CVS Emergencies

Question 1

Management of broad complex tachycardia

Answer 1

if unstable
- DC cardioversion
if stable
- amiodarone 300mg IV over 20-60 mins, then 900mg over 24 hours

Question 2

Management of narrow complex tachycardia

Answer 2

If unstable 
- DC cardioversion
If stable 
- Vasovagal manoeuvres
- adenosine 6mg -> 12mg -> 12mg (atropine on hand to counteract effect) 
- Senior help
- DC cardio version

Question 3

If torsades de pointes

Answer 3

Magnesium 2g /10 mins
stop QT prolonging drugs
Correct U&Es

Question 4

Causes of VT

Answer 4

Metabolic (hypokalaemia, hypomagnaesia)
IHD
Cocaine
Cardiomyopathy

Question 5

Causes of SVT

Answer 5

IHD
Thyrotoxicosis
Caffeine
Alcohol

Question 6

Outline three vagal maneourvees

Answer 6

• Carotid massage
• Valsalva maneouvre
• Face in cold water

Question 7

How does adenosine work?

Answer 7

When it is administered intravenously, adenosine causes transient heart block in the atrioventricular (AV) node. This is mediated via the A1 receptor, inhibiting adenylyl cyclase, reducing cAMP and so causing cell hyperpolarization by increasing outward K+ flux. It also causes endothelial-dependent relaxation of smooth muscle as is found inside the artery walls.

Question 8

How to assess left ventricular hypertrophy?

Answer 8

The most commonly used are the Sokolov-Lyon criteria (S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm).

Question 9

Causes of hypokalaemia

Answer 9

Increased loss
- Renal 
\+ diuretics
\+ RAAS 
\+ Hyperaldosteronism
- GI 
\+ D&V 
\+ Laxatives
- Skin 
\+ Burns
\+ Erythroderma

TC shift

• Alkalosis
• Insulin & glucose
• catecholamines

Decreased intake

• TPN
• Malnutrition

Question 10

Causes of hyperkalaemia

Answer 10

Renal 
- AKI
- CKD
- ACE inhibitors/Aldosterone receptor antagonists
Exogenous 
- Potassium supplementation
- Tumour lysis, crush injury
Tissue shift
- DKA
Special 
- Dehydration

Question 11

Management of hyperkalaemia

Answer 11

A-E
Calcium gluconate 10ml of 10% calcium gluconate
10 units soluble insulin diluted in 25g glucose
10-20mg nebulised salbutamol
Calcium polystyrene sultanate resin will remove from blood

Question 12

Acute heart failure w/pulmonary oedema

Answer 12

A-E 
IV furosemide 50mg by slow injection
GTN 0.5mg/hour IV
Morphine 5mg IV 
CPAP