MedEd Flashcards
A 75 year old male with known colorectal carcinoma presents to A&E
with chest pain and shortness of breath. The pain is worse on breathing
in and coughing. What other sign/symptom would aid your diagnosis?
a Gradual onset chest pain
b Absent peripheral pulses
c Collapsing Pulse
d Haemoptysis
e Abdominal Pain
d Haemoptysis
Mr B a 52 year old male presents to his GP with central, tight chest
pain. He has noticed the pain comes on when he is gardening or walking
to the bus stop in a hurry, but normally goes away when he rests. What
medication would the GP prescribe to treat his underlying condition?
a GTN spray
b Propanolol (Beta Blocker)
c Ramipril (ACEi)
d Aspirin
e Atorvastatin (Statin)
b Propanolol (Beta Blocker)
GTN is to control chest pain
A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis? a Aortic Dissection b STEMI c Teitze’s Syndrome d Costochondritis e Pulmonary Embolism
a Aortic Dissection
A 54 year old gentleman with a BMI of 27kg/m2 presents with burning chest pain. He finds that it is often worse in the evening and has noted a strange taste in his mouth. What is the most likely diagnosis? a Angina b Teitze’s Syndrome c Aortic Dissection d GORD e Pericarditis
d GORD
def of angina
chest pain due to myocardial ischaemia
what brings on angina
exercise
what relieves angina
rest
what is the pathophysiology of angina
atherosclerosis in coronary arteries (CAD)
what is decubitus angina
chest pain when lying down
what is printzmetal angina
chest pain due to coronary artery vasospasm
what is unstable angina
chest pain at rest
what is syndrome X
chest pain but with normal exercise tolerance and normal coronary angiograms
history of ACS or angina
sudden onset central chest pain which is crushing and tight in nature
radiates to L arm/jaw
associated with sweating, nausea, SOB
exacerbated by exertion, relieved by rest
how is angina diagnosed
triad of angina features
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
what is typical angina?
all 3 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
what is atypical angina?
2 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
what should be done in the case of unstable angina
likely ACS
emergency admission into hospital required
what should be done with stable angina but without known CAD
this could be an atypical angina complete investigations 1 CT coronary angiography 2 functional imagina 3 invasive coronary angiography
how should atypical angina be investigated
exercise ECG or stress testing
or echo
what is the medical management for angina
anti-anginals such as BB/CCBs
preventative or episodic treatment such as GTN spray
when should an ambulance be called after adminstering GTN
If no relief after 5 minutes with 2nd spray
def of aortic dissection
tear in tunica intima resulting in blood between the inner and outer tunica media (false lumen)
what classification is used for aortic dissection
stanford classification
how are aortic dissections classified
type a - tear in ascending aorta
type b - tear in descending aorta (after left subclavian branch)
what are risk factors for aortic dissection
ABCD
Atherosclerosis/Ageing
Blood pressure high
CTDs (SLE, marfans, ehlers-danlos)
Drugs (cocaine)
history of aortic dissection
sudden onset central tearing chest pain which radiates to the back
what history would you expect with a false lumen occluding the carotids
black out
hemiparesis
what history would you expect with a false lumen occluding the coronary arteries
angina
MI
what history would you expect with a false lumen occluding the renal artery
AKI
renal failure
what history would you expect with a false lumen occluding the coeliac trunk
severe abdo pain
examination of aortic dissection
tachycardia
BP discrepancy >20mmHg between arms
WPP
murmur on the back radiated from the left scapulae to the abdomen
what are the signs of aortic insufficiency
WPP + collapsing pulse
EDM
what is the gold standard for aortic dissection
gold standard investigation for intimal flap
what would you see on a CXR with aortic dissection
widened mediastinum and aortic notch visible
what might you see on an ECG with aortic dissection
LVH hypertrophy
def of pericarditis
inflammation of the pericardial sac
what are causes of pericarditis
CARDIAC RIND Collagen vascular disease Autoimmune/Aortic Aneurysm Radiation Drugs Infection (viral or bacterial) Acute renal failure Cardiac infarction Rheumatic Fever Injury/idiopathic Neoplasm Dresslers syndrome
what are viral causes of pericarditis
Viral – coxsackie, flu, EBV, mumps
what are bacterial causes of pericarditis
pneumonia, strep, staph, TB, RF
history of pericarditis
sharp pleuritic central chest pain which can radiate to the neck and shoulders
associated with fever + SOB
worse when lying down, breathing in and coughing
better when leading forward
examination of pericarditis
pericardial friction rub “walking on snow”
soft S1
S4 gallop
complications of pericarditis
cardiac tamponade
pericardial effusion
def of PE
sudden occlusion of pulmonary vessel due to thrombus formation
is ventilation of perfusion affected in PE
perfusion
history of PE
sudden onset SOB and pleuritic chest pain which can be left or right sided depending on where the thrombus lodges
associated with haemoptysis, leg swelling
made worse by coughing or breathing in
examination of PE
tachycardia + tachypnoea
cyanosis (if large)
leg swelling
how should a PE be managed
dependent on the wells score
if high (>4) then give LMWH until INR>2
then give warfarin
how should a PE be managed if the patient is haemodynamically unstable
thrombolysis or embolectomy
def of GORD
reflux of gastric contents into the oesophagus often as a result of a reduced LOS tone or hiatus hernia
history of GORD
slow onset of central burning, retrosternal chest pain which may radiate to the stomach and neck
associated with an acidic taste in mouth, sore throat and cough
often comes on after meals or when lying down
RFs for GORD
stress
obesity
pregnancy
invesitgations for GORD
ECG to exclude cardiac causes
OGD, barium swallow
def of chostochondritis
temporary inflammation of the costal cartilages
causes of chostochondritis
idiopathic
strenuous lifting
infection
what sort of pain is chostochondritis
pleuritic chest pain with tenderness on the sides od the sternum
which chostosternal joints are typically affected in chostochondritis
3/4/5
what is teitzes syndrome
inflammation of the costal cartilage similar to chostochondritis however there is also palpable swelling
which chostosternal joints are typically affected in teitzes syndrome
2/3
what is the treatment for chostochondritis or teitzes syndromr
rest
NSAIDs
corticosteroid injections if severe
A 60 year old patient presents to A&E with central crushing chest pain, radiating to the jaw. His ECG is normal. What is the next step? a Creatine Kinase b Repeat ECG c Discharge d Exercise ECG e Troponin
e Troponin
A 46 year old diabetic man presents to A&E following collapse. The patient is very distressed and is sweating. On the way to the hospital, his wife had to stop the car to allow him to vomit. His ECG is normal but his 12 hour troponins are positive. What is the most likely diagnosis? a Inferior STEMI b Anterior STEMI c NSTEMI d Unstable Angina e Ventricular Wall Aneurysm
c NSTEMI (ECG can be normal in NSTEMI)
A 68 year old patient presents to A&E with sharp central chest pain. She was discharged 4 weeks ago following an MI. Her ECG shows saddle-shaped ST segments diffusely. What is the most likely diagnosis? a Repeat MI b Dressler’s Syndrome c Pericarditis d Ventricular Wall Aneurysm e Heart Failure
b Dressler’s Syndrome
A 56 year old overweight man with a history of high cholesterol comes in complaining of central crushing chest pain that came on at rest. He has had a similar pain before but only when playing tennis. His ECG shows ST depression and a 12 hour troponin is negative. a Inferior STEMI b Anterior STEMI c NSTEMI d Unstable Angina e Ventricular Wall Aneurysm
d Unstable Angina (if troponin is negative it is unstable angina, even with ST depression)
what is ACS
an umbrella term for unstable, NSTEMI, STEMI
what is a STEMI
ST elevation MI
complete occlusion of coronary artery resulting in myocardial infarction
what would be seen on an ECG with a STEMI
ST elevation
new onset LBBB
what is a NSTEMI
non-ST elevation MI
partial occlusion of coronary artery resulting in myocardial ischaemia (permanent myocardial damage)
what is raised in a NSTEMI (and STEMI)
creatine kinase and troponin
what is not raised in unstable angina
troponin or CK
what would be seen on an ECG with NSTEMI
MAY have ST depression, T wave inversion or normal ECG
what are the ischaemic complications of MI
repeat MI
post-infarction angina
what should be measured if a repeat MI is suspected
CK-MB rather than troponins
what does post-infarction angina normally occur
hours to days post MI
what are the mechanical complications of MI
HF
papillary muscle rupture
ventricular aneurysm
why does HF occur post MI
damaged cardiac tissue
what are signs of papillary muscle rupture post MI
new and loud PSM (MR) which radiates to the axilla
how does ventricular aneurysm occur post MI
from weakened ventricular wall from damaged cardiac tissue
what can a ventricular aneurysm post MI cause
blocking blood from heart
what are the arrythmic complications of MI
infarcted and damaged tissue can change electrical characteristics leading to formation of re-entry circuits such as:
1 VT
2 VF
3 complete heart block
how is pericarditis associated with MI
often develops soon after MI due to a inflammatory response to necrotic tissue
how is dresslers syndrome associated with MI
occurs weeks after MI due to antibodies forming against circulating myocardial antigens
A 50 year old man presents to his GP with central chest pain. The ECG shows a STEMI. His sats are 96%. What medication should the GP give whilst waiting for an ambulance? a Fondaparinux 2.5mg b Oxygen c Propanolol d Aspirin/Clopidogrel 300mg e Ramipril
d Aspirin/Clopidogrel 300mg
A 70 year old female with known hypertension and hypercholesterolaemia presents with central crushing chest pain, which radiates to the left arm. The pain started 2 hours ago. Her ECG shows LBBB. What is the most appropriate management. a Thrombolysis b Angiography c Fibrinolysis d PCI e CABG f Fondaprinux
d PCI
A 78 year old woman is bought to A&E following chest pain. Her ECG shows ST depression and T-wave inversion. 12 hour troponins are positive. What is the most appropriate management? a PCI b Fibrinolysis c Fondaparinux d CABG e Thrombolysis f Angiography
c Fondaparinux
A man is being discharged following an MI. Which of the following drugs should not make up a part of his post MI management? a ACEi b Aspirin c Clopidogrel d Heparin e Statin f B-Blocker
d Heparin
what is the management of ACS
ABCDEFG 1 oxygen (if sats <90%) 2 3As -antiplatelets (aspirin + clopidogrel) -analgesic (morphine) -anti-ischaemic (GTN)
what is the principle aim of STEMI management
coronary reperfusion therapy (open coronary vessels to allow blood flow to the myocardium)
what are therapies for coronary reperfusion after STEMI
PCI
fibrinolysis
when would PCI be used after a STEMI
if patient presents within 12hrs of onset of symptoms and it can happen before fibrinolysis could be given (within 2hrs)
what would fibrinolysis be used after a STEMI
patient presents within 1 hours of symptoms
what is the management of STEMI if a patient presents >12hrs after onset of symptoms
coronary angiography with follow up PCI if indicated
what is the management for an NSTEMI/unstable angina
IMMEDIATE aspirin + antithrombin therapy (fondaparinux with low bleeding risk, LMWH as an alternative if pts are undergoing coronary angiography within 24hrs of admission)
what is the score used to determine 6month mortality of NSTEMI patients
GRACE Risk
what is the treatment for high risk NSTEMI/unstable angina
IV glycoprotein IIb/IIIa inhibitors coronary angiography (+ follow on PCI if indicated)
what are names of IV glycoprotein IIb/IIIa inhibitors
tirofiban/eptifibatide
what is the treatment for low risk NSTEMI/unstable angina
conservative management without angiography
unless ischaemia demonstrated by persistant symptoms
what is the ongoing medical management for ACS
1 ACEi
2 Dual antiplatelet therapy (aspirin + clopidogrel)
3 statin
4 BB
what is the surgical management for ACS
CABG may indicated for triple vessel disease or left mainstem disease >50%
A 55 year old gentleman with a history of systemic hypertension presents to A&E with breathlessness on exertion & orthopnoea. Examination reveals cardiomegaly & a displaced apex beat to the left.
Myocardial Infarction Left Ventricular Failure Constrictive pericarditis Right Ventricular Failure Congestive Cardiac Failure
Left Ventricular Failure
A 62 year old gentleman presents with fatigue, breathlessness & anorexia. On examination his JVP is noted as being elevated, he has hepatomegaly & swollen ankles.
Myocardial Infarction Left Ventricular Failure Constrictive pericarditis Right Ventricular Failure Congestive Cardiac Failure
Congestive Cardiac Failure
definition of HF
cardiac output>body’s demands
what is low-output HF
decreased cardiac output
what is high-output HF
increased body demand
what causes low-output HF
excessive
what are causes of LVF
IHD
HTN
dilated cardiomyopathy
MR
what are causes of RHF
LVF
pulmonary HTN
lung disease
TR
what three features are characteristic of LVF
SOB
orthopnoea
PND
what are characteristic features of RVF
peripheral oedema
ascites
raised JVP
what could pulsation in the neck and face indicate
TR
what signs are there with LVF
stony dullness (pleural effusion)
bibasal crepitations
displaced apex beat (cardiomegaly)
S3
what signs are there with RVF
raised JVP
hepatomegaly
pitting oedema
what are the bedside investigations for HF
history + examination
peak flow + spirometry
what bloods would be taken when investigating HF
BNP
NTproBNP (N-terminal pro BNP)
what is N-terminal pro BNP
a prohormone for BNP
what imaging investigations are taken when investigating HF
12 lead ECG
TTE echo doppler
CXR
what are the diagnostic investigations of HF
BNP + echo
what is done if investigating HF and the pt has a Hx of MI
only complete echo
what is done if investigating HF and pt has no Hx of MI
BNP + echo
what is BNP
brain natriuretic peptide
what secretes BNP
ventricular myocardium in response to LV pressure
what reflects myocyte stretch
increased GFR and reduced renal Na resorption
what is the benefits and negatives of BNP testing
sensitive test - can rule out HF
poorly specific test - cannot diagnose HF
what is the next step in investigations if BNP is high (investigating HF)
arrange echo
what are features of HF on a CXR
Alveolar oedema 'bat wings' B (Kerley B lines) Cardiomegaly Dilated prominent upper lobe vessels Effusion (pleural)
what do kerley B lines indicate
interstitial oedema
A 62 year old man, 3 months after an MI, taking aspirin, atenolol and simvistatin, whose echocardigram shows worsening left ventricular function. Select the single most appropriate means of reducing cardiovascular risk
Spironolactone Anticoagulation Therapy Sublingual Gtn ACE inhibitor therapy Furosemide
ACE inhibitor therapy
what classification is used for HF
New York Heart Association Classification
what are the gradings in hte NYHA Classification
NYHA I
NYHA II
NYHA III
NYHA IV
what does NYHA I mean
HF present
no SOB
what does NYHA II mean
HF present
comfortable at rest but SOB on ordinary activity
what does NYHA III mean
HF present
SOB with less than ordinary activity
what does NYHA IV mean
HF present
SOB at rest
what is the first line medical management for HF
ACEi + BB
what is the second line medical management for HF following ACEi + BB
ARB (mild-moderate HF)
spironolactone (moderate-severe HF or MI in past month)
when would a Hydralazine/nitrate combo be used for second line HF treatment
moderate-severe afro-carribean
what is the second line medical management for HF
digoxin
cardiac resynchronisation therapy
what are the two groups of causes of HTN
primary (idiopathic)
secondary
what are renal causes of HTN
intrinsic -glomerulonephritis chronic pylonephritis renovascular -renal artery stenosis
what is the cause of renal artery stenosis in young and old
old - atheromatous
young - fibromuscular
what are endocrine causes of HTN
cushings conns phaeo acromegaly hyperparathyroidism
what does headache with or without visual disturbances indicate
malignant HTN
what is the definition of malignant HTN
> 200/130 mmHg
A 40 year old man with diabetes, proteinuria and hypertension of 148/98 mmHg
Β-blocker Calcium Channel Blocker Losartan ACE-I Thiazide Diuretic
ACE-I
why are ACEi good in HTN with proteinuria
ACEi are renoprotective
A 53 year old lady with hypertension was on an antihyperstive treatment by you, but has developed a dry cough and refuses to take the drug anymore. He is otherwise well. What is the Culprit?
Β-blocker Calcium Channel Blocker Losartan Spironolactone ACE-I
ACE-I
what is a SE of CCB
peripheral oedema
what is a SE of spironolactone
gynaecomastia
what are SEs of ACEi
cough (increased bradykinin)
hyperkalaemia
renal failure (RAS)
angioedema
what are SEs of ARB
vertigo, urticarial
what are SEs of thiazides
reduced K (ECG changes) reduced Na (confusion)
what are SEs of spironolactone
increased K
gynaecomastia
what are SEs of BB
bronchospasm
HF
what is the first line treatment for malignant HTN
IV labetalol
what can malignant HTN cause
CCF
encephalopathy
what are features of encephalopathy
headache
focal CNS
seizures
comas
what is the most appropriate investigation to confirm diagnosis of stable angina
exercise ECG
is CT coronary angiogram invasive or non-invasive
non-invasive
is coronary angiogram invasive or non-invasive
invasive
what are the most sensitive and specific cardiac enzymes (markers) of myocardial necrosis (MI)
troponin (T+I)
what is happening to the troponin levels 3-12hrs post MI
rising
what is happening to troponin levels for 24-48hrs post MI
peaked
what is happening to troponing levels for the 5-14days post MI
decreasing
when does CK-MB peak post MI
within 36hrs
what is looked for in bloods with DVT/PE
d-dimer (sensitive but not specific)
what imaging is completed for investigating DVT/PE
USS of proximal leg vein
when is a DVT likely
> 2 on Wells score
when is PE likely
> 4 on Well score
what is the gold standard investigation for PE
CT pulmonary angiogram
what is the Westermark-sign/Hampton Hump associated with
PE
what might be seen on ECG with PE
normal
tachycardia
RBBB
inverted T waves in V1-4
what is rarely seen on ECG with PE
S1Q3T3
what is d-dimer
fibrin degradation product which is a breakdown product of a clot
what does a new murmur and fever indicate until proven otherwise
infective endocarditis
what is acute infective endocarditis
endocarditis on normal valves
what is subacute infective endocarditis
endocarditis on abnormal valves
what is streptococcus viridans infective endocarditis associated with
dental work
what is s aureus infective endocarditis associated with
IVDU
what is staphylococcus epidermidis infective endocarditis associated with
prosthetic valves
what bloods are completed for infective endocarditis
blood culture (x3) FBC (raised WCC) raised CRP
what imaging is completed for infective endocarditis
echo
what criteria is used to diagnose infective endocarditis
Dukes Criteria
what are major positives of Dukes Criteria
positive blood culture (2 separate cultures)
positive echo (vegetations)
new valvular regurgitation
what are minor positives of Dukes Criteria
predisposition (dental work, IVDU) fever >38 degrees vascular or immunological signs (splinter haemorrhages etc) positive blood culture positive echo
what is more sensitive out of TTE and TOE
TOE
30 year old women returning from holiday. Sudden onset chest pain with shortness of breath, coughed blood. She has no other lung disease. What investigation would you do to confirm diagnosis?
12-lead ECG CT Pulmonary Angiogram D-dimer Spirometry Chest X-ray
CT Pulmonary Angiogram
A 35 year old lady presents with severe pain in her right calf. She has recently returned from a family holiday in Australia. She is taking no other medication other than the OCP. What investigation would you do first.
INR Proximal Leg Vein USS D-dimer FBC Thrombophilia screen
D-dimer
An 80 year old man with a history of ischaemic heart disease trips over a paving stone & fractures his hip. An ambulance takes him to A&E. 1 hour after arrival, he develops crushing central chest pain. Select the single most appropriate investigation
V/Q Scan Cardiac Troponin Chest X-ray Coronary Angiogram Transthoracic Echo
Cardiac Troponin
50 yr old man attends A&E with SOB, fever and hyperdynamic regular pulse of 100. BP 160/60 mmHg. He has a murmur at the left sternal edge. On further enquiry it is found he attended for a routine dental procedure 2 months ago. Which 2 of these investigations could you use to confirm diagnosis.
CT Pulmonary Angiogram Urinalysis Blood Cultures Fundoscopy TOE Echocardiogram
Blood Cultures
TOE Echocardiogram
A lady with no history of a previous heart attack is complaining of swelling in her legs which goes all the way up to her thighs, and she feels may be extending into her lower stomach. She says she feels depressed and thinks these are side-effects of the medications she is on. You notice that she has pulsation in her neck and her face appears engorged.
Echocardiogram BNP CT Angiogram Coronary Angiogram Chest X-ray.
BNP
what is the order in which all heart sounds occur
S4 S1 - lub Split S1 S2 - dub Split S2 S3
what causes HS1
closure of mitral and tricuspid valves
what causes HS2
closure of aortic and pulmonary valves
why can HS1 be heard as a split HS1
mitral valve closure followed very quickly by tricuspid valve closure
why can HS2 be heard as a split HS2
closure of aortic valve followed very quickly by pulmonary valve closure
what is paradoxical splitting of HS2
results from delayed onset or prolongation of LV systole (contraction)
what is persistant splitting of HS2
results from delayed onset or prolongation of RV systole or shortened LV systole
where is the normal HS sequence does HS3 occur
following HS2
what causes HS3
passive LV filling when blood strikes a compliant LV
‘tenessee’ is applied to which added HS
HS4
‘kentucky’ is applied to which added HS
HS3
where in the normal HS sequence does HS4 occur
just before HS1
what causes HS4
forceful atrial contraction during pre-systole that ejects blood into a hypertrophied ventricle which cannot expand further
Which of the following does not cause a systolic murmur?
Atrial septal defect Ventricular septal defect Hypertrophic obstructive cardiomyopathy (HOCM) Aortic regurgitation None of the above
Aortic regurgitation
what are pan systolic murmurs
regurgitation murmurs
1 triscupid regurgitation
2 mitral regurgitation
3 VSD
what are late systolic murmurs
valve prolapses
what are early diastolic murmurs
regurgitation murmurs
1 aortic regurg
2 pulmonary regurg
what are mid-diastolic murmurs
mitral stenosis
tricuspid stenosis
You perform a cardiovascular examination on an elderly gentleman who reports episodes of collapsing and often wakes up short of breath at night. Upon auscultation you discover an ejection systolic murmur, which radiates to the carotids. Aortic stenosis Aortic regurgitation Mitral regurgitation Tricuspid regurgitation Mitral stenosis
Aortic stenosis
where does mitral regurg radiate to
axilla
where does aortic stenosis radiate to
carotids
what can aortic stenosis present with
SAD
syncope
angina
dyspnoea (exertional or PND)
what is notable of the BP in aortic stenosis
NPP
what would be seen on an ECG with aortic stenosis
LVH
A 53-year-old woman with Atrial Fibrillation is reviewed by her cardiologists. On inspection the patients cheeks appear quite flushed. Auscultation reveals a very loud S1 and a mid diastolic murmur. Mitral stenosis Graham Steele Mitral regurgitation Aortic regurgitation Austin Flint
Mitral stenosis
what is a graham steell murmur
associated with pulmonary regurg
early diastolic mumur
what is an austin flint murmur
severe aortic regurg
turbulent blood hits the anterior leaflets of mitral valve
mid-diastolic mumur
what sort of murmur is heard in mitral stenosis
mid-diastolic murmur
what three features/conditions is mitral stenosis commonly associated with
AF
RF
flushed cheeks
which HS is loud in mitral stenosis
HS1
49-year-old women presents with 3 month history of increasing SOB on exertion. She has no chest pain, cough or ankle swelling. On examination: BP 158/61 and there are crackles at the bases of both lungs. On Auscultation you hear a diastolic decrescendo murmur loudest at the left sternal edge. Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Tricuspid regurgitation
Aortic regurgitation
what is notable of the BP in aortic regurg
WPP
what symptoms does aortic regurg present with
similar symptoms to HF
SOB
PND
syncope
what is notable of the pulse in aortic regurg
collapsing pulse AKA corrigans pulse AKA water hammer pulse
what is quinckes sign
pulsation of the nail beds, associated with AR
what is de mussets sign
bobbing of the head in synchrony with the heart rate associated with AR
what is beckers sign
visible pulsations of the retinal arteries and pupils
what does the P wave indicate
atrial depolarisation
what does the PR interval indicate
time between beginning of atrial depolarisation and start of ventricular depolarisation
what does the QRS indicate
depolarisation of ventricles
what does the ST segment indicate
isoelectric segment representing time between the end of ventricular depolarisation and start of repolarisationw
what does the T wave indicate
repolarisation of the ventricles
You perform a routine ECG on an elderly man and you find that the PR interval is 210ms in length. What does this recording suggest? 1st Degree Heart Block Mobitz Type I Mobitz Type II Mobitz type B Complete heart block
1st Degree Heart Block
what is the definition of 1st degree heart block
PR>0.2seconds
what are the symptoms associated with second degree heart block
syncope
dizziness
what is second degree heart block mobitz I (wenkebach)
progressive elongation of PR interval until a QRS is dropped
irregular
what commonly causes second degree heart block mobitz I?
BBs
inferior MI
what is second degree heart block mobitz II
intermittent non-conducted P waves without progressive prolongation of the PR interval
regular
what commonly causes second degree heart block mobitz II?
his-purkinje system disease often due to MI
what is third degree heart block
complete heart block
complete dissociation between the p waves and the QRS complexes
what are features of third degree heart block
bradycardia
hypotension
what propagates the ventricles in third degree heart block
accessory pathway called His bundle acts as an independent pacemaker
this accounts for the bradycardia
A 10-year-old boy is brought to A&E with palpitations. On examination his HR is 250. He is later diagnosed with Wolff-Parkinson-White syndrome. Which one of the following is a feature of WPW syndrome? Severe chest pain Accessory pathway bundle of Kent Delta wave on ECG at admission Long PR intervals Narrow QRS
Accessory pathway bundle of Kent
Delta wave on ECG at admission is only found in sinus rhythm, not in tachycardia
what is a supraventricular tachycardia
tachycardia arising from above the bundle of His
a re-entry circuit
what are the different types of SVT
AV nodal reentry tachycardia
AV reentry tachycardia
what is AVNRT
re-entry circuit around the AV node
tachycardia caused by electrical activity going round and round in the AV node, repeatedly activating and propagating down the ventricular pathways causing ventricular contraction
what is AVRT
accessory pathway is bundle of kent
this is WPW syndrome
tachycardiac caused by electrical activity going round and round between the atria and the ventricles vias the accesory pathway (bundle of kent)
what would be found on ECG with an SVT in tachycardia
regular
no p waves
narrow complex tachycardia
what would be found on ECG with an SVT in sinus rhythm
short PR interval AVRT only (WPW syndrome) has a delta wave
what is a ventricular tachycardia
tachycardia originating in the ventricles
how does VT lead to VF
VT may impair cardiac output which may result in decreased myocardial perfusion with progression to VF
what are signs of ventricular tachycardia on ECG
tachycardia
broad QRS
what is AF
disorganised atrial electrical activity and contraction
what is seen on ECG with AF
irregularly irregular rhythm
no p waves
fibrillatory waves may be seen
