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Specialities > Emergancy Cardio > Flashcards

Emergancy Cardio Flashcards

1
Q

What investigations do you want into a patient with pulmonary oedema:

A

Bloods:

  • U&Es
  • Troponins
  • ABG
  • NT- pro- BNP

Orifices:
- Catheter (in prep for diuresis)

Imaging:

  • CXR
  • Echo

ECG

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2
Q

What is your management of a patient with acute pulmonary oedema?

A

Sit up
High flow oxygen - 15L

Morphine or diamorphine
Furosemide - 80mg IV
GTN spray (2 puffs)

CPAP
Furosemide

If <100mmHg and struggling treat as cardiogenic shock.
Requiring:
- Inotropic support

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3
Q

What is the triad of Cardiac tamponade?

A

Beck’s triad:

  • low BP
  • Muffled heart sounds
  • Raised JVP
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4
Q

How do statins work?

A

HMG-CoA reductase

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5
Q

What are some signs of aortic dissection?

What is the test of choice?

A

Chest pain
- tearing through to the back

Variation in BP between the two arms

Ischemic or absent peripheral pulses

ST elevation in inferior leads

Hypertension

Aortic regurgitation

Investigations:
- CT angiogram of the chest/ abdo/ pelvis
or
TOE if not stable

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6
Q

What are the major risk factors for aortic dissection?

A

Hypertension

Smoking

Connective tissue disease

Bicuspid aortic

Syphilis

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7
Q

What are some causes of cardiogenic shock?

A 
M.I 
Acute heart failure 
Arrhythmias
Aortic dissection 
Obstructive causes
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8
Q

How are you going to treat an elderly person with structural heart disease who has AF, without adverse features?

A

Digoxin

- this a good rate limiting drug in the elderly that you are worried about giving a beta blocker to

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9
Q

How is left ventricular enlargement seen on an ECG?

A

V1: S wave + V5/6 R Wave = >35mm is Left ventricular hypertrophy

So if an S wave in V1 is 20mm and the R wave in V6 is 20mm
the two of them = 40mm which is greater than 35mm and thus there is left ventricular hypertrophy

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10
Q

What is an important cause of continual ST elevation and left ventricular failure following an M.I?

A

Aneurysm
- the wall muscle is weakened and dilates.

*patients need to be anti-coagulated for this

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11
Q

If a patient following an M.I develops severe breathlessness and muffled heart sounds, what may have occurred?

A

Free wall rupture leading to cardiac tamponade

They need urgent paracentesis and surgical intervention

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12
Q

When is adenosine contraindicated? what drug is used instead?

A

Asthma

Calcium channel blocker

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13
Q

How do you treat acute mitral regurgitation following an M.I?

A

Treat as you would Acute pulmonary oedema

- assess to hear murmur and contact surgeons

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14
Q

What are the major types of M.I and how might you differentiate them?

A

Type I:

  • ischemic embolic
  • sudden onset
  • Angina before

Type II:

  • Ischemic imbalance between supply and demand
  • anaemia
  • hypovolemia
  • arrhythmias
  • Sepsis

Type II
- sudden cardiac arrest

Type IV
- PCI related

Type V
- CABG related

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15
Q

List some causes of LBBB and what would you expect the ST segments/ T waves to be doing?

A

Ischemia
M.I - in setting of chest pain is a STEMI
Aortic stenosis
Left ventricular hypertrophy

ST/ T - waves should go the opposite way to the QRS in LBBB.
- called appropriate discordance

*if they go the same way it is suggestive of ischemia

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16
Q

Why are repeat troponins done?

A

Two reasons:
- Looking for dynamic changes (someone may have a high troponin out with an M.I so looking for changes)

  • Lag - troponins take time to elevate. They may not be risen initially
17
Q

Which patients have atypical symptoms with an M.I?

A

Diabetics
Females
Elderly

18
Q

If there is diagnostic uncertainty surrounding an M.I what can be done?

A

Echocardiogram
- will show regional wall abnormality

**this is differentiated from myocarditis which in which there won’t be regional areas affect but entire heart

19
Q

What are some causes of gross ST elevation?

A

Pericarditis
Left main stem occlusion
Triple vessel disease

20
Q

What is the number one differential in ST depression in V2-V4?

A

Posterior wall infarct

*seen with a large R wave which is essential a flipped Q wave

21
Q

What is the syndrome associated with critical stenosis of the LAD with increased risk of STEMI in coming days?

A

Wellen’s syndrome

Associated with:

  • Biphasic T waves in V2-3
  • Deep T waves in V2-3
22
Q

What should patients be placed on following an M.I to assess for arrhythmias?

A

Telemetry

- continual ECG monitoring

23
Q

What does the GRACE score determine?

A

Assess the 6 month mortality which helps determines the need for angiography as in patient or outpatient

> 3% requires inpatient angiography and PCI within 72 hours

<3% this can be done at a later date as an outpatient.

24
Q

Which arterial vessels can be used for CABG?

A

Left internal mammary

Gastro-epiploic

*saphenous is a vein

25
Q

How is an NSTEMI managed if the patient is clinical unstable? hypotension/ arrhythmias/ refractory pain/ dynamic ECG changes?

A

Angiography and PCI

26
Q

What do you see on echo of takusubo cardiomyopathy?

A

Apical ballooning

27
Q

What rhythm will never have a pulse and will always need shocked?

A

V Fib

- don’t confuse it with VT in sometimes having a pulse.

28
Q

What is an accurate way of testing lipid levels in the bloods to establish a potential diagnosis of familial hypercholesteraemia?

A

fasting lipid profile

29
Q

Which situation are Nitrates contraindicated?

A

Severe Low BP

Aortic stenosis

Obstructive cardiomyopathy

*in aortic stenosis and obstructive cardiomyopathy you don’t want to reduce pre-load

30
Q

What devices can be used to assist the heart in severe heart failure?

A

Intra-aortic Balloon Pump

  • diastolic it expands
  • systolic it deflates (creates a vacuum sucking blood up)

Left ventricular device

ECMO

31
Q

In order to use ivabradine in heart failure there are two points that have to be met:

A

Be in sinus
- it works on the sodium channels

> 75bpm

32
Q

What are Episilon waves indicative of?

A

Arrhythmogenic right ventricular cardiomyopathy
- often the cause of VT and AF in young people

Episilon wave is a “notch” seen at the end of the ST segment
- usually followed by T wave inversion

33
Q

What ECG findings may be present of Hypertrophic obstructive cardiomyopathy? and what other arrhythmia is it associated with?

A

LBBB
Deep Q waves (called Dagger waves on chest leads)
T-wave inversion
Left ventricular hypertrophy

Associated with:
- Wolf -Parkinson White syndrome

34
Q

What is the diagnosis if a person presents with ACS symptoms, raised troponin and corresponding ECG changes.
Taken for PCI the vessels are patent.
Angiogram demonstrates no obstruction.

What is the likely diagnosis?

A

Takotsubo cardiomyopathy

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