interactive cases i Flashcards
What are the ix for chest pain?
1) ECG
2) Troponin
+ve: coronary angiography
-ve: ETT
3) Echocardiography
What are cardiac ddx of chest pain?
IHD
Aortic dissection
Pericarditis
What are resp ddx of chest pain?
PE
Pneumonia
Pneumothorax
What are GI ddx of chest pain?
Oesophageal spasm
Oesphagitis, gastritis
What is a musc ddx of chest pain?
Costochondritis
If pt has a drug hx of dexamethasone with a pc of chest pain, what does this point towards?
Dexamethasone is an immunosuppresant thus increased risk of inflammation/infection => GI => oesophagitis
Which leads would you see a STEMI for:
a) anteriolateral STEMI,
b) inferior STEMI?
a) V2-6, I, VL
b) II, III, VF (with reciprocal changes in I + VL)
What’s the treatment once identifed an anteriolateral STEMI?
Percutaneous coronary intervention
Name the coronary artery and leads affected for the following:
a) anterior MI
b) lateral MI
c) inferior MI
a) LAD, V1-4
b) Circumflex, V5-6, I, VL
c) RCA, II, III, VF
What in a collapse hx points towards a cardiac cause?
Before - no warning
During - no tongue biting
After - not confused
What are ddx of collapse?
Hypoglycaemia - do not ever forget glucose Heart - Vasovagal - Arrhythmia: unexplained death in FH - Outflow obstruction: dizziness, exertional chest pain - Postural hypotension: lying + standing BP different Brain - Seizures
Name left and right-sided causes of outflow obstruction to the heart
Left: aortic stenosis, HOCM
Right: PE
Causes of long QT syndrome
Congenital - K+ channel mutations - sudden death in FH Acquired - low K+/Mg2+, drugs
Cardiac causes of increased JVP
RHF - secondary to LHF - pulmonary HTN Tricuspid regurg - valve leaflets - R ventricle dilatation Constrictive pericarditis - infection; TB - inflammation; connective tissue disease, i.e. lupus - malignancy
Name four systolic murmurs (whooshing sound) and how to differentiate them
Aortic stenosis - loudest at aorta - radiates to carotids Mitral regurg - loudest at mitral v - radiates to axilla Tricuspid regurg - loudest at tricuspid v VSD (ventricular septal defect) - occurs in young person w/o features of cardiac disease
Name fours palpitations/tachycardia and their possible causes
Sinus tachycardia
- sepsis, hypovalaemia, endocrine (thyrotoxicosis, phaeochromacytoma)
SVT
- AVRT, AVRNT (re-entry circuits that keep depolarisation going)
AF
- thyrotoxicosis, alcohol
- heart: pericardium, muscle, valve
- lungs: PE, cancer, pneumonia
VT
- long QT, ischaemia, electrolyte imbalance
How do you treat SVT?
Vagal manoeuvres
Adenosine
How do you treat AF?
Rhythm control - onsent >48hrs, anticoagulate 3-4 weeks before cardioversion Rate control - beta blockers - digoxin
Treat underlying cause + complications (thromboembolism therefore anticoaulgate)
How do you treat VT?
If no haemodynamic compromise => IV amiodarone
ICD
Look for underlying cause
Pulseless VT => defibrillate
What would an ECG of LVH show?
Deep S in V1/2
Tall R in V5/6
S in V1 + R in V5/6 = Larger/equal to 7 squares
Distinguish the three heart blocks in an ECG
1st: long PR interval (>1 square)
2nd: P waves not followed by QRS complex
3rd: no association between P waves and QRS complexes and broad QRS complex
What would indicate ischaemia in an ECG?
ST elevation
T inversion
Q waves present (old MI)
What does a prominent R- wave indicate?
in V1 => tall R wave => strain on right-side of heart => PE
What are the possible heart sounds you may hear?
S1 => closure of mitral valve
S2 => closure of aortic valve
S3 => associated w/ ventricular filling
S4 => associated w/ ventricular hypertrophy
fixed wide splitting of S2 => atrial septal defect
Rx of acute heart failure
1) sit up
2) O2
3) Furosemide (iv)
4) GTN infusion
5) treat underlying cause
Ddx of pleuritic chest pain
Pericarditis; flu sx recently? PE; immobile/travel? Pneumonia; fever? Pneumothorax; sudden onset? Pleural pathology; weight loss/malignancy?
ALS algorithm for VF/pulseless VT
Shock CPR (2 mins) Assess rhythm Adrenaline every 3-5 mins Amiodarone after 3 shocks Correct reversible causes
ALS algorithm for asystole/PEA
CPR (2 mins)
Adrenaline every 3-5 mins
Correct reversible causes
