ECG, pericarditis

Question 1

What is each square worth on an ecg

Answer 1

40 ms

Question 2

How to measure heart rate from ecg

Answer 2

300/6 or how many boxes between each peak

Question 3

anatomy of pericardium

Answer 3

2 layers
Visceral single cell layer adherent to epicardium
Fibrous parietal layer 2mm thick
Acellular collagen and elastin fibres
50ml of serous fluid

Question 4

what is acute pericarditis

Answer 4

Acute pericarditis is an inflammatory pericardial syndrome with or without effusion

Question 5

clinical diagnosis of pericarditis is made from

Answer 5

Chest Pain (85-90%)
Friction rub (33%)
ECG changes (60%)
Pericardial effusion (up to 60% usually mild)

2 of 4

Question 6

causes of pericarditid

Answer 6

viral
bacterial

Question 7

specific viruses that cause pericarditis

Answer 7

enteroviruses
adenoviruses
paroviruses

Question 8

non infectious causes of pericarditis

Answer 8

auto immune
neoplastic
metabolic

Question 9

clinical presentation of pericarditis

Answer 9

CHEST PAIN
-severe
-sharp and pleuritic
-rapid onset
-left anterior chest or epigastrium

Question 10

what are you looking for in the clinical examination for pericarditis investigation

Answer 10

Pericardial rub – pathognomonic, crunching snow
Sinus tachycardia
Fever
Signs of effusion (pulsus paradoxus, Kussmauls sign)

Question 11

what woudl ecg show for pericarditis

Answer 11

PR DEPRESSION
Diffuse ST elevation
NO reciprocal ST depression

Question 12

why is there ecg changes

Answer 12

pericardium is adjacent to myocardium hence it will show ecg changes due to the inflammation

Question 13

which ecg leads are inferior

Answer 13

2 ,3 , avf

Question 14

what would a FBC show for pericarditid

Answer 14

modest increase in WCC - white cell count
mild lympocytosis

Question 15

troponin levels in pericarditis ?

Answer 15

elevation suggest myopericarditis

Question 16

differential diagnosis of pericarditis ?

Answer 16

MYOCARDIAL ISCHAEMIA
pneumonia
pul embolus

Question 17

management of pericarditis

Answer 17

-sedentary activity until resolution
-nsaid( ibuprofen 600mg)
colchine for three months

Question 18

prognosis of pericarditis

Answer 18

Fever >38°CSubacute onset
Large pericardial effusion
Cardiac tamponade
Lack of response to aspirin or NSAIDs after at least 1 week of therapy

Question 19

what is heart failure

Answer 19

inability for the heart to deliver oxygenated blood to tissues at a satisfactory rate for the tissues metabolic requirement
A SYNDROME NOT A DIAGNOSIS

Question 20

What are the causes of heart failure

Answer 20

IHD
cardiomyopathy
valvular disease

Question 21

commonest cause of pericarditis

Answer 21

viral pericarditis

Question 22

what is cor pulmonalae

Answer 22

right sided heart failure cuased by resp disease

Question 23

what does cor pulmonalae cause

Answer 23

backlogof blood of right atrium, vena cava and the venous system

Question 24

what causes CP

Answer 24

COPD
pul embolism
LUNG DISEASE
cystic fibrosis
pulmonary hypertensions

Question 25

presentation of CP

Answer 25

Early CP= asymptomatic shortness of breath peripheral oedema breathlessness on exertion syncope chest pain

Question 26

why might a patient with CP have raised JVP

Answer 26

Due to a backlog of blood in the jugular vein

Question 27

management for cor pulmonale

Answer 27

- treating the symptoms and underlying cause -long term oxygen therapy

Question 28

common presentation for chronic heart failure

Answer 28

Breathlessness worsened by exertion Cough. They may produce frothy white/pink sputum. Orthopnoea Paroxysmal Nocturnal Dyspnoea Peripheral oedema (swollen ankles

Question 29

how would you investigate orthopnea

Answer 29

ask patient how many pillows they use

Question 30

what is paroxysmal noctural dyspnoea

Answer 30

term used to describe the experience that patients hvae when suddenly waking at night with shortness of breath and cough

Question 31

in what direction does the avr lead go and what does it show

Answer 31

from RA to LA activity of RV and interventricular septem

Question 32

in what direction does the avl lead go and what does it show

Answer 32

RA TO LL high lateral wall of LV

Question 33

in what direction does the avF lead go and what does it show

Answer 33

LA TO LL inferior wall of heart

Question 34

what activity does lead 1 show you

Answer 34

high lateral wall of LV

Question 35

WHAT ACTIVITY DOES LEAD 2 AND 3 SHOW YOU

Answer 35

inferior portion of the heart

Question 36

how many chest leads are there

Answer 36

6

Question 37

leads V1-V3 show you ?

Answer 37

RV same as AVR

Question 38

leads v2-v3 show you

Answer 38

interventricular septum same as AVR

Question 39

WHAT do leads v2-v4 show you

Answer 39

anterior wall of heart

Question 40

what should leads v5-v6 show you

Answer 40

lateral wall of lv

Question 41

What are th signs of hf

Answer 41

Tachycardia n Displaced apex beat n Raised JVP n Added heart sounds and murmurs n Hepatomegaly, especially if pulsatile and tender n Peripheral and sacral oedema n Ascites

Question 42

What is ejection faction

Answer 42

Amount of blood that leaves the heart per beat

Question 43

what is cardiac tamponade

Answer 43

Life threatening accumulation of fluid in the pericardial space-- compression of heart chambers= decrease in venous return = decrease in filling in the heart = decrease CO

Question 44

What is the essential blood marker for heart failure

Answer 44

Brain natriuretic peptide