Gen Med 1 Cardio Flashcards
60 M, chest pain and tightness. Nausea, sweating, breathlessness
Has HTN and takes amlodipine.
What is the most likely diagnosis?
Myocardial Infarction
What investigations do you do for an MI?
ECG Troponin i. If positive do a coronary angiogram ii. if negative fo an ETT Echocardiograph
What are the differentials of chest pain?
Cardiac
Respiratory
GI
Musculoskeletal
What are the cardiac causes of chest pain?
- Angina (IHD)
- MI (IHD)
- Pericarditis
- Aortic dissection
What are the respiratory causes of chest pain?
- Pneumonia
- PE
- Pleural effusion
- Pulmonary oedema
- Pneumothorax
- Collapsed lung
What are the GI causes of chest pain?
- Oesophageal spasm
- Oesophagitis
- GORD
- Hernia (hiatus)
- Oesophageal varices
What are the musculoskeletal causes of chest pain?
Costochondritis
Which ECG changes denotes an anterior MI?
– Left Anterior Descending Art.
– V1‐V4
Which ECG changes denotes a lateral MI?
- Circumflex
- V5, V6, Li, aVL
Which ECG changes denotes an inferior MI?
- Right coronary Artery
- LII, LIII, aVF
How do cardiac enzymes change after an MI?
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
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?
Tachyarrhythmia
What are the differentials for collapse?
Hypoglycaemia Cardiac i. vasovagal ii. arrhythmia iii. outflow obstruction (aortic stenosis/ HOCM/ PE) iv. postural hypotension CNS i. seizure
What do we look for for arrhythmias?
long QT (ECG)
Cardiac monitor
24 hr tape
What do we look for in Outflow obstruction?
Low volume/ slow rising pulse
ESM
Echo
What do we look for in postural hypotension?
Lying/ standing BP
What is long QT syndrome?
Abnormal ventricular repolarisation
Congenitally acquired (e.g. via mutations in the K+ channel)
FH of sudden death
Acquired( e.g. Low K+/ Mg2+. drugs)
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?
Tricuspid regurgitation
What are the differentials for a raised JVP?
- R heart failure (secondary to left heart failure, pulmonary HTN)
- Tricuspid regurgitation (valve leaflets, R ventricle dilatation)
- Constrictive pericarditis (infection, infl. , malignancy)
What are the differentials of a systolic murmur?
- Aortic stenosis
- Mitral regurgitation
- Tricuspid regurgitation
- VSD
How do you differentiate murmurs?
• Where is it
loudest/radiation?
• Associated features
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?
Atrial Fibrillation
What causes sinus tachy on an ECG?
Sepsis,
hypovolaemia,
endocrine (thyrotoxicosis,
phaeochromocytoma)
What causes SVT?
Re-entry circuits (AVRT and AVNRT)
What causes AF?
Thyrotoxicosis, alcohol
• Heart: muscle, valve, pericardium
• Lungs: Pneumonia, PE, cancer
What causes a VT?
ischaemia,
electrolyte abnormality,
long QT
What is an ECG sign of AVRT?
Short PR with delta wave (slow upslope of R)
What is the management of SVT?
- Vagal maneuvers
- Adenosine (cardiac monitor)
- DC cardioversion if evidence of haemodynamic compromise
What is the management of AF?
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)
What is the management of VT?
If no haemodynamic compromise: IV Amiodarone
• Look for & treat underlying cause
• ICD
• Pulseless VT: defibrillate
What ECG changes are shown by LVH?
• (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
What is shown in 1st degree heart block?
Long PR
What is 2nd degree heart block?
Dropped QRS periodically
What is 3rd degree heart block?
P and QRS not associated
What would you see on an ECG for ischaemia, arrhythmias and ventricular hypertrophy/ strain?
- Ischaemia
- ST, T, Q
- Arrhythmia or conduction defects
- Rate, Rhythm
- PR, QRS, QT
- Ventricular strain or hypertrophy
- Axis, R, S
What is each heart sound linked to?
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
What is the management of acute heart failure?
Sit up Oxygen Furosemide IV GTN infusion Treat underlying cause
How do you treat VF or pulseless VT?
- Shock
- CPR (2 min)
- Assess rhythm
- Adrenaline every 3‐5 min
- Amiodarone after 3 shocks
- Correct reversible causes
How do you treat Asystole or PEA?
- CPR (2 min)
- Adrenaline every 3‐5 min
- Correct reversible causes
What are the differentials of pleuritic chest pain?
- Pericarditis
- PE
- Pneumonia
- Pneumothorax
- Pleural pathology
- Sub‐diaphragmatic pathology
