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Amir Sam Lectures > Lecture 1 - Cardio > Flashcards

Lecture 1 - Cardio Flashcards

1
Q

Name a calcium channel blocker

A

Amlodipine etc.

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2
Q

What are typical symptoms of Myocardial Infarction?

A

Tight, crushing chest pain.

Nausea, vomiting

Sweating

Syncope

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3
Q

How would you investigate a possible Myocardial Infarction?

A

1) ECG -
2) Troponin

+ve -> Coronary Angiography

  • ve: Exercise Tolerance Test
    3) Echo
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4
Q

How soon after symptoms present should Troponin be checked?

A

6 Hours

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5
Q

What may be the cause of chest pain in a patient using steroids, and why?

A

Oesophagitis due to an infection (eg. candidiasis)

Steroids are an immunosuppressant.

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6
Q

What is the first line treatment for a STEMI?

A

Percutaneous Coronary Intervention (Angioplasty/Stent Insertion)

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7
Q

In which leads would you see ST Elevation after a Lateral STEMI?

A

V5, V6, I, AVL.

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8
Q

In which leads would you see ST Elevation after an Anterior STEMI?

A

V1-V4

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9
Q

In which leads would you see ST Elevation after an Inferior STEMI?

A

II, III, AVF

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10
Q

Which MI location corresponds to which coronary artery?

A

Anterior = LAD

Lateral = Circumflex

Inferior = RCA

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11
Q

What happens before a person collapsing due to a cardiac cause?

A

Nothing. No warning, no aura.

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12
Q

What happens after a person collapsing due to a cardiac cause?

A

No confusion.

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13
Q

What murmur is heard in Aortic Stenosis?

A

Ejection Systolic

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14
Q

What is the DDX of Collapse?

A

DNEFG - Hypoglycaemia

Vasovagal

Arrhythmia

Outflow Obstruction

Postural Hypotension

Seizure

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15
Q

How would you investigate possible Arrhythmias?

A

ECG (?Long QT)

Cardiac Monitor - 24 Hour Tape

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16
Q

What types of outflow obstruction are there?

A

Left =

Aortic Stenosis

HOCM

Right = PE

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17
Q

How would you investigate Outflow Obstruction?

A

Low volume/Slow rising pulse OE

Ejection Systolic Murmur

Echo

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18
Q

What is Long QT Syndrome?

A

Congenital mutations in K+ channels causes abnormal ventricular repolarisation.

Can also be acquired, due to low K+/Mg2+ or drugs.

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19
Q

How would you identify Long QT Syndrome on an ECG?

A

In a normal person the T wave should terminate before the midpoint between two consecutive QRS complexes.

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20
Q

What causes a Pan-Systolic murmur?

A

Tricuspid regurgitation (louder on inspiration)

Mitral regurgitation (louder on expiration)

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21
Q

What is a quick rule to determine whether a murmur’s origin is left or right sided?

A

Left sided murmurs tend to be louder on expiration. Right sided murmurs tend to be louder on inspiration.

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22
Q

What are the causes of a raised JVP?

A

R-Sided Heart Failure

Tricuspid Regurgitation

Constrictive Pericarditis

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23
Q

What are the causes of Right-Sided Heart Failure?

A

Left-Sided Heart Failure (Congestive)

Pulmonary Hypertension (due to PE, COPD etc.)

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24
Q

What causes Tricuspid Regurgitation?

A

Valve Leaflets (Leakage)

R-Ventricle Dilatation

25
Q

What are the causes of Constrictive Pericarditis?

A

Infection - eg. TB

Inflammation - eg. Connective Tissue Disease

Malignancy.

26
Q

What can cause a Systolic Murmur?

A

Aortic Stenosis

Mitral/Tricuspid regurgitation

Ventricular Septal Disease

27
Q

How can you differentiate between the murmurs of Mitral Regurgitation and Aortic Stenosis?

A

Mitral Regurgitation -

Loudest in Mitral Region, radiates to Axilla, Pan-Systolic

Aortic Stenosis -

Loudest in Aortic region, radiates to the carotids, Ejection-Systolic.

28
Q

Which features in a case would indicate the presence of Ventricular Septal Disease?

A

The presence of a pan-systolic murmur in a young person, or patient with no other stigmata of cardiac disease.

29
Q

Give an example of a Thiazide Diuretic.

A

Bendroflumethiazide etc.

30
Q

How would consolidation present during an examination of the Respiratory System?

A

Dull Percussion Notes

Coarse Crackles

31
Q

What would be your DDX for a patient whose ECG shows Sinus Tachycardia?

A

Sepsis*

Hypovolaemia*

Thyrotoxicosis

Phaeochromocytoma

Pulmonary Embolism

Physiological (Anxiety)

32
Q

How would you differentiate between Sinus Tachy and SVT on an ECG?

A

Sinus Tachy shows a clear p-wave before every QRS.

SVT - Fast, regular, no p-waves.

33
Q

How would you differentiate between Atrial Flutter and SVT on an ECG?

A

Atrial Flutter would have a predictable rate of 150bpm (In 2:1 Block)

SVT tends to have a faster rate.

34
Q

What are the two types of SVT, and what is the difference?

A

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.

35
Q

How would you distinguish between the two forms of SVT?

A

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.

36
Q

How would you distinguish between AF and SVT.

A

SVT = Fast, no p-wave, regular.

AF = Fast, no p-wave, Irregular.

37
Q

How would you classify the causes of AF?

A

Thyrotoxicosis, Alcohol

Cardiac causes

Pulmonary causes

38
Q

What are the cardiac causes of AF?

A

Ischaemic Heart Disease

Pericarditis

Rheumatic Heart Disease

Hypertensive Heart Disease

Valve Disease

39
Q

What are the pulmonary causes of AF?

A

Pneumonia

PE

Malignancy

40
Q

What are the causes of VT?

A

Ischaemia

Electrolyte Abnormalities

Long QT

41
Q

What would be your management plan for a patient with SVT?

A

1) Vagal Manoeuvres
2) Adenosine (whilst the patient is attached to a cardiac monitor)
3) DC Cardioversion, if there is evidence of Haemodynamic Compromise.

42
Q

What your management plan be for a patient with acute fast AF?

A

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.

43
Q

How would you manage a case of VT?

A

If no haemodynamic compromise: IV Amiodarone

Long Term: ICD

Treat underlying Cause

Pulseless VT: Defribrillate.

44
Q

What diagnosis is suggested by this ECG?

A

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

45
Q

What diagnosis is suggested by this ECG?

A

1st Degree Heart Block

Prolonged PR Interval

Should be less than 1 large square.

46
Q

What diagnosis is suggested by this ECG?

A

2nd Degree Heart Block

The presence of P-Waves without a QRS complex.

47
Q

What diagnosis is suggested by this ECG?

A

3rd Degree Heart Block

No association between P Waves and QRS complexes.

48
Q

Which ECG Changes are suggestive of Ischaemic Heart Disease?

A

ST Elevation

T Wave Inversion

Q Waves (old MI)

49
Q

Which ECG Changes are suggestive of Arrhythmia or Conduction Defects?

A

Rate Changes

Rhythm Changes

PR Interval

QRS

QT Interval

50
Q

What ECG changes are associated with Ventricular Strain or Hypertrophy?

A

Axis Deviation

R Wave (eg. Dominant R Wave in V1 is indicative of strain on the right side of the heart.)

S Wave

51
Q

What is suggested by the presence of a third Heart Sound (S3)?

A

Congestive Heart Failure

52
Q

What would you hear on Auscultation of a patient with Heart Failure?

A

Fine Crackles.

53
Q

What diagnosis would be suggested by the presence of ‘Fixed wide spitting of S2’?

A

Atrial Septal Defect

54
Q

What is the cause of a 4th Heart Sound (S4)?

A

Ventricular Hypertrophy

55
Q

What would be your immediate management plan in an Acute case of Heart Failure?

A

1) Sit the patient up and give 60-100% O2
2) Start on IV Furosemide
3) May need GTN Infusion

Treat the Cause

56
Q

What diagnosis does this ECG suggest?

A

Ventricular Fibrillation

57
Q

What diagnosis is suggested by this ECG?

A

Widespread Saddle-Shaped ST Elevation

58
Q

What are the causes of Pleuritic Chest Pain (worse on inspiration)?

A

Pericarditis

PE

Pneumonia

Pneumothorax

Pleural pathology

(Sub-Diaphragmatic Pathology, eg. Abscess)

Amir Sam Lectures (6 decks)

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