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ICM - OBS > CVS ECG etc > Flashcards

CVS ECG etc Flashcards

1
Q

ECG changes in myocardial ischaemia include….

A

….
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

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2
Q

Territory for ECG changes in V1-4?

A

left anterior descending

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3
Q

Territory for ECG changes in I, II, aVF

A

right coronary / (inferior aspect of heart)

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4
Q

Territory for ECG changes in I, V4-6, aVL?

A

LAD, left circumflex

anterolateral

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5
Q

Territory for ECG changes in I, aVL +/- V5&6

A

Left circumflex

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6
Q

changes in V1-3

A

posterior

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7
Q

posterior aspect?

A

Horizontal ST depression
tall, broad R waves
Upright T waves
dominant R wave in V2

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8
Q

ECG changes in Hypokalaemia?

A 
U waves 
small/abent T waves 
prolonged PR interval 
ST depression 
long QT
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9
Q

ECG changes in LBBB?

A

W shaped QRS in V1

M shaped QRS in V6

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10
Q

ECG changes in RBBB?

A

M shaped QRS in V1

W shaped QRS in V6

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11
Q

ECG changes in Hyperkalaemia?

A

peaked/tall tented t waves
Loss/flattening of P waves
Broad QRS complexes
Sinusoidal wave pattern

can develop into VF

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12
Q

causes of prolonged PR interval?

A 
Ischaemic heart disease 
digoxin toxicity 
hypokalaemia 
rheumatic fever 
lyme disease
sarcoidosis
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13
Q

short PR intervals

A

wolff-parkinson-white syndrome (congenital acessrory conducting pathway between atria and ventricles - AVRT)

AF can degenerate to VF rapidly

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14
Q

ECG changes in Wolff-Parkinson White?

A

short PR interval
delta wave - wide QRS with slurred upstroke
left or right Axis deviation

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15
Q

Investigation in suspected aortic stenosis?

A

ECHO

- angiogram is done if symptomatic valve replacement is being considered

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16
Q

Investigation in suspected aortic regurg?

A

ECHO

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17
Q

Investigation in suspected mitral stenosis?

A

CXR - Left atrial enlargement
ECG - AF
ECHO

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18
Q

Investigation in suspected Mitral Regurgitation?

A

ECHO is diagnostic
CXR - finding cardiomegaly
ECG - broad p waves

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19
Q

Investigation in suspected Mitral valve Prolapse?

A

ECHO - usually an accidental finding

20
Q

Investigation in suspected Patent ductus arteriosus?

21
Q

Investigation in suspected Rheumatic Fever?

A 
Throat Swabs - culture 
Bloods - raised ASO titre, ESR and CRP 
ECG - prolonged PR interval 
CXR
ECHO - valvulitis
22
Q

Investigation in suspected Hypertrophic Cardiomyopathy ?

A

ECHO - mitral regurg, hypertrophy

ECG - LVH, non-specific ST and T wave changes, D Q waves

23
Q

Investigation in suspected dilated cardiomyopathy?

24
Q

Investigation in suspected Heart Failure?

A

BNP levels raised , routine others done include FBC, U&Es, CRP
CXR - cardiomegaly, pulmonary oedema
ECHO - pericardial effusion, tamponade

25
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
26
Investigation in suspected LBBB?
ECG - W in V1 and M in V6 | If new onset LBBB - think MI
27
Investigation in suspected RBBB?
ECG - M in V1 and W in V6 | - usually broad complex tachycardia
28
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
29
Investigation in suspected Atrial Fibrillation and findings?
ECG - absence of p waves, irregular rate
30
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
31
Investigation in suspected Atrial Flutter?
ECG - 'sawtooth appearance' - in particular in II, III, aVF CXR, TFTs can be done to exclude other causes
32
Investigation in suspected Ventricular Tachycardia?
ECG - broad QRS complexes, tachycardic
33
Investigation in suspected Supraventricular tachycardia?
ECG - narrow complex QRS, Tachycardix, Absent and unclear p waves
34
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
35
Investigation in suspected Myocardial infarction?
ECG - ST elevation, ST/T wave changes Troponin levels -
36
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
37
Investigation in suspected Prinzmetal/variant angina?
ECG - transient ST elevation during eps of chest pain
38
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
39
Investigation in suspected Acute rheumatic fever?
Bloods - raised strep antibodies, Raised CRP/ESR Positive Throat swabs ECG - prolonged PR interval
40
Investigation in suspected Acute pericarditis?
ECG - widespread 'saddle-shaped' ST elevation and PR depression All patients must have a TOE ECHO
41
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
42
Investigation in suspected cardiac tamponade?
ECG - electical alternans (changing QRS amplitude with beats)
43
Investigation in suspected Pericardial Effusion?
ECG - small QRS voltage CXR - water bottle sign ECHO - movement of the heart - floating/dancing appearance
44
Investigation in suspected Atrial septal Defect?
ECG ostium primum = RBBB and left axis deviation, prolonged PR ostium secundum = RBBB and right axis deviation
45
Investigation in suspected Ventricular Septal Defect?
ECHO CXR and cardiac catheterisation also considered in some cases
46
Investigation in suspected Coarctation of the aorta?
ECHO
47
Investigation in suspected Tetralogy of fallot?
``` CXR = boot shaped heart ECG = RVH ```

ICM - OBS (18 decks)

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