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CARDIOLOGY - RIA > ECG > Flashcards

ECG Flashcards

1
Q

what is the triad for CARDIAC TAMPONADE?

A

1- Hypotensive
2- Raised JVP
3- muffled heart sounds

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2
Q

What is acute pericarditis?

A

Inflammation of the pericardium. Presents as central chest pain worse on inspiration or lying flat and relieved by sitting forwards.
- saddle shaped ST segment

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3
Q

What are the 5 types of cardiomyopathy and what are they?

A

1) Dilated cardiomyopathy - enlargement and weakening of the LV
2) HOCM (hypertrophy-CM) - inherited condition where the heart muscle becomes thickened and stiff –> LV outflow obstruction
3) Restrictive cardiomyopathy - Restricted filling of the ventricles
4) Ischaemic cardiomyopathy - ischaemia leading to weakening and dilation of LV
5) Takotsubo cardiomyopathy - stress induced acute weakening of heart

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4
Q

What is the pericardium and what are the 4 conditions that can arise from pericardial pathology?

A

Pericardium is a double walled sack containing the heart.

1) Acute pericarditis
2) Constrictive pericarditis
3) Cardiac tamponade
4) Pericardial effusion

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5
Q

Where do the left and right coronary arteries arise from?

A

From the aortic sinuses located behind the aortic valve; therefore they fill when the ventricles relax as blood recoils

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6
Q

What are the branches of the LEFT CORONARY ARTERY?

A
  • Left anterior descending
  • Left marginal artery
  • Left circumflex
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7
Q

What does the LEFT ANTERIOR DESCENDING supply?

A

RV, LV, interventicular septum

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8
Q

What does the LEFT MARGINAL ARTERY supply?

A

LV

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9
Q

What does the LEFT CIRCUMFLEX ARTERY supply?

A

LA, LV

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10
Q

What are the branches of the RIGHT CORONARY ARTERY?

A
  • right marginal artery

- posterior interventricular artery

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11
Q

What does the RIGHT MARGINAL ARTERY supply?

A

RV, apex

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12
Q

What is the pericardium and what 4 diseases can arise from pericardial pathology?

A

Pericardium is a double walled sac containing the heart.

1) Acute pericarditis
2) Constrictive pericarditis
3) Pericardial effusion
4) Cardiac tamponade

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13
Q

What is the pericardium and what 4 diseases can arise from pericardial pathology?

A

Pericardium is a double walled sac containing the heart.
1) ACUTE PERICARDITIS - inflammation of the pericardium

2) CONSTRICTIVE PERICARDITIS - pericardium is rigid
3) PERICARDIAL EFFUSION - accumulation of fluid in the pericardial sac
4) CARDIAC TAMPONADE - accumulation of pericardial fluid that raises intrapericardial pressure

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14
Q

What is DRESSLERS SYNDROME?

A

Development of pericarditis 2-6 weeks post MI. Due to autoimmune reaction against antigenic proteins formed as the myocardium recovers.

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15
Q

What is the characteristic pain of pericarditis?

A

central pleuritic chest pain, worse lying flat and relieved by leaning forwards

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16
Q

what are the signs on an ECG of pericarditis?

A

Widespread saddle shaped ST segment elevation

PR depression

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17
Q

What is the patient presentation of constrictive pericarditis?

A

Features of RHF ; raised JVP, hepatosplenomegaly, ascites, oedema

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18
Q

What does the CXR of constrictive pericarditis show?

A

small heart +/- calcification

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19
Q

what is Ewart’s sign?

A

sign present in pericardial effusion caused by a large effusion compressing left lower lobe of lung causing bronchial breathing in the left base of lung

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20
Q

What are signs on; CXR, ECG and Echo in pericardial effusion

A

CXR - enlarged globular heart

ECG - low voltage QRS complexes and alternating QRS morphologies

Echo -

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21
Q

what is the treatment for pericardial effusion?

A

Pericardiocentesis - either diagnostic or therapeutic

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22
Q

What is Beck’s triad and what does it indicate?

A
  • falling BP
  • increasing JVP
  • muffled heart sounds

feature of cardiac tamponade

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23
Q

ECG changes on posterior MI

A

ST depression in anterior leads; V2-V4 w/ tall R waves

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24
Q

occlusion of which coronary artery leads to a posterior MI

A

right coronary artery

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25
Q

what does the following suggest; persistent ST elevation after a previous MI

A

LEFT VENTRICULAR ANEURYSM

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26
Q

what are the characteristics on an ECG for trifasciular block?

A
  • RBBB
  • 1st degree heart block
  • Left ventricular strain
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27
Q

Treatment for Bradycardia < 40 bpm + symptomatic?

A

1st line = IV atropine (0.6-1.2)

2nd line = temporary pacing wire

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28
Q

What is the QRS complex in Ventricular tachycardia?

A

Broad complex

QRS > 120ms

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29
Q

1st line treatment for VENTRICULAR TACHYCARDIA?

A

IV amiodarone OR lidocaine AND high flow O2 by face mask

if no response then DC shock

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30
Q

List side effects of AMIODARONE?

A
  • photosensitivity
  • corneal deposits
  • hepatitis
  • pnuemonitis
  • lung fibrosis
  • increased INR
31
Q

What is the mechanism of action of AMIODARONE?

A

Is a class 3 antiarrhythmic; prolongs action potential to slow the conduction rate.

32
Q

Treatment for;
- VENTRICULAR FIBRILLATION
and
- PULSELESS VENTRICULAR TACHYCARDIA

A

ASYNCHRONIZED DC SHOCK
PEA –> adrenaline 1mg

If p waves start appearing then the patient is responding to pacing

33
Q

Treatment for;

SUSTAINED VT

A

AMIODARONE 300 mg IV

then further 150 mg

34
Q

what is TORSADES DE POINTES?

A

VT with varying axis.
rapid
irregular

the arrhythmia may cease spontaneously or degenerate into VF

35
Q

name the 5 SUPRAVENTRICULAR TACHYCARDIAS.

A

1) ATRIAL FIBRILLATION
2) ATRIAL FLUTTER
3) ATRIAL TACHYCARDIA
4) AV NODAL RE-ENTERANT
5) AV RE-ENTRY TACHYCARDIA

36
Q

What are the ECG characteristics of ATRIAL FLUTTER?

A
  • typically around 300 bpm
  • P waves = saw tooth pattern
  • regular
37
Q

What is the treatment for ATRIAL FLUTTER?

A
  • carotid sinus massage + IV adenosine
  • Amiodarone to restore sinus rhythm
  • Anticoagulation for –> cardioversion
  • Amiodarone + sotalol to manitain sinus rhythm
38
Q

name 3 valsalve maneuvres.

A
  • blowing on wrist
  • squatting
  • carotid sinus massage
39
Q

Symptoms of AF?

A
  • chest pain
  • dyspnoea
  • palpitations
  • faintness
  • asymptomatic
40
Q

ECG characteristics of AF?

A
  • irregularly irregular
  • tachycardia
  • absent p waves
  • narrow complex (QRS < 120ms)
41
Q

what are the 4 types of AF?

A
  • PAROXYSMAL
  • RECURRENT
  • PERSISTANT
  • RECURRENT
42
Q

definition of PAROXYSMAL AF?

A

AF that spontaneously converts to normal sinus rhythm within 7 days. Patients that have infrequent episodes (<1/month) whom are haemodynamically stable.

43
Q

definition of PERSISTENT AF?

A

Episode lasting longer than 7 days and is not self terminating.

44
Q

definition of PERMANENT AF?

A

AF persists after an attempt to cardiovert both electrically and chemically… AF is accepted as final rhythm and patient requires treatment with anticoagulation and rate control.

45
Q

definition of RECURRENT AF?

A

after 2 or more episodes.

46
Q

What is the 1st + 2nd line management of a haemodynamically unstable patient w/ AF?

A

Immediate heparinisation + attempt of cardioversion w/ synchroniseed DC shock.

Cardioversion fails –> IV AMIODARONE + 2nd cardioversion attempt

47
Q

name 3 medications that can be used for rate control in AF;

A
  • beta blockers
  • Calcium channel antagonists; diltiazem/verapamil
  • Digoxin
48
Q

name 3 medications that can be used for rhythm control in AF;

A
  • flecanide
  • sotalol
  • propafenone
49
Q

what is the treatment for AF patients that do not respond to antiarhythmics?

A

Catheter ablation techniques,

such as pulmonary vein isolation.

50
Q

What is the long term maintenance of sinus rhythm medication given to patients with persistent or paroxysmal AF? (following successful cardioversion)

A

DRONEDARONE

51
Q

INR aim for an elderly (>75) with long term AF?

A

2

52
Q

INR aim for long term AF?

A

2.5

53
Q

INR aim following DVT/PE?

A

3.5

54
Q

INR aim before and 4 week after cardioversion

A

2.5-3.0

55
Q

What is PR interval in 1st degree heart block?

A

> 0.22 sec

56
Q

What heart block appears as; prolonging of PQ interval until there is a dropped QRS beat, in repeated cycles?

A

2nd degree heart block; type 1

wenckeback/mobitz 1

57
Q

What heart block appears as constant + normal PR intervals with occasional QRS dropped beats?

A

2nd degree heart block; type 2

Mobitz 2

58
Q

ECG of 3rd degree heart block?

A

no relationship between p waves and qrs complexes.

59
Q

Name 3 medications that can cause HYPERKALAEMIA

A
  • ACEi
  • NSAIDs
  • K sparing diuretics (spironolactone)
60
Q

Name the ECG features of HYPERKALAEMIA?

A
  • tall tented t waves
  • loss of p waves
  • broad QRS complexes
  • ventricular fibrillation
61
Q

Clinical features of HYPERKALAEMIA?

A
  • muscle weakness/pain
  • palpitations
  • numbness
62
Q

What are the 3 components of HYPERKALAEMIA management?

A

1) Cardiac muscle stabilisation
2) Extra–>intracellular shift of K+
3) K+ removal

63
Q

How is cardiac muscle stabilisation due to hyperkalaemia achieved?

A

IV calcium gluconate

64
Q

How is extra-intracellular K+ shift achieved?

A

IV combined insulin/dextrose infusion
+
Nebulised salbutamol

65
Q

3 ways to remove K+ from the body?

A

Dialysis, diuretics, Calcium resonium (oral/enema)

66
Q

ECG features of HYPOKALAEMIA?

A
  • U waves
  • Absent/small T waves
  • prolonged PR interval
  • ST depression
  • Long QT
67
Q

Symptoms of HYPERCALCAEMIA?

A

Bones, stones, groans and psychic moans
Corneal calcification
HTN

68
Q

ECG changes in HYPERCALCAEMIA?

A

Shortened QT interval

(mild); broad based tall peaking t waves

69
Q

Management of HYPERCALCAEMIA?

A
  • rehydration w/ normal saline
  • rehydration bisphosphonates
  • calcitonin
  • steroids (if cause is sarcoidosis)
  • Loop diuretics (furosemide)
70
Q

Clinical features of HYPOCALCAEMIA?

A
  • muscle tetany
  • perioral paraesthesia
  • if chronic; depression, cataracts
71
Q

features of pathological Q waves

A

> 40 ms wide
2 mm deep
25% depth of the QRS complex
seen in leads 1-3

72
Q

ECG changes that indicate CAD is likely to be present 1

A

LBBB

Pathological Q waves

ST segment and T wave abnormalities

73
Q

characteristics of LBBB

A

broad QRS (>3 small squares or 0.12 sec)

Deep S wave in V1

No Q wave in V5/V6

CARDIOLOGY - RIA (8 decks)

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