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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
what does the following suggest; persistent ST elevation after a previous MI
LEFT VENTRICULAR ANEURYSM
26
what are the characteristics on an ECG for trifasciular block?
- RBBB - 1st degree heart block - Left ventricular strain
27
Treatment for Bradycardia < 40 bpm + symptomatic?
1st line = IV atropine (0.6-1.2) | 2nd line = temporary pacing wire
28
What is the QRS complex in Ventricular tachycardia?
Broad complex | QRS > 120ms
29
1st line treatment for VENTRICULAR TACHYCARDIA?
IV amiodarone OR lidocaine AND high flow O2 by face mask | if no response then DC shock
30
List side effects of AMIODARONE?
- photosensitivity - corneal deposits - hepatitis - pnuemonitis - lung fibrosis - increased INR
31
What is the mechanism of action of AMIODARONE?
Is a class 3 antiarrhythmic; prolongs action potential to slow the conduction rate.
32
Treatment for; - VENTRICULAR FIBRILLATION and - PULSELESS VENTRICULAR TACHYCARDIA
ASYNCHRONIZED DC SHOCK PEA --> adrenaline 1mg If p waves start appearing then the patient is responding to pacing
33
Treatment for; | SUSTAINED VT
AMIODARONE 300 mg IV then further 150 mg
34
what is TORSADES DE POINTES?
VT with varying axis. rapid irregular the arrhythmia may cease spontaneously or degenerate into VF
35
name the 5 SUPRAVENTRICULAR TACHYCARDIAS.
1) ATRIAL FIBRILLATION 2) ATRIAL FLUTTER 3) ATRIAL TACHYCARDIA 4) AV NODAL RE-ENTERANT 5) AV RE-ENTRY TACHYCARDIA
36
What are the ECG characteristics of ATRIAL FLUTTER?
- typically around 300 bpm - P waves = saw tooth pattern - regular
37
What is the treatment for ATRIAL FLUTTER?
- carotid sinus massage + IV adenosine - Amiodarone to restore sinus rhythm - Anticoagulation for --> cardioversion - Amiodarone + sotalol to manitain sinus rhythm
38
name 3 valsalve maneuvres.
- blowing on wrist - squatting - carotid sinus massage
39
Symptoms of AF?
- chest pain - dyspnoea - palpitations - faintness - asymptomatic
40
ECG characteristics of AF?
- irregularly irregular - tachycardia - absent p waves - narrow complex (QRS < 120ms)
41
what are the 4 types of AF?
- PAROXYSMAL - RECURRENT - PERSISTANT - RECURRENT
42
definition of PAROXYSMAL AF?
AF that spontaneously converts to normal sinus rhythm within 7 days. Patients that have infrequent episodes (<1/month) whom are haemodynamically stable.
43
definition of PERSISTENT AF?
Episode lasting longer than 7 days and is not self terminating.
44
definition of PERMANENT AF?
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
definition of RECURRENT AF?
after 2 or more episodes.
46
What is the 1st + 2nd line management of a haemodynamically unstable patient w/ AF?
Immediate heparinisation + attempt of cardioversion w/ synchroniseed DC shock. Cardioversion fails --> IV AMIODARONE + 2nd cardioversion attempt
47
name 3 medications that can be used for rate control in AF;
- beta blockers - Calcium channel antagonists; diltiazem/verapamil - Digoxin
48
name 3 medications that can be used for rhythm control in AF;
- flecanide - sotalol - propafenone
49
what is the treatment for AF patients that do not respond to antiarhythmics?
Catheter ablation techniques, | such as pulmonary vein isolation.
50
What is the long term maintenance of sinus rhythm medication given to patients with persistent or paroxysmal AF? (following successful cardioversion)
DRONEDARONE
51
INR aim for an elderly (>75) with long term AF?
2
52
INR aim for long term AF?
2.5
53
INR aim following DVT/PE?
3.5
54
INR aim before and 4 week after cardioversion
2.5-3.0
55
What is PR interval in 1st degree heart block?
> 0.22 sec
56
What heart block appears as; prolonging of PQ interval until there is a dropped QRS beat, in repeated cycles?
2nd degree heart block; type 1 | wenckeback/mobitz 1
57
What heart block appears as constant + normal PR intervals with occasional QRS dropped beats?
2nd degree heart block; type 2 | Mobitz 2
58
ECG of 3rd degree heart block?
no relationship between p waves and qrs complexes.
59
Name 3 medications that can cause HYPERKALAEMIA
- ACEi - NSAIDs - K sparing diuretics (spironolactone)
60
Name the ECG features of HYPERKALAEMIA?
- tall tented t waves - loss of p waves - broad QRS complexes - ventricular fibrillation
61
Clinical features of HYPERKALAEMIA?
- muscle weakness/pain - palpitations - numbness
62
What are the 3 components of HYPERKALAEMIA management?
1) Cardiac muscle stabilisation 2) Extra-->intracellular shift of K+ 3) K+ removal
63
How is cardiac muscle stabilisation due to hyperkalaemia achieved?
IV calcium gluconate
64
How is extra-intracellular K+ shift achieved?
IV combined insulin/dextrose infusion + Nebulised salbutamol
65
3 ways to remove K+ from the body?
Dialysis, diuretics, Calcium resonium (oral/enema)
66
ECG features of HYPOKALAEMIA?
- U waves - Absent/small T waves - prolonged PR interval - ST depression - Long QT
67
Symptoms of HYPERCALCAEMIA?
Bones, stones, groans and psychic moans Corneal calcification HTN
68
ECG changes in HYPERCALCAEMIA?
Shortened QT interval | (mild); broad based tall peaking t waves
69
Management of HYPERCALCAEMIA?
- rehydration w/ normal saline - rehydration bisphosphonates - calcitonin - steroids (if cause is sarcoidosis) - Loop diuretics (furosemide)
70
Clinical features of HYPOCALCAEMIA?
- muscle tetany - perioral paraesthesia - if chronic; depression, cataracts
71
features of pathological Q waves
> 40 ms wide > 2 mm deep > 25% depth of the QRS complex seen in leads 1-3
72
ECG changes that indicate CAD is likely to be present 1
LBBB Pathological Q waves ST segment and T wave abnormalities
73
characteristics of LBBB
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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