Lecture 1 - Cardio Flashcards
Name a calcium channel blocker
Amlodipine etc.
What are typical symptoms of Myocardial Infarction?
Tight, crushing chest pain.
Nausea, vomiting
Sweating
Syncope
How would you investigate a possible Myocardial Infarction?
1) ECG -
2) Troponin
+ve -> Coronary Angiography
- ve: Exercise Tolerance Test
3) Echo
How soon after symptoms present should Troponin be checked?
6 Hours
What may be the cause of chest pain in a patient using steroids, and why?
Oesophagitis due to an infection (eg. candidiasis)
Steroids are an immunosuppressant.
What is the first line treatment for a STEMI?
Percutaneous Coronary Intervention (Angioplasty/Stent Insertion)
In which leads would you see ST Elevation after a Lateral STEMI?
V5, V6, I, AVL.
In which leads would you see ST Elevation after an Anterior STEMI?
V1-V4
In which leads would you see ST Elevation after an Inferior STEMI?
II, III, AVF
Which MI location corresponds to which coronary artery?
Anterior = LAD
Lateral = Circumflex
Inferior = RCA
What happens before a person collapsing due to a cardiac cause?
Nothing. No warning, no aura.
What happens after a person collapsing due to a cardiac cause?
No confusion.
What murmur is heard in Aortic Stenosis?
Ejection Systolic
What is the DDX of Collapse?
DNEFG - Hypoglycaemia
Vasovagal
Arrhythmia
Outflow Obstruction
Postural Hypotension
Seizure
How would you investigate possible Arrhythmias?
ECG (?Long QT)
Cardiac Monitor - 24 Hour Tape
What types of outflow obstruction are there?
Left =
Aortic Stenosis
HOCM
Right = PE
How would you investigate Outflow Obstruction?
Low volume/Slow rising pulse OE
Ejection Systolic Murmur
Echo
What is Long QT Syndrome?
Congenital mutations in K+ channels causes abnormal ventricular repolarisation.
Can also be acquired, due to low K+/Mg2+ or drugs.
How would you identify Long QT Syndrome on an ECG?
In a normal person the T wave should terminate before the midpoint between two consecutive QRS complexes.
What causes a Pan-Systolic murmur?
Tricuspid regurgitation (louder on inspiration)
Mitral regurgitation (louder on expiration)
What is a quick rule to determine whether a murmur’s origin is left or right sided?
Left sided murmurs tend to be louder on expiration. Right sided murmurs tend to be louder on inspiration.
What are the causes of a raised JVP?
R-Sided Heart Failure
Tricuspid Regurgitation
Constrictive Pericarditis
What are the causes of Right-Sided Heart Failure?
Left-Sided Heart Failure (Congestive)
Pulmonary Hypertension (due to PE, COPD etc.)
What causes Tricuspid Regurgitation?
Valve Leaflets (Leakage)
R-Ventricle Dilatation
What are the causes of Constrictive Pericarditis?
Infection - eg. TB
Inflammation - eg. Connective Tissue Disease
Malignancy.
What can cause a Systolic Murmur?
Aortic Stenosis
Mitral/Tricuspid regurgitation
Ventricular Septal Disease
How can you differentiate between the murmurs of Mitral Regurgitation and Aortic Stenosis?
Mitral Regurgitation -
Loudest in Mitral Region, radiates to Axilla, Pan-Systolic
Aortic Stenosis -
Loudest in Aortic region, radiates to the carotids, Ejection-Systolic.
Which features in a case would indicate the presence of Ventricular Septal Disease?
The presence of a pan-systolic murmur in a young person, or patient with no other stigmata of cardiac disease.
Give an example of a Thiazide Diuretic.
Bendroflumethiazide etc.
How would consolidation present during an examination of the Respiratory System?
Dull Percussion Notes
Coarse Crackles
What would be your DDX for a patient whose ECG shows Sinus Tachycardia?
Sepsis*
Hypovolaemia*
Thyrotoxicosis
Phaeochromocytoma
Pulmonary Embolism
Physiological (Anxiety)
How would you differentiate between Sinus Tachy and SVT on an ECG?
Sinus Tachy shows a clear p-wave before every QRS.
SVT - Fast, regular, no p-waves.
How would you differentiate between Atrial Flutter and SVT on an ECG?
Atrial Flutter would have a predictable rate of 150bpm (In 2:1 Block)
SVT tends to have a faster rate.
What are the two types of SVT, and what is the difference?
AVNRT - The re-entry circuit is within the AVN.
AVRT - An accessory pathway exists within the Ventricular wall. The Wave of depolarisation therefore passes down both the Bundle of His, and the Ventricular walls.
How would you distinguish between the two forms of SVT?
AVRT tends to present with a short PR interval, and a Delta Wave (R-Wave Upstroke) on ECG.
*You won’t see a delta wave when the patient is in tachycardia. The wave of depolarisation goes down the correct route, yet uses the accessory pathway to return directly to the AVN.
How would you distinguish between AF and SVT.
SVT = Fast, no p-wave, regular.
AF = Fast, no p-wave, Irregular.
How would you classify the causes of AF?
Thyrotoxicosis, Alcohol
Cardiac causes
Pulmonary causes
What are the cardiac causes of AF?
Ischaemic Heart Disease
Pericarditis
Rheumatic Heart Disease
Hypertensive Heart Disease
Valve Disease
What are the pulmonary causes of AF?
Pneumonia
PE
Malignancy
What are the causes of VT?
Ischaemia
Electrolyte Abnormalities
Long QT
What would be your management plan for a patient with SVT?
1) Vagal Manoeuvres
2) Adenosine (whilst the patient is attached to a cardiac monitor)
3) DC Cardioversion, if there is evidence of Haemodynamic Compromise.
What your management plan be for a patient with acute fast AF?
Rate Control:
Beta Blocker, Digoxin
Rhythm Control:
DC Cardioversion.
Risk of Stroke if >48 Hours, so Anticoagulate for 3-4 Weeks before Cardioversion.
Remember to treat the Cause, and consider Complications.
How would you manage a case of VT?
If no haemodynamic compromise: IV Amiodarone
Long Term: ICD
Treat underlying Cause
Pulseless VT: Defribrillate.
What diagnosis is suggested by this ECG?
Left Ventricular Hypertrophy - Not diagnostic, merely suggestive.
Voltage Criteria =
Deep S in V1/2
Tall R in V5/6
S in V1 + R in V5/6 >7 squares
What diagnosis is suggested by this ECG?
1st Degree Heart Block
Prolonged PR Interval
Should be less than 1 large square.
What diagnosis is suggested by this ECG?
2nd Degree Heart Block
The presence of P-Waves without a QRS complex.
What diagnosis is suggested by this ECG?
3rd Degree Heart Block
No association between P Waves and QRS complexes.
Which ECG Changes are suggestive of Ischaemic Heart Disease?
ST Elevation
T Wave Inversion
Q Waves (old MI)
Which ECG Changes are suggestive of Arrhythmia or Conduction Defects?
Rate Changes
Rhythm Changes
PR Interval
QRS
QT Interval
What ECG changes are associated with Ventricular Strain or Hypertrophy?
Axis Deviation
R Wave (eg. Dominant R Wave in V1 is indicative of strain on the right side of the heart.)
S Wave
What is suggested by the presence of a third Heart Sound (S3)?
Congestive Heart Failure
What would you hear on Auscultation of a patient with Heart Failure?
Fine Crackles.
What diagnosis would be suggested by the presence of ‘Fixed wide spitting of S2’?
Atrial Septal Defect
What is the cause of a 4th Heart Sound (S4)?
Ventricular Hypertrophy
What would be your immediate management plan in an Acute case of Heart Failure?
1) Sit the patient up and give 60-100% O2
2) Start on IV Furosemide
3) May need GTN Infusion
Treat the Cause
What diagnosis does this ECG suggest?
Ventricular Fibrillation
What diagnosis is suggested by this ECG?
Widespread Saddle-Shaped ST Elevation
What are the causes of Pleuritic Chest Pain (worse on inspiration)?
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
(Sub-Diaphragmatic Pathology, eg. Abscess)
