DPD Deck - CARDIO Flashcards by Rahul Penumaka

An anterolateral STEMI will show ST elevation in which leads?

1, aVL and V1-V6

aVL - AnteroLateral

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An inferior STEMI will show ST elevation in which leads?

2, 3, aVF (basically everything NOT in anterolateral) - which also has L in it so aVR is irrelevant

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Left main stem coronary artery is made up of which two vessels?

The LEFT ANTERIOR DESCENDING CORONARY ARTERY and the CIRCUMFLEX ARTERY

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An anterior MI involves which coronary artery and would show changes on which leads?

ARTERY: LEFT ANTERIOR DESCENDING
LEADS: V1, V2, V3, V4

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A lateral MI involves which coronary artery and would show changes on which leads?

ARTERY: CIRCUMFLEX
LEADS: 1, aVL, V5, V6

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An inferior MI involves which coronary artery and would show changes on which leads?

ARTERY: RIGHT CORONARY ARTERY
LEADS: 2, 3, aVF

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Which CK is used in relation to MIs and UA?

CK-MB isoform

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Describe the time course of CK-MB

CK-MB rises 3-12 hours after the MI
It then peaks at 24 hours
Returns to normal by 48-72 hours

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Why is the trajectory of Troponin important?

Because a single measurement is useless, you want to know if it is rising or falling

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List the conditions in which Troponin may be raised

MI
Sepsis
Pneumonia
Falls 
Renal Impairment

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List situations in which CK-MB may be raised

MI
cardiac surgery
myocarditis
electrical cardioversion

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Vasovagal syncope is associated with what?

The 3P’s:
Precipitating factor (e.g DEHYDRATION)
Posture
Prodromal aura

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What are the CARDIAC causes of falls?

Postural hypotension
Arrhythmia (family history of sudden death)
Outflow obstruction: Aortic stenosis or PE (Would be heard)
Ruptured aortic aneursym
Vasovagal syncope (benign)

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List the DDx of falls

HYPOGLYCAEMIA
Vasovagal syncope
Arrhythmia
Outflow Obstruction
Postural hypotension
Seizure

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What are the Ix for an arrhythmia?

ECG (looking for long QT syndrome)
Cardiac monitor in a monitor bed
24 hour tape

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What are the Ix for outflow obstruction/finding on examination?

Low volume/slow rising pulse
An ejection systolic murmur will be heard
Echocardiogram can be performed

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What are the Ix for postural hypotension

Take standing/lying BP
SBP will fall >20 mmHg after 3 minutes
DBP will fall >10 mmHg after 3 minutes

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What is long QT syndrome?

An arrhythmia where there is ABNORMAL VENTRICULAR REPOLARISATION

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What is one sign that might indicate long QT syndrome?

A family history of sudden death

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What are the causes of long QT syndrome?

Causes of long QT syndrome can be classified as CONGENITAL or ACQUIRED
CONGENTIAL: Mutations in K channels
ACQUIRED: Drugs or Low K+/Mg2+

Symptoms of Heart Failure

Fatigue
Dyspnea
Orthopnea
Paroxysmal Noctural Dyspnea

Signs of Heart Failure

Cardiomegaly
S3/S4
Tachycardia
Bi-basal crackles
Pleural effusion
Peripheral oedema
Smooth, tender enlarged liver

What are 3 causes of a raised JVP?

Right heart failure
Tricuspid Regurgitation
Constrictive pericarditis

Name the causes of constrictive pericarditis

Infection: TB
Inflammation: Connective tissue disease
Malignancy

Name the 4 differentials for PALPITATIONS

1. Sinus tachycardia 2. Supraventricular tachycardia (SVT) 3. Atrial fibrillation 4. Ventricular tachycardia

Describe SINUS TACHYCARDIA and list its causes

Everything is normal but the QRS may be narrow and the rhythm is regular Causes of sinus tachycarida: Physiological Sepsis Hypovolaemia Enodcine causes: thyrotoxicosis and phaeochromocytoma

Describe SVT

It is a re-entry circuit that involves a normal and accessory pathway In SVT you will see no p waves before the QRS However, the rhythm (Which can be determined by measuring distance between complexes) will be regular

What is the difference between AVNRT and AVRT?

AVNRT: The re-entry circuit is at the lvel of the AV node as a result you have constant electrical signals sent which causes rapid contraction AVRT: (eg. Wolff-Parkinson White syndrome): The re-entry circuit is not at the level of the ventricles

Describe AVRT

Short PR interval and a slurred QRS complex called a delta wave which is seen at rest or after treatment

Describe ATRIAL FIBRILLATION as it appears on an ECG

Irregular rhythm | no p-waves

What are some of the causes of AF

``` Thyrotoxicosis, Alcohol Heart causes: muscle affected - IHD Valve affected: Mitral stenosis Pericardium affected Lungs: Pneumonia or PE ```

Describe Ventricular tachycardia as it appears on an ECG

Fast, broad QRS

List causes of Ventricular tachycardia

Ischaemia Electrolyte abnormality Long QT

What is the management of SVT?

Vagal manouevers: Valsalva (or carotid sinus massage) Give adenosine (use cardiac monitor) If there is haemodynamic compromise - give DC cardioversion

What is the management of AF?

``` Rhythm control Note: If onsent >48 hours, anticoagulate for 3-4 weeks before cardioversion to avoid clots Control rate: Beta-blockers Digoxin ```

What is the management of VT?

If there is no haemodynamic compromise give IV amiodraone (which prolongs the heart refractory period) ICD If pulseless: Defibrillate

How do you detect hypertension on an ECG?

Deep S waves in V1/V2 | Tall R waves in V5/V6

How do you detect LVH?

If requires an echocardiogram LVH by voltage criteria can be determined by: S waves in V1 AND R waves in v5 or v6 greater than/equal to 7 large boxes

What are the differential diagnoses for PLEURITIC CHEST PAIN?

``` Pericarditis PE Pneumonia Pneumothorax Pleural pathology ```

What is the difference between DC cardioversion and defibrillation?

Cardioversion is synchronised while defibrillation is not, it just ‘shocking’ the patient

What is S1 associated with?

Mitral valve closure

What is S2 associated with?

Aortic valve closure

What is S3 associated with and when does it appear?

S3 appears after S1 and S2 and is associated with VENTRICULAR FILLING

What is S4 associated with and when does it appear?

S4 appears before S1 and is associated with VENTRICULAR HYPERTROPHY

Describe the management for acute heart failure

1. Sit up and give oxygen (60%-100%) 2. IV Furosemide 3. GTN may be given in SPECIAL CIRCUMSTANCES - angina and heart failure 4. Treat underlying cause of heart failure

What is the management plan for someone with VF/pulseless VT?

``` o Shock o CPR (2 min) o Assess rhythm o Adrenaline every 3-5 minutes o Amiodarone after 3 shocks o Correct reversible causes ```

What is the management plan for someone in asystole/with PEA?

o CPR (2 min) o Adrenaline every 3-5 min o Correct reversible causes

List the cardiovascular causes of clubbing

``` Infective endocarditis Congenital cyanotic heart disease Atrial myoxma (tumour on the atrial septum) Axillary artery aneurysm Brachial arteriovenous fistula ```