSTOLIC Heart Failure
Inability of the heart to contract, EF<40%
| Caused by IHD/MI/Cardiomyopathies
48
Describe the features of DIASTOLIC Heart Failure
Inability of the heart to relax, EF>50% (HFpEF)
| Caused by Ventricular Hypertrophy/Tamponade
49
Right Ventricular Failure is caused by LVF or Chronic Lung Disease, give 3 features
Peripheral Oedema
Ascites
Facial Engorgement
50
State 3 causes of ACUTE Heart Failure
Infections
Anaphylaxis
PE
51
Heart Failure can be Low Output or High Output, give some causes of High Output
IE High but not high enough
| Pregnancy, Hyperthyroidism, Anaemia
52
Describe the use of BNP
BNP can be used to rule out Heart Failure if it is less than 100ng/l
Not diagnostic as BNP can be raised by anything that causes chamber stress (AF etc)
53
Using the A-E mnemonic describe the 5 features of a CXR of Heart Failure
```
A - Alveolar Oedema (Bat Wings)
B - Kerley B Lines (Interstitial Oedema)
C - Cardiomegaly
D - Dilated Veins
E - Effusions
```
54
Other than bloods and CXR, what is the gold standard for testing cardiac function?
Echocardiography
55
What is Cardiac MRI used for in the context of Heart Failure?
Better at imaging the RV
| Good at assessing scar tissue
56
Give 5 features of Heart Failure
```
Cyanosis
Low BP
Narrow Pulse Pressure
Apex Displacement
RV Heave
```
57
Describe the New York Classification of Heart Failure
I - Heart Disease present but no limitations
II - Comfortable at rest but dyspnoea in normal activities
III - Less than ordinary activity causes dyspnoea
IV - Dyspnoea at rest
58
There are many medications that can be given for Heart Failure, but what device could patients have fitted?
Cardiac Resynchronisation Therapy
Adds pacing to septal and lateral walls will reduce QRS width
Considered if signs of LBBB
Can combine with Defib device
59
State four causes of Aortic STENOSIS
Senile Calcification
Congenital (Bicuspid Valves)
CKD
Rheumatic Fever
60
Describe the triad of Aortic STENOSIS
Angina
Heart Failure
Syncope
61
Give four features of the murmur heard in Aortic STENOSIS
Ejection Systolic
Aortic Area
Radiates to carotids
Crescendo Decrescendo
62
What instances would you consider a valve replacement in Aortic Stenosis
Symptomatic
| Asymptomatic with abnormal LV function, abnormal exercise test, other cardiac surgeries
63
What valve procedure would you consider if elderly/comorbidities?
TAVI
Transcatheter Aortic Valve Insertion
via Femoral
64
Give two acute and two chronic causes of Aortic REGURGITATION
Acute - Chest Trauma, Infective Endocarditis
| Chronic - Congenital, Rheumatic Fever
65
Describe three features of Aortic REGURGITATION
Exertional Dyspnoea
Orthopnea
PND
66
Other than the murmur, describe two signs of Aortic REGURGITATION
Corrigan's Pulse - Collapsing pulse
| De Musset's Sign - Head bobbing with heartbeat
67
Describe two managements of Aortic REGURGITATION
```
Afterload reduction (ACEI/ARB)
Valve replacement
```
68
State three causes of Mitral STENOSIS
Rheumatic Fever
Congenital
Infective Endocarditis
69
Describe two ways in which Mitral STENOSIS can present
```
Pulmonary Hypertension (Dyspnoea, Haemoptysis, Malar Flush)
LA Compression (Hoarseness, Dysphagia)
```
70
Describe three features of the murmur of Aortic REGURGITATION
Early Diastolic
Left Sternal Edge
Best heard sat forward in expiration
71
Describe two features of the murmur of Mitral STENOSIS
Mid Diastolic murmur
| Best heard on expiration with patient on left
72
Describe four possible managements of Mitral STENOSIS
AF - Rate control and anticoagulate
Diuretics
Balloon Valvuloplasty
Valve Replacement
73
Describe four causes of Mitral REGURGITATION
Rheumatic Fever
Mitral Valve Prolapse (APCKD, Marfans)
IHD
Infective Endocarditis
74
Give 5 features of Mitral REGURGITATION
```
Dyspnoea
Fatigue
Palpitations
Displaced Apex
AF
```
75
State 3 features of the Mitral REGURGITATION murmur
Pan Systolic Murmur
Heard in Mitral Area
Radiates to Axilla
76
What two features indicate Infective Endocarditis unless proven otherwise
Fever
| New Murmur
77
Give 4 risk factors of Infective Endocarditis
Mitral Valve Prolapse
Prosthetic Material (not stent)
Rheumatic Heart Disease
Poor Dental Hygiene + Procedure
78
Describe four features of Infective Endocarditis
Sepsis
Cardiac Lesions - New Murmur
Immune Complex Deposition - Vasculitis, Splinter Haemorrhages
Emboli - Janeway Lesions
79
State the two most effective diagnostic methods for Infective Endocarditis
Blood Cultures - Atleast 3 from different sites over a few hours
TOE
80
Describe the criteria of MAJOR Infective Endcarditis
Positive Blood Cultures
Endocardial Involvement
Positive Echo
Valvular Regurg
81
Describe the criteria of MINOR Infective Endcarditis
```
Predisposing factors
Pyrexia
Embolic/Vasculitis Signs
Suggestive blood cultures (not meeting criteria)
Suggestive Echo
```
82
Antibiotics are given via a central line in Infective Endocarditis. Give the Empirical, Strep, Enterococci and Staph management
Empirical - Amoxicillin and Gentamicin
Strep - Benzylpenicillin and Gentamicin
Enterococci - Amoxicillin and Gentamicin
Staph - Flucloxacillin and Gentamicin
83
How would you monitor Infective Endocarditis?
Echo Weekly
ECG Twice Weekly
Bloods Twice Weekly
84
Bradycardia can be caused by SA or AV node dysfunction. Give 4 causes of SA node dysfunction
Hypothyroidism
Hypothermia
Rheumatic Fever
Haemachromatosis
85
What is Sick Sinus?
Sinus Node Fibrosis
| Presents as Tachy Brady
86
What is 1st Degree HB? How would you manage?
PR Interval >0.2 seconds (5 large squares)
| No specific treatment, just monitor
87
What is 2:1 HB? How would you manage?
AKA Wenkebach
Progressive lengthening of PR followed by drop of QRS
Can occur in young fit patients OR after MI
No specific treatment, just monitor
88
What is 2:2 HB? How would you manage?
Constant PR interval then QRS suddenly dropped
| Pacing required as can progress to complete HB
89
Complete HB occurs when there is no relationship between P and QRS. How does the ECG change depending on where the block is?
Occurring at Bundle of His - Narrow Escape Complex
| Occurring below Bundle of His - Broad Escape Complex
90
Give 3 causes of Complete HB
Digoxin toxicity
Inferior STEMI
Severe Hyperkalaemia
91
Complete HB requires urgent pacing. What medical management can you give?
Atropine - Muscarinic Antagonist
| Isoprenaline - Beta Agonist
92
What is a Junctional Rhythm
Abnormal rhythm arising from AV node
93
Give 4 causes of AF
Heart Failure
Hypertension
PE
Hypokalaemia
94
What investigations would you do for AF?
ECG - May wish to use home monitor if intermittent
| Echo - to look for any underlying structural abnormalities/prepare for cardioversion
95
How would you manage ACUTE AF (<48hrs ago)? What do you need to consider?
Give Heparin and aim to DC cardiovert
| Generally cardiovert young patients due to stroke risk (always listen for carotid bruits first)
96
What anticoagulation would you give in Chronic AF? State the two scoring systems used.
DOACs - Rivaroxiban, Apixiban, Dabigatran
Warfarin
CHADS VASc and HAS BLED
97
Describe the rate control of AF
1 - Beta Blockers
2 - CCB
3 - Amioderone
98
Describe the rhythm control of AF
Flecainide or Amioderone
| If cardioverting will require atleast 3 weeks of anticoagulation and an echo prior
99
AVRTs are Narrow Complex Tachycardias, describe their pathway
Impulse starts in AV node, travels to ventricles and then back up into atria via accessory pathway (ORTHODROMIC)
100
AVNRTs are Narrow Complex Tachycardias, describe their pathway
Re-entrant loops form within the AV node itself
101
What is diagnostic on an ECG about AVRT/AVNRTs?
No P Waves
102
Describe the managements of AVRT/AVNRT
Aim to transiently block the AVN (also helps differentiate it from AF)
1 - Vagal Manouvres
2 - IV Adenosine (6mg, then 12g, then 12mg with long flush)
103
Describe 3 side effects of Adenosine
Chest Discomfort
Transient Hypotension
Flushing
104
Describe the 2 types of VT
Monomorphic - Appearance of all beats match eachother, common post MI scarring
Polymorphic - Beat to beat variation, includes Torsades de Pointes
105
What is Torsades de Pointes? Give two causes.
A type of long QT syndrome
| Amioderone, Hypokalaemia
106
Ventricular Tachycardia can be managed medically (lidocaine), but when would you cardiovert?
If haemodynamically compromised
107
What are fusion beats?
Sinus and ventricular beats fuse
108
What are capture beats?
Normal conduction of SVT beats
| Appears normal
109
What is SVT with Aberrancy?
Aberrancy is a functional BBB with increased HR
| Won't be able to tell the different between SVT with BBB until back in sinus rhythm
110
What is Antidromic WPW?
AVRT that conducts the opposite way
Conducts down through accessory pathway and up through AV node
Delta waves form as the impulse passes through accessory pathway
Treated the same as NCT
111
What is a Cardiac Tamponade?
Accumulation of blood/fluid/pus/clots/gas resulting in reduced ventricular filling an haemodynamic compromise
112
Give 5 causes of Cardiac Tamponade
```
Malignancy
Trauma
Aortic DIssection
Infective
Drugs (Hydralazine, Isoniazid)
```
113
Give 5 presentations of Cardiac Tamponade
```
Dyspnoea
Tachycardia
Tachypnoea
Distended jugular vein
Pericardial Friction Rub
```
114
What is Pulsus Parodoxus?
Exaggeration of a normal decrease in systolic in inspiration in Cardiac Tamponade
Helps differentiate between that and Pericardial Effusion
115
Name two investigations you would do for Cardiac Tamponade. What would they show?
Bloods - CK, Troponin, Us and Es
| CXR - Water Bottle shaped heart
116
Describe three managements of Cardiac Tamponade
Pericardiocentesis
Oxygen
Leg Elevation - promotes venous return
117
How would an Ostium Secondum ASD present?
Usually asymptomatic until left to right shunt develops
Shunt becomes more exaggerated as you age due to decreased LV compliance
Onset of Dysponea/HF aged 40-60
118
How would an Ostium Primum ASD present? What are it's associations?
Usually presents in childhood
May be asymptomatic or may be fatigued, dyspnoea
Associated with Downs Syndrome and AV Valve abnormalities
119
How would ASD present on an ECG and a CXR?
RBBB with LAD (primum) or RAD (secondum)
| CXR - Atrial Enlargement, Small aortic knuckle
120
Give two complications of ASD
```
Eisenmenger Syndrome (Reversal of shunt an subsequent cyanosis)
Paradoxical Emboli
```
121
Describe some possible presentations of VSD
May present with Heart Failure in infancy, or may remain asymptomatic until later life
Signs of Pulmonary Hypertension
Murmur (Harsh pansystolic at left sternal edge with left parasternal heave)
122
VSD present normally on an ECG, how would they present on a CXR?
Small VSD - Normal
| Large VSD - Cardiomegaly, Large pulmonary arteries
123
What is Coarctation of the Aorta? Name two associations
Congenital narrowing of descening aorta usually distal to left subclavian
Associated with Bicuspid Valve and Turner's Syndrome
124
Name 5 presentations of Coarctation of the Aorta
```
Radioradial delay
Weak femoral pulse
Hypertension
Systolic murmur over left scapula
Cold feet
```
125
Name two investigations for Coarctation of the Aorta
CT/MRI Aortogram
CXR - Rib notching (blood diverts down intercostal arteries to supply lower body, causing these vessels to dilate and erode ribs)
126
Tetralogy of Fallot is the most common cyanotic heart defect, what is the embryological cause?
Abnormal separation of Truncus Arteriosus into Aorta and Pulmonary Artery
127
What are the four abnormalities in Tetralogy of Fallot
VSD
Pulmonary Stenosis
RV Hypertrophy
Overriding Aorta
128
How might Tetralogy of Fallot present?
May be asymptomatic at birth but gets more cyanotic as PA closes
May squat (increases vascular resistance to decrease the degree of shunting)
Repaired adult - exertional dyspnoea, palpitations
129
What 3 investigations could you do for suspected Tetralogy of Fallot
ECG - RV hypertrophy with RBBB
CXR - classical boot shaped heart
Echo
130
What is Dressler's Syndrome?
Late onset Pericarditis post MI
| Usually 1-6 weeks after initial MI (may be immune mediated)
131
How might Dressler's Syndrome present?
Pain - left shoulder, pleuritic, worse when lying down
Malaise
Dyspnoea
Fever
132
Describe 3 Investigations of Dressler's Syndrome
FBC - Leucocytosis
Heart Autoantibodies
ECG - ST Elevation
133
Describe the management of Dressler's Syndrome
Asparin - 750-1000mg tds for 2 weeks before tapering
| Colchicine - Improves response to NSAIDs
134
State two congenital causes of Long QT syndrome
Jervell and Lange Nielson Syndrome - sensorineural deafness
| Romano Ward
135
Describe the pathophysiology of Rheumatic Fever
Peak incidence between 5-15 y
| Triggered 2-4wks after Strep Pyogenes infecton
136
Why does Rheumatic Fever cause valvular manifestations?
Antibody to carbohydrate wall of Streptococcus cross reacts with valve tissue (antigenic mimicry)
137
What is the Jones Criteria for Rheumatic Fever?
Requires evidence of Strep Infection (titre, throat culture) +2 major symptoms OR 1 major and 2 minor
138
How do you manage Rheumatic Fever?
Bed rest until CRP has been normal for 2 weeks (this may take up to 3 months)
IV Benzylpenicillin
Penicillin V
Asparin
139
Describe three features of Salicyclate Toxicity
Tinnitus, Hyperventilation, Metabolic Acidosis
140
State three associations of Dilated Cardiomyopathy
Alcohol
Hypertension
Haemochromatosis
141
How does Dilated Cardiomyopathy present?
Same symptoms as Heart Failure
142
Define Cardiomyopathy
Myocardial disorder where the heart muscle is structurally or functionally abnormal without Coronary Artery Disease, Hypertension, Valvular, or Congenital Heart Defects
143
What is Hypertrophic Cardiomyopathy?
Autosomal Dominant genetic disorder characterised by LV Hypertrophy, impaired diastolic filling, and abnormalities of mitral valve
Most common cause of sudden cardiac death in young adults and athletes
144
How does Hypertrophic Cardiomyopathy present?
Varies between asymptomatic to profound exercise limitations, arrhythmias and sudden death
Symptoms of mitral regurg
145
What is the most common arrhtyhmia seen in Hypertrophic Cardiomyopathy?
Atrial Fibrillation
146
Describe three possible managements for Hypertrophic Cardiomyopathy
Rhythm Control (Anti Arrhythmics, Catheter Ablation)
Anticoagulation (AF risk)
ICD (Implantable Cardioverter Defibrillator)
147
What is Restrictive Cardiomyopathy?
Normal left ventricular cavity size and systolic function, but with increased myocardial stiffness
Usually idiopathic or caused by increased deposition (eg Fabry's Disease)
148
How would you manage Restricitve Cardiomyopathy?
Children - Transplant
| Adults - Heart Failure Management
149
Acute Pericarditis can be primary (idopathic) or secondary. Name four secondary causes.
Infective
Autoimmune
Drugs (Procainamide, Hydralazine, Isoniazid)
Metabolic (Uraemia, Hypothyroidism)
150
Describe the presentation of Acute Pericarditis
Chest pain WORSE on inspiration/lying flat, IMPROVED by sitting forward
May hear pericardial rub
151
What would the ECG of Acute Pericarditis?
Saddle shaped ST elevation
152
How would you manage Pericarditis?
NSAIDs/Asparin with PPIs for 1-2wks
Colcihicine for 3 months for prevention
If non resolving/autoimmune - steroids
153
Apart from dyspnoea/chest pain in Pericardial Effusion, give three other signs/symptoms
Hiccoughs (compression of phrenic nerve)
Nausea (compression of diaphragm)
Bronchial Breathing at left lung base (Ewarts Sign)
154
What is Constrictive Pericarditis?
Heart is encased in rigid pericardium, normally idiopathic or following TB/Pericarditis
155
How would Constrictive Pericarditis present?
Right heart failure with raised JVP
| Kussmaul's Sign (JVP rising paradoxically with Inspiration)
156
What would you see on XRAY of Constrictive Pericarditis?
Small heart
| Pericardial Calcification
157
Using LMNOP mnemonic, how would you manage Acute Heart Failure?
```
Loop Diuretics
Morphine
Nitrates
Oxygen
Position
```
158
Name a cause of Right Axis Deviation
Pulmonary Embolism
159
Give two points about preparing a patient for an ECG
- The skin must be clean and dry (any recent use of moisturiser will require alcohol wipe)
- If excessively hairy and unable to get a good connection (eg by parting the hairs) then the chest must be shaved
160
State the five steps to describing an ECG
1) Rhythm (Regular/Irregular)
2) Conduction Intervals (eg prolonged PR)
3) Cardiac Axis (any deviation)
4) QRS Description
5) ST segment description
161
Which Mobitz type is also called Wenkebach ?
Type 1
162
Describe the septations of the Left Bundle Branch
Divided into anterior and posterior fascicle
Anterior fascicle is normally the blocked one
163
How would blockage of the left anterior fascicle present on ECG?
LBBB and
| Left Axis Deviation
164
How would blockage of the Left Posterior Fascicle present on an ECG?
Right Axis Deviation
165
What is Bifascicular block and how would it present on an ECG?
When there is both RBBB and Left Anterior Fascicle blockage
Shows as RBBB and Left Axis Deviation
166
What is Trifascicular Block?
Blockage of both the anterior and posterior left fascicles, and the right bundle branch
AKA complete HB
167
Name three places that a supraventricular rhythm can originate
SA node
AV node
Atrial Muscle
168
How would ventricular pacing appear on an ECG?
A pacing spike prior to each QRS complex
169
How would dual chamber pacing appear on an ECG?
A pacing spike before each P wave and each QRS complex
170
Once a STEMI is confirmed, describe the management options if a PCI centre is quickly accessible.
If the onset of the STEMI was within 12 hours, and a PCI is available within 2 hours.
Give loading dose of Prasugrel (60mg) or Clopidogrel (600mg) AND UFH.
PCI
171
Once a STEMI is confirmed, describe the management options if a PCI centre is NOT quickly accessible.
Thrombolyse with Alteplase
Clopidogrel AND UFH
PCI when possible
