DPD: AMIR SAM Cardio Flashcards
Which investigations must be performed in acute chest pain presentation ?
- ECG
- Troponin
+ve: coronary angiography
‐ve: ETT - Echocardiography
How can you differentiatially diagnose chest pain?
Cardiac: IHD, aortic dissection, pericarditis
Resp: PE, Pneumonia, Pneumothorax
GI: Oesophageal spasm, oesophagitis, gastritis
MSK: Costochondritis
Which artery is involved in an anterior MI? Which ECG leads will show this?
LAD
V1 - V4
Which artery is involved in a lateral MI? Which ECG leads will show this?
Circumflex
V5, V6, I, aVL
Which artery is involved in an inferior MI? Which ECG leads will show this?
RCA
II, III, aVF
How can you differentiatially diagnose collapse?
- Hypoglycaemia: DNEFG
- Cardiac: Vasovagal, Arrhythmia, Outflow obstruction, Postural hypotension
- Neuro: Seizure
What will you look for on an ECG if you suspect arrythmia as cause of collapse? Why?
Long QT
Predisposes to tachyarrythmia
What may cause outflow obstruction leading to collapse?
Aortic stenosis (low volume, slow rising carotid pulse, ESM)
HOCM
PE
What is long QT syndrome? What are the causes of it?
Abnormal ventricular repolarisation
Congenital: mutation in K+ channels
Acquired: low K+/ Mg2+, drugs
List 3 differentials for raised JVP
RHF
Tricuspid regurgitation
Constrictive pericarditis
What characterises a neurological cause for loss of consciousness, with respects to before, during and after the episode?
Before: Aura
During: Tongue biting
After: Confusion
What characterises a cardiac cause for loss of consciousness, with respects to before, during and after the episode?
Before: no warning
During: no tongue biting
After: no confusion
What 2 differentials should you consider in a patient with sinus tachycardia?
Sepsis
Hypovolaemia
What causes a supra ventricular tachycardia? What does this look like on an ECG?
Re-entry circuit
No P waves before QRS
What are the 2 types of re-entry circuits?
AVNRT: reentry at the level of the AVN
AVRT: reentry along accessory pathway
What is seen in a ECG of a patient with an accessory pathway? (not in tachycardia)
Delta wave
Short PR interval + slurred upstroke due to presence of accessory pathway
What is your differential diagnosis for atrial fibrillation?
Alcohol excess, thyrotoxicosis
Heart: muscle, valve, pericardium
Lungs: pneumonia, PE, cancer
List 3 causes of ventricular tachycardia
Ischaemia
Electrolyte imbalance
Long QT syndrome
How do you manage a SVT
Vagal manœuvres
If ineffective, give adenosine with a cardiac monitor
If in haemo-dynamic compromise consider DC cardioversion
What does management of AF consist of?
Rhythm control: cardio version in <48 hrs (DC cardiovert +/- Amiodarone)
Rate control: B blocker/ Digoxin
Anticoagulate (if appropriate)
How do you manage VT with no haemodynamic compromise?
IV Amiodarone
Treat underlying cause
Consider ICD
How would you manage pulseless VT?
Defibrillate
What are the ECG characteristics of left ventricular hypertrophy?
Deep S in V1/2
Tall R in V5/6
What evidence of ischaemia can be seen on an ECG?
ST elevation
T inversion
Q waves indicating old MI’s
How do you assess an ECG for arrhythmia or conduction defects?
Rate slow or fast? Rhythm sinus or AF? PR interval: first degree heart block? Broad QRS: bundle branch block Prolonged QT interval predisposes to VT
How do you assess an ECG for ventricular strain or hypertrophy?
Look at R + S
Is there evidence of strain on left side of heart possible due to HTN
What is the 3rd heart sound associated with?
Ventricular filling
What is the 4th heart sound associated with?
Ventricular hypertrophy
What is indicated by a fixed wide splitting of S2?
Atrial septal defect
What treatment is suitable for type 2 respiratory failure?
BiPAP
What treatment is required for acute HF?
Sit up
O2
Furosemide IV
GTN infusion if in pain
What is the differential diagnosis for pleuritic chest pain?
Pericarditis PE Pneumonia Pneumothorax Pleural pathology
