ECG, IHD, cardio exam, HTN

Question 1

which lead is used as rhythm strip usually

Answer 1

II

Question 2

what is sinus arrhythmia

Answer 2

a normal variation where heart rate changes with respiration

Question 3

what is a premature atrial complex

Answer 3

an atrial ectopic.

an early beat generated in the atria with a normal QRS

Question 4

what is a premature ventricular complex? how would it look on ECG?

Answer 4

a ventricular ectopic beat. broad QRS in absence of P wave.

a ventricular extra beat

Question 5

how does atrial fibrillation appear on ecg?

Answer 5

absence of p waves

irregularly irregular rhythm

Question 6

how does atrial flutter appear on ECG?

Answer 6

saw tooth appearance of p waves.

too many p waves.

Question 7

normal p wave length

Answer 7

<120ms (3 small squares)

Question 8

what does the PR interval indicate

Answer 8

AV conduction time

Question 9

what is first degree AV block

Answer 9

gradually increasing PR interval and eventually a non conducted P wave

Question 10

normal QRS length

Answer 10

100ms

Question 11

what causes right axis deviation

Answer 11

right ventricular hypertrophy

Question 12

lateral ECG leads

Answer 12

V5 V6

Question 13

inferioir ECG leads

Answer 13

2, 3, aVF

Question 14

high lateral ECG leads

Answer 14

1, aVL

Question 15

pronounced Q wave is indicative of

Answer 15

prior infarct

Question 16

how long does ST elevation last in STEMI

Answer 16

only 48 hours

Question 17

horizontal ST depression indicates

Answer 17

significant myocardial

Question 18

3 types of ST depression

Answer 18

downgoing
horizontal
upgoing (might be ok)

Question 19

atrial fibrillation on ECG

Answer 19

no p waves

irregularly irregular

Question 20

what is torsades de pointes

Answer 20

QT lengthening can lead to this abnormal ecg that can cause vtachycardia and sudden death

Question 21

how is hypokalaemia reflected on ECG

Answer 21

dampened t waves

Question 22

definition of acute myocardial infarction. 3 features it includes

Answer 22

symptoms (chest pain, SOB etc)
change in ECG
elevation of cardiac markers

Question 23

in AMI, is primary percutaenous intervention or fibrinolysis preferred?

Answer 23

primary percutaneous intervention (clot retrieval)

Question 24

4 medications you will be put on after an AMI

Answer 24

beta blockers (reduce recurrency, reduce angine, reduce arrhythmias)
aspirin (antiplatelet therapy important for future prevention)
ACEI
statin

Question 25

what do you need to clarify about when a patient says they have "palpitations"

Answer 25

fast beats? missed beats? irregular? forceful?

Question 26

possible diagnoses of "palpitations"

Answer 26

sinus tachycardia atrial fibrillatoin supraventricular tachycardia ventricular tachycardia

Question 27

investigations to be completed for palpitations

Answer 27

ECG is needed most importantly but can be difficult. may need implantable monitor. also echocardiogram for underlying strucutral disease of the heart maybe UEC to determine if there is electrolyte imbalance

Question 28

2 mechanisms of tachycardia

Answer 28

single group of cells firing rapidly (the nodes) or re-entry

Question 29

mechanism of re-entry

Answer 29

2 electrical paths around an area of scar, one path becomes unable to conduct and then the other path can go around the scar, go up the other path, and may get past the block and then create a circular electrical circuit

Question 30

what is atrial flutter

Answer 30

re-entry tachycardia within the atria leading to sawtooth ecg

Question 31

what are premature ventricular complexes

Answer 31

ectopic depolarisation within the ventricle that bypasses the his-purkinje system to cause slow depolarisation within ventricles usually benign

Question 32

treatment for atrial fibrillation

Answer 32

often want to control the rate instead of the rhythm beta blockers, digoxin and then want to control stroke risk vs bleeding risk (aspirin? warfarin?) and if nothing works then may need catheter ablation of pulmonary veins

Question 33

first degree AV block

Answer 33

PR interval > .2 seconds

Question 34

second degree AV block | types 1 and 2

Answer 34

``` 1 = gradually increasing PR interval until a p isnt conducted 2 = intermittently blocked p waves ```

Question 35

third degree av block

Answer 35

dissociation of atrial and ventricular activity

Question 36

diagnosing hypertension

Answer 36

BP > 140/90 on 2 separate measurements

Question 37

what level does Hb have to be for conjunctival pallor

Answer 37

less than 80

Question 38

what causes cyanosis

Answer 38

deoxy Hb (as opposed to anemia)

Question 39

what does JVP tell us

Answer 39

the filling pressure of the right side of the heart

Question 40

how to tell if it is JVP vs carotid

Answer 40

``` cant feel it pulsing double wave hepatojugular reflux inhalation changes occlude it varies with position ```

Question 41

what is kussmauls sign

Answer 41

JVP rising with inspiration | indicative of constrictive pericarditis

Question 42

what does S3 indicate?

Answer 42

turbulence during early ventricle filling voume overload (aortic or mitral regurge) dilated cardiomyopathy

Question 43

what does S4 indicate? | when is it?

Answer 43

before S1. | indicates turbulence duering atrial contractoin in stiff ventricle (HTN, aortic stenosis, Hypertrophic cardiomyopathy)

Question 44

aortic stenosis murmur?

Answer 44

crescendo-decrescendo

Question 45

mitral regurgitation murmur ?

Answer 45

pansystolic