Emergancy Cardio Flashcards
What investigations do you want into a patient with pulmonary oedema:
Bloods:
- U&Es
- Troponins
- ABG
- NT- pro- BNP
Orifices:
- Catheter (in prep for diuresis)
Imaging:
- CXR
- Echo
ECG
What is your management of a patient with acute pulmonary oedema?
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
What is the triad of Cardiac tamponade?
Beck’s triad:
- low BP
- Muffled heart sounds
- Raised JVP
How do statins work?
HMG-CoA reductase
What are some signs of aortic dissection?
What is the test of choice?
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
What are the major risk factors for aortic dissection?
Hypertension
Smoking
Connective tissue disease
Bicuspid aortic
Syphilis
What are some causes of cardiogenic shock?
M.I Acute heart failure Arrhythmias Aortic dissection Obstructive causes
How are you going to treat an elderly person with structural heart disease who has AF, without adverse features?
Digoxin
- this a good rate limiting drug in the elderly that you are worried about giving a beta blocker to
How is left ventricular enlargement seen on an ECG?
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
What is an important cause of continual ST elevation and left ventricular failure following an M.I?
Aneurysm
- the wall muscle is weakened and dilates.
*patients need to be anti-coagulated for this
If a patient following an M.I develops severe breathlessness and muffled heart sounds, what may have occurred?
Free wall rupture leading to cardiac tamponade
They need urgent paracentesis and surgical intervention
When is adenosine contraindicated? what drug is used instead?
Asthma
Calcium channel blocker
How do you treat acute mitral regurgitation following an M.I?
Treat as you would Acute pulmonary oedema
- assess to hear murmur and contact surgeons
What are the major types of M.I and how might you differentiate them?
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
List some causes of LBBB and what would you expect the ST segments/ T waves to be doing?
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
Why are repeat troponins done?
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
Which patients have atypical symptoms with an M.I?
Diabetics
Females
Elderly
If there is diagnostic uncertainty surrounding an M.I what can be done?
Echocardiogram
- will show regional wall abnormality
**this is differentiated from myocarditis which in which there won’t be regional areas affect but entire heart
What are some causes of gross ST elevation?
Pericarditis
Left main stem occlusion
Triple vessel disease
What is the number one differential in ST depression in V2-V4?
Posterior wall infarct
*seen with a large R wave which is essential a flipped Q wave
What is the syndrome associated with critical stenosis of the LAD with increased risk of STEMI in coming days?
Wellen’s syndrome
Associated with:
- Biphasic T waves in V2-3
- Deep T waves in V2-3
What should patients be placed on following an M.I to assess for arrhythmias?
Telemetry
- continual ECG monitoring
What does the GRACE score determine?
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.
Which arterial vessels can be used for CABG?
Left internal mammary
Gastro-epiploic
*saphenous is a vein
