DPD Deck - CARDIO Flashcards
An anterolateral STEMI will show ST elevation in which leads?
1, aVL and V1-V6
aVL - AnteroLateral
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
Left main stem coronary artery is made up of which two vessels?
The LEFT ANTERIOR DESCENDING CORONARY ARTERY and the CIRCUMFLEX ARTERY
An anterior MI involves which coronary artery and would show changes on which leads?
ARTERY: LEFT ANTERIOR DESCENDING
LEADS: V1, V2, V3, V4
A lateral MI involves which coronary artery and would show changes on which leads?
ARTERY: CIRCUMFLEX
LEADS: 1, aVL, V5, V6
An inferior MI involves which coronary artery and would show changes on which leads?
ARTERY: RIGHT CORONARY ARTERY
LEADS: 2, 3, aVF
Which CK is used in relation to MIs and UA?
CK-MB isoform
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
Why is the trajectory of Troponin important?
Because a single measurement is useless, you want to know if it is rising or falling
List the conditions in which Troponin may be raised
MI Sepsis Pneumonia Falls Renal Impairment
List situations in which CK-MB may be raised
MI
cardiac surgery
myocarditis
electrical cardioversion
Vasovagal syncope is associated with what?
The 3P’s:
Precipitating factor (e.g DEHYDRATION)
Posture
Prodromal aura
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)
List the DDx of falls
- HYPOGLYCAEMIA
- Vasovagal syncope
- Arrhythmia
- Outflow Obstruction
- Postural hypotension
- Seizure
What are the Ix for an arrhythmia?
ECG (looking for long QT syndrome)
Cardiac monitor in a monitor bed
24 hour tape
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
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
What is long QT syndrome?
An arrhythmia where there is ABNORMAL VENTRICULAR REPOLARISATION
What is one sign that might indicate long QT syndrome?
A family history of sudden death
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
- Sinus tachycardia
- Supraventricular tachycardia (SVT)
- Atrial fibrillation
- 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
- Sit up and give oxygen (60%-100%)
- IV Furosemide
- GTN may be given in SPECIAL CIRCUMSTANCES - angina and heart failure
- 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
