General

Question 1

Which ECG changes can arise from previous ischaemic damage?

Answer 1

1. LBBB
2. ST elevation
3. pathological p waves
4. T wave inversion
5. Negative QRS

Question 2

In which leads is it normal to see a negative QRS complex?

Answer 2

V1, V2, aVR

Question 3

List causes of a raised troponin?

Answer 3

tachycardia, fluid overload, myocarditis, trauma, poor renal function (poor excretion of troponin). Don’t always assume STEMI if there are no ECG changes and small rise in troponin

Question 4

How does left ventricular hypertrophy appear in an ECG?

Answer 4

Increased QRS/R wave amplitude, left axis deviation

Question 5

What is Beck’s triad?

Answer 5

indicative of cardiac tamponade= fluid accumulation within pericardial sac. Signs are hypotension, distended neck veins, and muffled heart sounds

Question 6

Pathology in which three systems can result in fluid overload?

Answer 6

1. Heart (majority of causes)
2. Liver
3. Kidneys (rarest)

Question 7

How might the fluid distribution differ in someone with heart failure versus someone with liver failure?

Answer 7

Heart failure- legs, sacral oedema

Liver failure- ascites

Question 8

Young person with palpitations associated with going to sleep. Episodes last around 10 mins, feels like they are missing a beat. Diagnosis?

Answer 8

supraventricular premature beats= benign condition, no treatment, reassuring advice

Question 9

Feature of pericarditis on ECG?

Answer 9

saddle ST elevation widespread

Question 10

What is the investigation for aortic dissection?

Answer 10

CT angio aorta (can see ST elevation in ECG but this is not diagnostic!)

Question 11

What are the components of CHA2DS2-VASC score?

Answer 11

congestive heart failure
hypertension >140/90
age >75
diabetes
stroke/TIA
vascular disease
ages 65-74
sex- female

Question 12

A 71-year-old man who is known to have atrial fibrillation comes for review. He had a transient ischaemic attack two weeks ago and takes bendroflumethiazide for hypertension but is otherwise well. His latest blood pressure is 124/76 mmHg. You are discussing management options to try and reduce his future risk of having a stroke. What is his CHA2DS2-VASc score?

Answer 12

4

One point for hypertension, one point for being over the age of 65 years (but under the age of 75 years) and two points (‘S2’) for the recent TIA.

Question 13

Chest pain reduced by leaning forward. Saddle shaped ST elevation in most leads and PR depression. What is the likely treatment and diagnosis?

Answer 13

acute pericarditis

NSAIDs and colchicine