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DPD Stuff > Gen Med 1 Cardio > Flashcards

Gen Med 1 Cardio Flashcards

1
Q

60 M, chest pain and tightness. Nausea, sweating, breathlessness
Has HTN and takes amlodipine.

What is the most likely diagnosis?

A

Myocardial Infarction

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2
Q

What investigations do you do for an MI?

A 
ECG
Troponin
i. If positive do a coronary angiogram
ii. if negative fo an ETT
Echocardiograph
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3
Q

What are the differentials of chest pain?

A

Cardiac
Respiratory
GI
Musculoskeletal

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4
Q

What are the cardiac causes of chest pain?

A
  • Angina (IHD)
  • MI (IHD)
  • Pericarditis
  • Aortic dissection
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5
Q

What are the respiratory causes of chest pain?

A
  • Pneumonia
  • PE
  • Pleural effusion
  • Pulmonary oedema
  • Pneumothorax
  • Collapsed lung
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6
Q

What are the GI causes of chest pain?

A
  • Oesophageal spasm
  • Oesophagitis
  • GORD
  • Hernia (hiatus)
  • Oesophageal varices
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7
Q

What are the musculoskeletal causes of chest pain?

A

Costochondritis

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8
Q

Which ECG changes denotes an anterior MI?

A

– Left Anterior Descending Art.

– V1‐V4

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9
Q

Which ECG changes denotes a lateral MI?

A
  • Circumflex

- V5, V6, Li, aVL

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10
Q

Which ECG changes denotes an inferior MI?

A
  • Right coronary Artery

- LII, LIII, aVF

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11
Q

How do cardiac enzymes change after an MI?

A

Tropnin peaks 1-2 days after a large MI rising quickly or within the first day after a small MI

CK/ myoglobin peaks a few hours after an MI

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12
Q

30 M collapse with no warning, no tongue biting and no confusion. Brother died at a young age.
Normal examination findings
What is the likley diagnosis?

A

Tachyarrhythmia

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13
Q

What are the differentials for collapse?

A 
Hypoglycaemia
Cardiac
i. vasovagal
ii. arrhythmia
iii. outflow obstruction (aortic stenosis/ HOCM/ PE)
iv. postural hypotension
CNS
i. seizure
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14
Q

What do we look for for arrhythmias?

A

long QT (ECG)
Cardiac monitor
24 hr tape

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15
Q

What do we look for in Outflow obstruction?

A

Low volume/ slow rising pulse
ESM
Echo

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16
Q

What do we look for in postural hypotension?

A

Lying/ standing BP

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17
Q

What is long QT syndrome?

A

Abnormal ventricular repolarisation
Congenitally acquired (e.g. via mutations in the K+ channel)
FH of sudden death
Acquired( e.g. Low K+/ Mg2+. drugs)

18
Q

45 yr old man, fever, malaise, drug use- 38 degrees, increased JVP, S1S2PSM (louder on inspiration) and hepatomegaly.

What is the most likely cause of his raised JVP?

A

Tricuspid regurgitation

19
Q

What are the differentials for a raised JVP?

A
  • R heart failure (secondary to left heart failure, pulmonary HTN)
  • Tricuspid regurgitation (valve leaflets, R ventricle dilatation)
  • Constrictive pericarditis (infection, infl. , malignancy)
20
Q

What are the differentials of a systolic murmur?

A
  • Aortic stenosis
  • Mitral regurgitation
  • Tricuspid regurgitation
  • VSD
21
Q

How do you differentiate murmurs?

A

• Where is it
loudest/radiation?
• Associated features

22
Q 
65 M
Breathless, palpitations
HTN
on Bendroflumethiazide
38C
160 bpm, irregular
110/80
Dull percussion with coarse crackles in L base

What will you see on an ECG?

A

Atrial Fibrillation

23
Q

What causes sinus tachy on an ECG?

A

Sepsis,

hypovolaemia,

endocrine (thyrotoxicosis,
phaeochromocytoma)

24
Q

What causes SVT?

A

Re-entry circuits (AVRT and AVNRT)

25
Q

What causes AF?

A

Thyrotoxicosis, alcohol
• Heart: muscle, valve, pericardium
• Lungs: Pneumonia, PE, cancer

26
Q

What causes a VT?

A

ischaemia,
electrolyte abnormality,
long QT

27
Q

What is an ECG sign of AVRT?

A

Short PR with delta wave (slow upslope of R)

28
Q

What is the management of SVT?

A
  • Vagal maneuvers
  • Adenosine (cardiac monitor)
  • DC cardioversion if evidence of haemodynamic compromise
29
Q

What is the management of AF?

A 
Rhythm control
• If onset > 48hours, anticoagulate for 3‐4 weeks before 
cardioversion
• Rate control
– beta blocker
– Digoxin
• Think of the underlying 
Cause
• Think of the 
Complications (Anticoagluation)
30
Q

What is the management of VT?

A

If no haemodynamic compromise: IV Amiodarone
• Look for & treat underlying cause
• ICD
• Pulseless VT: defibrillate

31
Q

What ECG changes are shown by LVH?

A 
• (Remember SR)
• Deep S in V1/2
• Tall R in V5/6
• S in V1 + R in V5 or V6
(whichever is larger) ≥ 7 
large squares
32
Q

What is shown in 1st degree heart block?

A

Long PR

33
Q

What is 2nd degree heart block?

A

Dropped QRS periodically

34
Q

What is 3rd degree heart block?

A

P and QRS not associated

35
Q

What would you see on an ECG for ischaemia, arrhythmias and ventricular hypertrophy/ strain?

A
  • Ischaemia
  • ST, T, Q
  • Arrhythmia or conduction defects
  • Rate, Rhythm
  • PR, QRS, QT
  • Ventricular strain or hypertrophy
  • Axis, R, S
36
Q

What is each heart sound linked to?

A 
S1. Closure of mitral valve
S2. Closure of aortic valve
FIXED WIDE SPLITTING OF S2. Atrial septal defect
S3. Associated with 
ventricular filling
S4. Associated with 
ventricular hypertrophy
37
Q

What is the management of acute heart failure?

A 
Sit up
Oxygen 
Furosemide IV
GTN infusion
Treat underlying cause
38
Q

How do you treat VF or pulseless VT?

A
  • Shock
  • CPR (2 min)
  • Assess rhythm
  • Adrenaline every 3‐5 min
  • Amiodarone after 3 shocks
  • Correct reversible causes
39
Q

How do you treat Asystole or PEA?

A
  • CPR (2 min)
  • Adrenaline every 3‐5 min
  • Correct reversible causes
40
Q

What are the differentials of pleuritic chest pain?

A
  • Pericarditis
  • PE
  • Pneumonia
  • Pneumothorax
  • Pleural pathology
  • Sub‐diaphragmatic pathology

DPD Stuff (23 decks)

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