CVS Flashcards
ECG changes in myocardial ischaemia include….
….
hyperacute T waves - first sign but persists for few mins
ST elevation - persists for 20mins in 2 contiguous leads
- 2.5mm in men and 1.5mm in women
New onset LBBB
ST depression - posterior MI
Territory for ECG changes in V1-4?
left anterior descending
Territory for ECG changes in I, II, aVF
right coronary / (inferior aspect of heart)
Territory for ECG changes in I, V4-6, aVL?
LAD, left circumflex
anterolateral
Territory for ECG changes in I, aVL +/- V5&6
Left circumflex
changes in V1-3
posterior
posterior aspect?
Horizontal ST depression
tall, broad R waves
Upright T waves
dominant R wave in V2
ECG changes in Hypokalaemia?
U waves small/abent T waves prolonged PR interval ST depression long QT
ECG changes in LBBB?
W shaped QRS in V1
M shaped QRS in V6
ECG changes in RBBB?
M shaped QRS in V1
W shaped QRS in V6
ECG changes in Hyperkalaemia?
peaked/tall tented t waves
Loss/flattening of P waves
Broad QRS complexes
Sinusoidal wave pattern
can develop into VF
causes of prolonged PR interval?
Ischaemic heart disease digoxin toxicity hypokalaemia rheumatic fever lyme disease sarcoidosis
short PR intervals
wolff-parkinson-white syndrome (congenital acessrory conducting pathway between atria and ventricles - AVRT)
AF can degenerate to VF rapidly
ECG changes in Wolff-Parkinson White?
short PR interval
delta wave - wide QRS with slurred upstroke
left or right Axis deviation
Investigation in suspected aortic stenosis?
ECHO
- angiogram is done if symptomatic valve replacement is being considered
Investigation in suspected aortic regurg?
ECHO
Investigation in suspected mitral stenosis?
CXR - Left atrial enlargement
ECG - AF
ECHO
Investigation in suspected Mitral Regurgitation?
ECHO is diagnostic
CXR - finding cardiomegaly
ECG - broad p waves
Investigation in suspected Mitral valve Prolapse?
ECHO - usually an accidental finding
Investigation in suspected Patent ductus arteriosus?
ECHO
Investigation in suspected Rheumatic Fever?
Throat Swabs - culture Bloods - raised ASO titre, ESR and CRP ECG - prolonged PR interval CXR ECHO - valvulitis
Investigation in suspected Hypertrophic Cardiomyopathy ?
ECHO - mitral regurg, hypertrophy
ECG - LVH, non-specific ST and T wave changes, D Q waves
Investigation in suspected dilated cardiomyopathy?
ECHO, CXR
Investigation in suspected Heart Failure?
BNP levels raised , routine others done include FBC, U&Es, CRP
CXR - cardiomegaly, pulmonary oedema
ECHO - pericardial effusion, tamponade
Investigation in suspected Hypertension
Fundoscopy - papilloedema, retinal haemorrhages
Bloods - routine , good to check lipids, TFTs, U&Es, LFTs etc
Urine - Albumin-creatinine ratio and urine protein levels
ECG
Investigation in suspected LBBB?
ECG - W in V1 and M in V6
If new onset LBBB - think MI
Investigation in suspected RBBB?
ECG - M in V1 and W in V6
- usually broad complex tachycardia
Investigation in suspected atrioventricular Blocks?
ECG
1st Degree = persistent prolonged PR interval
2nd/Mobitz I = increasing PR interval till a missed beat
2nd/Mobitx II = constant PR interval followed by a missed beat
3rd Degree = No relation between p and Q waves
Investigation in suspected Atrial Fibrillation and findings?
ECG - absence of p waves, irregular rate
Scoring systems to think about in Atrial Fibrillation?
CHA2DS2VASC score = if 2 or more then offer anticoag
- if 1 - consider anticoag
ORBIT score - now used to asses bleeding risk
0-2 = low risk
3 = medium risk
4-7 = low risk
Investigation in suspected Atrial Flutter?
ECG - ‘sawtooth appearance’ - in particular in II, III, aVF
CXR, TFTs can be done to exclude other causes
Investigation in suspected Ventricular Tachycardia?
ECG - broad QRS complexes, tachycardic
Investigation in suspected Supraventricular tachycardia?
ECG - narrow complex QRS, Tachycardix, Absent and unclear p waves
Investigation in suspected Ventricular fibrillation?
ECG
Chaotic irregular deflections of varying amplitude
No identifiable P waves, QRS complexes, or T waves
Rate 150 to 500 per minute
Investigation in suspected Myocardial infarction?
ECG - ST elevation, ST/T wave changes
Troponin levels -
If patient with an suspected MI presents within 12hrs of symptoms onset what procedure can be done?
PCI - has to be done withine 2hrs (120mins) of presentation
If unable to do PCI within 2hrs - fibrinolysis
Investigation in suspected Prinzmetal/variant angina?
ECG - transient ST elevation during eps of chest pain
Investigation in suspected thrombo/phlebitis?
O/E - worm like mass, tender to palpation, firm surrounding tissue/vein and felt superficially- below skin
US - exclude concurrent DVT
potentially check D-Dimer level
Investigation in suspected Acute rheumatic fever?
Bloods - raised strep antibodies, Raised CRP/ESR
Positive Throat swabs
ECG - prolonged PR interval
Investigation in suspected Acute pericarditis?
ECG - widespread ‘saddle-shaped’ ST elevation
most specific ECG change = PR depression
All patients must have a TOE ECHO
Investigation in suspected infective Endocarditis?
Blood cultures
ECHO - checking for growth/vegetation
U&Es - check renal function
Diagnosis uses DUKE Criteria = persistent bacteraemia found on blood cultures
Investigation in suspected cardiac tamponade?
ECG - electical alternans (changing QRS amplitude with beats)
Investigation in suspected Pericardial Effusion?
ECG - small QRS voltage
CXR - water bottle sign
ECHO - movement of the heart - floating/dancing appearance
Investigation in suspected Atrial septal Defect?
ECG
ostium primum = RBBB and left axis deviation, prolonged PR
ostium secundum = RBBB and right axis deviation
Investigation in suspected Ventricular Septal Defect?
ECHO
CXR and cardiac catheterisation also considered in some cases
Investigation in suspected Coarctation of the aorta?
ECHO
Investigation in suspected Tetralogy of fallot?
CXR = boot shaped heart ECG = RVH
