DPD Amir Sam 1 Flashcards
Cardio
60M
Tight chest pain 2hrs
Nausea and sweating
Hx HTN, on amlodipene
What are your cardio differentials?
Ischaemic heart disease
Aortic dissection
Pericarditis
60M
Tight chest pain 2hrs
Nausea and sweating
Hx HTN, on amlodipene
What is the most appropriate investigation?
ECG
What are you looking for in an ECG of a Pt with chest pain?
STEMI/NSTEMI
What investigation would you do after the ECG of a Pt with chest pain?
Troponin levels
What investigation would you do if the troponin levels were positive?
Angiography
What investigation would you do if the troponin levels were negative?
ETT
What investigation would you do after the troponins of a Pt with chest pain?
Echocardiogram
What would the echo show in a Pt with an MI?
Regional wall motion abnormality (RWMA)
What would you do in a Pt with a STEMI?
Percutaneous coronary intervention
What would you do in a Pt with a NSTEMI?
Aspirin, clopidogrel, LMWH etc
How would a Pt present with aortic dissection?
Tearing pain, radiating to the back
What would you note on examination of a Pt with aortic dissection?
Aortic regurgitation
Radio-radial relay
Difference in BP in right and left upper limbs
How would a Pt present with pericarditis?
Pleuritic pain
Worse on inspiration
Relieved when leaning forwards
Flu-like symptoms
How would you treat a Pt with pericarditis?
Give NSAIDs
Why could a Pt w/ a brain tumour on high dose dexamethasone to reduce inflammation around the lesion present with chest pain?
Dexamethasone- steroid
Steroid- immunosuppressant
Immunosuppressed- susceptible to candidiasis
An occlusion of the LAD coronary artery would lead to what type of MI?
Anterior MI
An occlusion of the circumflex coronary artery would lead to what type of MI?
Lateral MI
An occlusion of the right coronary artery would lead to what type of MI?
Inferior MI
Where would you expect to see ST elevation in an anterior MI?
V1-V4
Where would you expect to see ST elevation in a lateral MI?
V5-6, I, aVL
Where would you expect to see ST elevation in an inferior MI?
II, III, aVF
What do you ask a Pt/witness seeing someone collapse?
What happened before?
What happened during?
What happened after?
What can happen before the collapse and what does it signify?
Aura- likely seizure
Nothing- likely cardiovascular involvement
What can happen during the collapse and what does it signify?
Tongue biting/incontinence- likely seizure
What are the causes of collapse?
Hypoglycaemia Vasovagal syncope Outflow obstruction Arrhythmia Postural hypotension Seizure
What are the types of left/right sided outflow obstructions?
L- aortic stenosis, HOCM
R- pulmonary embolus
What would you request for in a Pt suspected of postural hypotension?
Standing and lying BP
What would you request for in a Pt suspected of an arrhythmia?
ECG
Cardiac monitor bed
24hr tape
What are the causes of a long QT?
Congenital- K+ channel mutation
[Pts may recall a FHx of sudden death]
Acquired- low K+/Mg++; drugs
45M fever and malaise Known IVDU Raised JVP to ear Pan-systolic murmur Louder on inspiration Hepatomegaly Diagnosis?
Tricuspid regurgitation
IVDU- infective endocarditis
V raised JVP
PSM -> RILE
Louder on inspiration therefore right-sided
What are the causes of a raised JVP?
Right sided HF
Tricuspid regurgitation
Constrictive pericarditis
What are the causes of RHF?
2" to LHF (CCF) Pulmonary hypertension (PE, COPD etc)
What are the causes of tricuspid regurgitation?
Valve leaflet damage (endocarditis)
Right ventricular dilation
What are the causes of constrictive pericarditis?
Infection (eg. TB)
Inflammation (eg. connective tissue disorder)
Malignancy
What are the causes of a systolic murmur?
AS MR TR VSD
What are the characteristics of an aortic stenosis?
2nd intercostal @ R sternal border
Radiates to carotids
Slow rising pulse
What are the characteristics of a mitral regurgitation?
5th intercostal L mid-clavicular
Radiates to axilla
What are the characteristics of a tricuspid regurgitation?
5th intercostal @ L sternal border
V high JVP
What type of murmur will you hear in someone with a VSD?
Pan-systolic murmur
What are the types of tachycardia?
Sinus
Supraventricular
AF
Ventricular
What are the causes of a sinus tachycardia?
Sepsis
Hypovolaemia
Endocrine (thyrotoxicosis, phaeo)
What are the causes of a supraventricular tachycardia?
Re-entry circuit
Via accessory pathway
What are the causes of AF?
Thyrotoxicosis Alcohol Pericarditis (peri) Muscle (myo) Valvular (endo) Pneumonia/PE/cancer
What are the causes of a ventricular tachycardia?
Ischaemia
Electrolyte imbalance
Long QT syndrome
What could you see on an ECG of a Pt with AVRT?
Delta wave (WPW syndrome)
How would you treat a patient in SVT?
Valsalva/carotid massage (vasovagal manouvre)
Adenosine
IV amiodarone if haemodynamically stable
DC cardioversion if not HDS (drop in BP)
What two types of medication should you give a Pt with AF?
Rate controlling
Rhythm controlling
Why would you give anticoagulants for 3-4 weeks before cardioverting in a Pt with an onset of AF >48hrs?
Risk of thromboembolus
What rate controlling drugs could you give a Pt with AF?
Beta blocker
Digoxin
What would you see in a Pt with LVH by voltage criteria?
Deep S (V1-2) Tall R (V5-6) Total is greater than 7 large squares
