CVS Flashcards
How would you calculate the heart rate from an ECG strip?
Each strip is 10 seconds long
Count the amount of QRS and then multiply by 6
What lead is normally the most positive? What would be the most positive in LBBB and RBBB respectively?
Lead II is normally the most positive
LBBB - Lead aVL
RBBB- Lead III
State the normal parameters for the PR interval, the QRS interval and the QT interval
PR - 120-200ms
QRS - <120ms
QT - 2 large squares
RBBB can be present without heart disease, however name three common causes of LBBB
Anterior MI
CHF
Left Ventricular Hypertrophy
Describe the diagnostic features of a STEMI
Cardiac Chest Pain
ECG changes (persistent ST elevation or new LBBB)
Raised Troponin I (greater than 100 nanograms)
What are the parameters for ECG changes in a STEMI?
ST elevation in atleast 2 leads
Elevation greater than 1mm in limb leads and 2mm in chest leads
Describe the ECG changes in an NSTEMI
ST segment depression
T wave inversion
When might an STEMI be mistaken for an NSTEMI?
If you have ST segment depression in V1-V4, it may be the reciprocal changes of a posterior STEMI
Describe the pathophysiology of ACS
Plaque rupture
Thrombosis to varying degrees
Inflammation
Artery occlusion and reduced blood supply to myocardium
What layer of the heart do the coronary arteries lie in?
Epicardium
Describe 5 of the classical presentations of ACS
Central crushing chest pain lasting >20 mins Nausea Sweating Breathlessness Palpitations
Some ACS can be ‘Silent’, what groups of people can this occur in? How would they present?
Elderly and Diabetics
Syncope
Epigastric Pain
What is the S4 heart sound?
Blood striking against a non compliant ventricle
What happens to Troponin I in an MI
Begin to rise 3-4hrs post MI
Remain elevated for up to two weeks
When should Troponin I be sampled?
One sample on admission
If onset of the symptoms was less than 3 hours ago, take another sample one hour after the original
Give 4 false positives of Troponin I
Advanced renal failure
Large PE
Severe CCF
Aortic Dissection
Give 3 possible features of an MI on a CXR
Cardiomegaly
Pulmonary Oedema
Widened Mediastinum
In four steps describe the initial medical management of suspected ACS
1) Morphine and Antiemetic (Metacloperamide)
2) Oxygen (Sats>94% or <88% if CO
3) Nitrates (GTN Spray)
4) Asparin 300mg Loading Dose
What are the four requirements for Prasugrel in an MI?
Undergoing PCI
Less than 75 y/o
Weight >60kg
No prior TIA/Stroke
Describe the approach to an MI discharge (ABCD)
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)
Describe the 4 step management of NSTEMI
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
What is the Grace Score?
Used on ACS patients to estimate their inpatient and 3 year mortality
Describe the complications of an MI
Pericarditis
Cardiac Tamponade
Cardiac Arrest
Name four STEMI mimics
Early repolarisation in young & fit
Pericarditis (saddle shaped)
Brugada Syndrome (Sodium Channelopathy)
Takotsubo Cardiomyopathy (temporary and brought on by stress - broken heart syndrome)
What is stable angina?
Chest discomfort provoked by effort/emotion and relieved by rest
Describe four potential symptoms of Stable Angina
Chest Pain
Throat tightness
Arm Heaviness
Exertional Breathlessness
What features would make Angina unlikely?
Continuous/Very prolonged pain
Unrelated to activity level
Associated with other symptoms such as dizziness/dysphagia
Describe two methods of functional imaging
Stress Echo
Cardiac MRI
Describe four main pharmacological managements of Stable Angina
Asparin (75mg)
GTN Spray
Beta Blockers
Long term nitrates (Isosorbide Mononitrate)
When would you prescribe Ivabradine?
As an alternative to a Beta Blocker, for example if the patient is Hypotensive
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)
Other than Stable/Unstable, describe two other types of Angina
Decubitus Angina - precipitated by lying flat
Vasospastic Angina - spasm of coronary artery
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
Describe the classes of HTN in terms of clinic readings
Class 1 - 140/90
Class 2 - 160/100
Severe - 180/110
Describe the classes of HTN in terms of home readings
Class 1 - 135/85
Class 2 - 150/95
Give 4 broad causes of Secondary HTN
Renal (Renal Artery Stenosis, PCKD)
Pregnancy
Drugs (Steroids, COCP, Cocaine)
Endocrine (Cushings, Conns)
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
How does Hypertension present?
Generally asymptomatic
If sweating/palpitations - Phaeochromocytoma
If muscle tetany/weakness - Hyperaldosteronism
Describe 5 investigations (apart from BP) necessary for HTN
Full range of bloods (inc cholesterol) Urinalysis (A:Cr, Protienuria, Haematuria) ECG Fundoscopy Cardiac Echo
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
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
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)
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
Describe the management of a Hypertensive EMERGENCY
Reduce diastolic to 110mmHg in 3-12hrs
Use IV Sodium Nitroprusside/Labetolol/GTN/Esmolol (acts in 30s)
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
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
Describe the features of SYSTOLIC Heart Failure
Inability of the heart to contract, EF<40%
Caused by IHD/MI/Cardiomyopathies
Describe the features of DIASTOLIC Heart Failure
Inability of the heart to relax, EF>50% (HFpEF)
Caused by Ventricular Hypertrophy/Tamponade
Right Ventricular Failure is caused by LVF or Chronic Lung Disease, give 3 features
Peripheral Oedema
Ascites
Facial Engorgement
State 3 causes of ACUTE Heart Failure
Infections
Anaphylaxis
PE
Heart Failure can be Low Output or High Output, give some causes of High Output
IE High but not high enough
Pregnancy, Hyperthyroidism, Anaemia
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)
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
Other than bloods and CXR, what is the gold standard for testing cardiac function?
Echocardiography
What is Cardiac MRI used for in the context of Heart Failure?
Better at imaging the RV
Good at assessing scar tissue
Give 5 features of Heart Failure
Cyanosis Low BP Narrow Pulse Pressure Apex Displacement RV Heave
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
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
State four causes of Aortic STENOSIS
Senile Calcification
Congenital (Bicuspid Valves)
CKD
Rheumatic Fever
Describe the triad of Aortic STENOSIS
Angina
Heart Failure
Syncope
Give four features of the murmur heard in Aortic STENOSIS
Ejection Systolic
Aortic Area
Radiates to carotids
Crescendo Decrescendo
What instances would you consider a valve replacement in Aortic Stenosis
Symptomatic
Asymptomatic with abnormal LV function, abnormal exercise test, other cardiac surgeries
What valve procedure would you consider if elderly/comorbidities?
TAVI
Transcatheter Aortic Valve Insertion
via Femoral
Give two acute and two chronic causes of Aortic REGURGITATION
Acute - Chest Trauma, Infective Endocarditis
Chronic - Congenital, Rheumatic Fever
Describe three features of Aortic REGURGITATION
Exertional Dyspnoea
Orthopnea
PND
Other than the murmur, describe two signs of Aortic REGURGITATION
Corrigan’s Pulse - Collapsing pulse
De Musset’s Sign - Head bobbing with heartbeat
Describe two managements of Aortic REGURGITATION
Afterload reduction (ACEI/ARB) Valve replacement
State three causes of Mitral STENOSIS
Rheumatic Fever
Congenital
Infective Endocarditis
Describe two ways in which Mitral STENOSIS can present
Pulmonary Hypertension (Dyspnoea, Haemoptysis, Malar Flush) LA Compression (Hoarseness, Dysphagia)
Describe three features of the murmur of Aortic REGURGITATION
Early Diastolic
Left Sternal Edge
Best heard sat forward in expiration
Describe two features of the murmur of Mitral STENOSIS
Mid Diastolic murmur
Best heard on expiration with patient on left
Describe four possible managements of Mitral STENOSIS
AF - Rate control and anticoagulate
Diuretics
Balloon Valvuloplasty
Valve Replacement
Describe four causes of Mitral REGURGITATION
Rheumatic Fever
Mitral Valve Prolapse (APCKD, Marfans)
IHD
Infective Endocarditis
Give 5 features of Mitral REGURGITATION
Dyspnoea Fatigue Palpitations Displaced Apex AF
State 3 features of the Mitral REGURGITATION murmur
Pan Systolic Murmur
Heard in Mitral Area
Radiates to Axilla
What two features indicate Infective Endocarditis unless proven otherwise
Fever
New Murmur
Give 4 risk factors of Infective Endocarditis
Mitral Valve Prolapse
Prosthetic Material (not stent)
Rheumatic Heart Disease
Poor Dental Hygiene + Procedure
Describe four features of Infective Endocarditis
Sepsis
Cardiac Lesions - New Murmur
Immune Complex Deposition - Vasculitis, Splinter Haemorrhages
Emboli - Janeway Lesions
State the two most effective diagnostic methods for Infective Endocarditis
Blood Cultures - Atleast 3 from different sites over a few hours
TOE
Describe the criteria of MAJOR Infective Endcarditis
Positive Blood Cultures
Endocardial Involvement
Positive Echo
Valvular Regurg
Describe the criteria of MINOR Infective Endcarditis
Predisposing factors Pyrexia Embolic/Vasculitis Signs Suggestive blood cultures (not meeting criteria) Suggestive Echo
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
How would you monitor Infective Endocarditis?
Echo Weekly
ECG Twice Weekly
Bloods Twice Weekly
Bradycardia can be caused by SA or AV node dysfunction. Give 4 causes of SA node dysfunction
Hypothyroidism
Hypothermia
Rheumatic Fever
Haemachromatosis
What is Sick Sinus?
Sinus Node Fibrosis
Presents as Tachy Brady
What is 1st Degree HB? How would you manage?
PR Interval >0.2 seconds (5 large squares)
No specific treatment, just monitor
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
What is 2:2 HB? How would you manage?
Constant PR interval then QRS suddenly dropped
Pacing required as can progress to complete HB
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
Give 3 causes of Complete HB
Digoxin toxicity
Inferior STEMI
Severe Hyperkalaemia
Complete HB requires urgent pacing. What medical management can you give?
Atropine - Muscarinic Antagonist
Isoprenaline - Beta Agonist
What is a Junctional Rhythm
Abnormal rhythm arising from AV node
Give 4 causes of AF
Heart Failure
Hypertension
PE
Hypokalaemia
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
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)
What anticoagulation would you give in Chronic AF? State the two scoring systems used.
DOACs - Rivaroxiban, Apixiban, Dabigatran
Warfarin
CHADS VASc and HAS BLED
Describe the rate control of AF
1 - Beta Blockers
2 - CCB
3 - Amioderone
Describe the rhythm control of AF
Flecainide or Amioderone
If cardioverting will require atleast 3 weeks of anticoagulation and an echo prior
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)
AVNRTs are Narrow Complex Tachycardias, describe their pathway
Re-entrant loops form within the AV node itself
What is diagnostic on an ECG about AVRT/AVNRTs?
No P Waves
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)
Describe 3 side effects of Adenosine
Chest Discomfort
Transient Hypotension
Flushing
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
What is Torsades de Pointes? Give two causes.
A type of long QT syndrome
Amioderone, Hypokalaemia
Ventricular Tachycardia can be managed medically (lidocaine), but when would you cardiovert?
If haemodynamically compromised
What are fusion beats?
Sinus and ventricular beats fuse
What are capture beats?
Normal conduction of SVT beats
Appears normal
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
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
What is a Cardiac Tamponade?
Accumulation of blood/fluid/pus/clots/gas resulting in reduced ventricular filling an haemodynamic compromise
Give 5 causes of Cardiac Tamponade
Malignancy Trauma Aortic DIssection Infective Drugs (Hydralazine, Isoniazid)
Give 5 presentations of Cardiac Tamponade
Dyspnoea Tachycardia Tachypnoea Distended jugular vein Pericardial Friction Rub
What is Pulsus Parodoxus?
Exaggeration of a normal decrease in systolic in inspiration in Cardiac Tamponade
Helps differentiate between that and Pericardial Effusion
Name two investigations you would do for Cardiac Tamponade. What would they show?
Bloods - CK, Troponin, Us and Es
CXR - Water Bottle shaped heart
Describe three managements of Cardiac Tamponade
Pericardiocentesis
Oxygen
Leg Elevation - promotes venous return
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
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
How would ASD present on an ECG and a CXR?
RBBB with LAD (primum) or RAD (secondum)
CXR - Atrial Enlargement, Small aortic knuckle
Give two complications of ASD
Eisenmenger Syndrome (Reversal of shunt an subsequent cyanosis) Paradoxical Emboli
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)
VSD present normally on an ECG, how would they present on a CXR?
Small VSD - Normal
Large VSD - Cardiomegaly, Large pulmonary arteries
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
Name 5 presentations of Coarctation of the Aorta
Radioradial delay Weak femoral pulse Hypertension Systolic murmur over left scapula Cold feet
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)
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
What are the four abnormalities in Tetralogy of Fallot
VSD
Pulmonary Stenosis
RV Hypertrophy
Overriding Aorta
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
What 3 investigations could you do for suspected Tetralogy of Fallot
ECG - RV hypertrophy with RBBB
CXR - classical boot shaped heart
Echo
What is Dressler’s Syndrome?
Late onset Pericarditis post MI
Usually 1-6 weeks after initial MI (may be immune mediated)
How might Dressler’s Syndrome present?
Pain - left shoulder, pleuritic, worse when lying down
Malaise
Dyspnoea
Fever
Describe 3 Investigations of Dressler’s Syndrome
FBC - Leucocytosis
Heart Autoantibodies
ECG - ST Elevation
Describe the management of Dressler’s Syndrome
Asparin - 750-1000mg tds for 2 weeks before tapering
Colchicine - Improves response to NSAIDs
State two congenital causes of Long QT syndrome
Jervell and Lange Nielson Syndrome - sensorineural deafness
Romano Ward
Describe the pathophysiology of Rheumatic Fever
Peak incidence between 5-15 y
Triggered 2-4wks after Strep Pyogenes infecton
Why does Rheumatic Fever cause valvular manifestations?
Antibody to carbohydrate wall of Streptococcus cross reacts with valve tissue (antigenic mimicry)
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
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
Describe three features of Salicyclate Toxicity
Tinnitus, Hyperventilation, Metabolic Acidosis
State three associations of Dilated Cardiomyopathy
Alcohol
Hypertension
Haemochromatosis
How does Dilated Cardiomyopathy present?
Same symptoms as Heart Failure
Define Cardiomyopathy
Myocardial disorder where the heart muscle is structurally or functionally abnormal without Coronary Artery Disease, Hypertension, Valvular, or Congenital Heart Defects
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
How does Hypertrophic Cardiomyopathy present?
Varies between asymptomatic to profound exercise limitations, arrhythmias and sudden death
Symptoms of mitral regurg
What is the most common arrhtyhmia seen in Hypertrophic Cardiomyopathy?
Atrial Fibrillation
Describe three possible managements for Hypertrophic Cardiomyopathy
Rhythm Control (Anti Arrhythmics, Catheter Ablation)
Anticoagulation (AF risk)
ICD (Implantable Cardioverter Defibrillator)
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)
How would you manage Restricitve Cardiomyopathy?
Children - Transplant
Adults - Heart Failure Management
Acute Pericarditis can be primary (idopathic) or secondary. Name four secondary causes.
Infective
Autoimmune
Drugs (Procainamide, Hydralazine, Isoniazid)
Metabolic (Uraemia, Hypothyroidism)
Describe the presentation of Acute Pericarditis
Chest pain WORSE on inspiration/lying flat, IMPROVED by sitting forward
May hear pericardial rub
What would the ECG of Acute Pericarditis?
Saddle shaped ST elevation
How would you manage Pericarditis?
NSAIDs/Asparin with PPIs for 1-2wks
Colcihicine for 3 months for prevention
If non resolving/autoimmune - steroids
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)
What is Constrictive Pericarditis?
Heart is encased in rigid pericardium, normally idiopathic or following TB/Pericarditis
How would Constrictive Pericarditis present?
Right heart failure with raised JVP
Kussmaul’s Sign (JVP rising paradoxically with Inspiration)
What would you see on XRAY of Constrictive Pericarditis?
Small heart
Pericardial Calcification
Using LMNOP mnemonic, how would you manage Acute Heart Failure?
Loop Diuretics Morphine Nitrates Oxygen Position
Name a cause of Right Axis Deviation
Pulmonary Embolism
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
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
Which Mobitz type is also called Wenkebach ?
Type 1
Describe the septations of the Left Bundle Branch
Divided into anterior and posterior fascicle
Anterior fascicle is normally the blocked one
How would blockage of the left anterior fascicle present on ECG?
LBBB and
Left Axis Deviation
How would blockage of the Left Posterior Fascicle present on an ECG?
Right Axis Deviation
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
What is Trifascicular Block?
Blockage of both the anterior and posterior left fascicles, and the right bundle branch
AKA complete HB
Name three places that a supraventricular rhythm can originate
SA node
AV node
Atrial Muscle
How would ventricular pacing appear on an ECG?
A pacing spike prior to each QRS complex
How would dual chamber pacing appear on an ECG?
A pacing spike before each P wave and each QRS complex
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
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
