DPD Flashcards
What are the risk factors for ischaemic heart disease?
smoking
diabetes mellitus
hypertension
hyperlipidaemia
previous episode of IHD
FHx of IHD
Differentials for chest pain
cardiac: IHD/ACS, aortic dissection, pericarditis
resp: PE, pneumonia, pneumothorax
GI: oesophageal spasm, oesophagitis, gastritis
Musculoskeletal: costochondritis
Risk factors for PE
clots in legs (DVT), previous PE, recent fracture, malignancy, recent surgery, recent immobility, oral contraceptive pill
long haul flight (immobility)
ECG pattern for left ventricular hypertrophy
deep S in V1/V2
tall R wave in V5/V6
largest S and largest R in chest leads > 45mm when added together
ECG features of ischaemia
ST change (elevation or depression)
T wave inversion (MI)
pathological Q waves (old MI)
Which leads on an ECG represent a lateral view of the heart?
I, aVL, V5, V6
what coronary artery supplies the lateral territory of the heart?
circumflex artery
what ECG leads present the anterior aspect of the heart?
V3, V4 and V2 to some extent
what coronary artery supplies the anterior territory of the heart?
LAD
what coronary artery supplies areas of the heart matching to V3, V4 and V2 (to an extent)?
Left anterior descending
what coronary artery supplies areas of the heart matching to I, aVL, V5 and V6?
circumflex artery
what ECG leads represent the septal region of the heart?
V1 and V2
What coronary artery supplies the septal region of the heart?
left anterior descending
what coronary artery supplies the region corresponding to V1 and V2 on ECG?
left anterior descending
what ECG leads correspond to the inferior aspect of the heart?
II, III and aVF
what coronary artery supplies the inferior region of the heart?
right coronary artery
what coronary artery supplies the area of the heart corresponding to II, III and AvF?
right coronary artery
differentials for collapse
hypoglycaemia
cardiac: postural hypotension,
arrhythmias, outflow obstruction [HOCM, severe AS, massive PE], vasovagal syncope
seizure
what does a long QT on ECG mean?
abnormal ventricular repolarisation which predisposes patients to ventricular tachycardias
differentials for a raised JVP
right heart failure - secondary to LHF or pulmonary HTN
tricuspid regurgitation
constrictive pericarditis (infection, CTD, malignancy)
what causes a systolic murmur?
aortic stenosis
mitral regurgitation
tricuspid regurgitation
ventricular septal defect
Causes of sinus tachycardia
sepsis
hypovolaemia
thyrotoxicosis
phaeochromocytoma
anxiety
causes of atrial fibrillation
thyrotoxicosis
ischaemic damage to heart muscle
chest infection
alcohol
pathology affecting the heart or lungs
causes of ventricular tachycardia
ischaemia electrolyte abnormality (K+, Mg+) long QT
Robert attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 125/85 mmHg.
How would you manage this patient?
he is HAEMODYNAMICALLY STABLE
- Vagal manoeuvres (e.g. carotid sinus massage)
- Adenosine (IV) x 3
- if unable to return to sinus may DC cardiovert
adenosine is CI in asthmatics
what are the 2 common types of supra-ventricular tachycardia?
AV nodal reentrant tachycardia [AVNRT]
atrioventricular reciprocating tachycardia [AVRT} - accessory pathway present
Alex attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 80/60mmHg.
How would you manage this patient?
he is haemodynamically unstable
the arrhythmia is compromising his CO.
DC cardioverstion
Jo attends GP for a health check. The GP feels her pulse and finds it to be irregularly irregular. An ECG confirms AF.
How would you manage Jo?
as don’t know onset….
Rhythm control:
anti-coagulate for 3-4 weeks if suitable candidate for cardioversion. use NOAC or warfarin
Rate control: beta blocker, digoxin
prophylaxis: CHADs VASC vs HASBLED. anti-coagulate with NOAC or warfarin e.g. riveroxaban
investigate possible underlying causes and treat
Lucy attends A&E with palpitations. Her ECG shows a ventricular tachycardia. She has a palpable radial pulse. her BP is 120/80mmHg
as she is haemodynamically stable do not shock immediately
- IV amiodarone
if pulseless VT -> start ALS and cardioversion as soon as possible
what is S3 associated with?
rapid ventricular filling
what is S4 associated with?
ventricular hypertrophy and the atria trying to contract against the stiff ventricle
Max is a 65yr old man who attends A&E with an acute deterioration of his heart failure.
How do you manage him in A&E?
- sit him up
- oxygen if saturations are low
- GTN infusion (venodilates reducing preload)
- diaMorphine (venodilates)
- Furosemide IV - diuretic and venodilates
treat any underlying cause e.g. infection
What are ECG features of pericarditis?
saddle-shaped ST elevation across all leads or most of them (not belonging to a specific heart territory)
differentials of pleuritic chest pain
5 Ps
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
sub-diaphragmatic pathology may cause it too e.g. hepatic abscess
Max has been admitted after an acute episode of heart failure. How will you manage his heart failure in the long term?
- ACEi -> prevent cardiac remodelling
- beta-blocker - reduce work
- spironolactone - prevents chronic RAAS activity
- diuretic (furosemide)
- digoxin
ABDDS
differentials for breathlessness
seconds: pneumothorax, PE, foreign body
mins/hours: airway inflammation/obstruction, chest infection, acute heart failure
days/weeks: interstitial lung disease, malignancy, large pleural effusion, neuromuscular, anaemia, thyrotoxicosis, any of the above as chronic process
what is the management of a PE?
give LMWH
start warfarin
continue LMWH until INR within therapeutic levels.
If the FEV1/FVC ratio is > 70% what sort of lung disease might a patient have?
restrictive
If the FEV1/FVC ratio is < 70% what sort of lung disease might a patient have?
obstructive
what might cause interstitial/alveolar shadowing on a CXR ?
fluid - pulmonary oedema
pus - pneumonia
blood - pulmonary haemorrhage
what can cause reticulo-nodular shadowing on a CXR?
lung fibrosis
what can cause a homogenous shadow on a CXR?
pleural effusion
lung or lobar collapse