Deck 2 Flashcards
Q. Which two waves may be suggestive of a MI on an ECG?
A. STEMI – ST elevation MI: diagnosed at time of ECG
B. Non-ST-elevation MI: retrospective diagnosis made after troponin results
C. Q-wave MI: new pathological waves
D. Non-Q wave MI: no new waves
Q. What ECG results are suggestive of larger infarcts?
STEMI and ECGs suggestive of LBBB
Q. What occurs to the heart in LBBB? How does this affect an ECG?
A. In LBBB, the normal direction of septal depolarisation is reversed (becomes right to left), as the impulse spreads first to the RV via theright bundle branchand then to the LV via the septum.
B. This extends the QRS duration and eliminates normal Q waves
C. R waves are tall due to change in direction of depolarisation: left axis deviation (LAD) and notched (M shaped) because the ventricles are activated sequentially (R then L)
Q. Describe four features of cardiac chest pain
A. Unremitting
B. Usually severe but may be mild or absent
C. Occurs at rest
D. Associated with sweating, breathlessness, nausea and/or vomiting
E. One third occur in bed at night
Q. What is the initial management of an MI?
A. (999 call)
B. Take aspirin immediately
C. Pain relief – morphine
Q. Describe the hospital management of an MI?
A. Make diagnosis B. Bed rest – reperfusion C. Oxygen therapy D. Aspirin +/- P2Y12 inhibitor E. ? betablocker, antianginal therapy, urgent coronary angiography
Q. What is troponin?
A. Protein complex regulates actin:myosin contraction, it is a highly sensitive marker for cardiac muscle syndrome, however it may not represent permanent muscle damage
Q. 1. What can troponin be suggestive of?
A. Gram negative sepsis, pulmonary embolism, myocarditis, heart failure, arrhythmias, cytotoxic drugs, others
Q. What does dual antiplatelet therapy consist of?
A. P2y12 inhibitor in combination with aspirin
B. Three oral options of p2Y12 inhibitor: clopidogrel, prasugrel, ticagrelor
C. IV option – cangreol
D. Exclude serious bleed prior to administration due to bleeding risk
Q. What is the most commonly used anticoagulant? How does it work?
A. Low-molecular weight heparin (or fondaparinux)
B. Inhibits fibrin formation and platelet activation
C. Targets formation and activity of thrombin
Q. What adverse effects are associated with p2Y12 inhibitors?
A. Bleeding: epistaxis, GI bleeds, haematuria
B. Rash
C. GI disturbance
D. Dyspnoea
Q. What pain relief should be used in acute cardiac syndromes cases?
A. Opiates (but can delay absorption of PY12inhibitors)
B. Nitrates for unstable angina/coronary vasospasm (may be ineffective for MI)
Q. What is deep vein thrombosis?
A. DVT is the thrombosis of the blood in the vessels of the legs, it can cause swelling and pain but often occurs asymptomatically
B. DVT may settle completely as natural thrombosis can be dissolved by natural processes
Q. What three events may occur if a DVT extends up the deep veins?
A. Thrombus can become dislodged from the vein and lodge in the lungs – pulmonary embolism (small emboli – chest pain, hemoptysis, multiple or large – breathlessness)
B. Chronic blockage in deep veins, damage valves – long term swelling, skin problems at ankle
C. Less commonly, the emboli can also travel through the heart and back to rest of the body including the brain – paradoxical embolism – stroke
Q. What investigations could be done for DVT diagnosis?
A. D-dimer – normally excludes diagnosis (a positive D-dimer does not confirm diagnosis)
B. Ultrasound – compression test of proximal veins
Q. What is standard treatment of DVT?
A Low molecular weight heparin s/c od for 5 days (daltrparin)
B Oral warfarin INR 2-3 for 6 months
C Compression stockings
Q. Name three risk factors for DVT?
A. Surgery, immobility, leg fracture/POP, OC pill, HRT, pregnancy, long haul flights/travel (rare), inherited thrombophilia (genetic predisposition, 5% population, familia)
Q. Name 3 DVT prevention methods?
A. Mechanical: hydration, early mobilisation, compression stockings, foot pumps
B. Chemical: LMW heparin
Q. Name three symptoms and signs of PE?
A. Signs: Tachycardia, tachypneoa, pleural rub
B. Symptoms: breathlessness, pleauritic chest pain, (signs/symptoms of DVT: pain/swelling, may also have risk factors)
Q. Describe the management of a patient with suspected PE
A. Investigations: CXR, ECG, (sinus tachy), blood gases (type 1 resp failure)
B. Further investigations: D-dimer, V/Q scan, computed tomography pulmonary angiography (CTPA) with contrast
C. Treatment: ensure normal blood, LWM heparin, warfarin etc, IVC filter
Q. Name two features of pleuritic chest pain
A. Chest pain that is typically sharp and stabbing, usually made worse when breathing in/coughing
Q. What may happen due to thrombosis in the peripheral circulation?
A. Peripheral vascular disease: claudication, rest pain, gangrene
Q. Name four signs of circulatory shock
A. Skin is pale, cold, sweaty and vasoconstricted B. Pulse is weak and rapid C. Pulse pressure reduced D. Urine output reduced E. Confusion, weakness, collapse, coma
Q. Name two causes of hypovolemic shock
A. Loss of blood: acute GI bleed, trauma, peri/post operative, splenic rupture
B. Loss of fluid: dehydration, burns, pancreatitis
Q. Describe the 3 classes of haemorrhagic shock
A. Class I: 15% Blood loss, pulse < 100 bpm, BP normal, Pulse pressure normal, RR 14-20, urine output > 30ml/hr, slightly anxious
B. Class II: 15-30% Blood loss, pulse > 100bpm, BP normal, pulse pressure decreased, RR 20-30 (increased), urine output 20-30ml/hr (Reduced), midly anxious
C. Class III: 30-40% blood loss, pulse > 120bpm, BP decreased, pulse pressure decreased, RR 30-40, urine output 5015ml/hr, consusion
Q. What is the main compensatory mechanism in haemorrhagic shock?
A. Reduction in stroke volume/BP/Stroke pressure
B. Stimulates baroreceptor: increased symp leads to vasoconstriction
C. Decrease is urine output, capillary BP, increased thirst
D. BP normal until 30-40% blood loss (!) –Check capillary refill time
Q. What are the three components of the “lethal triad” underlying the concept of damage control surgery?
A. Coagulopathy, hypothermia, metabolic acidosis
B. Leading causes of death in surgical patients
C. Some surgeries must be foreshortened so patients can be warmed and so that hypothermia and acidosis can be corrected
- Q. What is septic shock? How should it be treated?
A. Sepsis is when the body develops an inflammatory response associated with infection
B. Septic shock is when sepsis is complicated by persistent hypotension unresponsive to fluid resuscitation
C. Antibiotics!
Q. Which organs are most at risk during shock?
A. Kidneys (acute tubular necrosis), Lung (ARDS), heart (MI), brain (confusion/coma)
Q. What is acute respiratory distress syndrome?
A. Diffuse injury to cells which form the alveolar barrier, surfactant dysfunction, activation of acute inflammatory response, abnormal coagulation
B. Resulting in: impaired gas exchange within lungs at level of microscopic alveoli
C. Mortality rate 20-50%
Q. Name three causes of acute respiratory distress syndrome (ARDS)
A. Extra-pulmonary: shock of any cause, head injury, drug reaction, sepsis
B. Pulmonary: pneumonia, chemical pneumonitis, smoke inhalation, near drowning
