PT 2 Flashcards
Q. What is atrial flutter? What can cause it? And what is seen on ECG?
A. Atrial flutter is a type of super-ventricular tachycardia (SVT) caused by a re-entrant circuit within the right atrium
B. AE: idiopathic, IHD, atrial dilation (septal defect, PE, mitral/tricuspid disease)
C. ECG: regular atrial rate of 200bpm (200-400bpm depending on RA size)
D. Ventricular rate is determined by the AV conduction ratio 2:1 is the commonst (3:1, 4:1 possible)
E. Sawtooth pattern – best seen in II/III/VF, narrow complex QRS
What is atrial fibrillation? What may cause atrial fibrillation? Describe the management options
A. Irregularly irregular rhythm, no P waves, absence of isoelectric baseline, narrow QRS (unless BBB, aberrant pathway, WPW), coarse/fine fibrillatory walls (mimic p walls) VR – 110-160bpm
B. AVN bombarded with depolarisation waves of varying strength, and only conducts in ‘all or non fashion’
C. Initiating event (e.g. PAC) + Substrate for maintenance (e.g. dilated left atrium)
D. First Episode, Recurrent (>2 episodes), Paroxysmal (self-terminates <7d), Persistent (>7d), Permanent (>1yr)
E. AE: IHD, HTN, PE, hyperthyroidism, mitral valve disease
F. PRES: asymptomatic, chest pain, palpitations, SOB
G. Mx: acute— cardioversion (electrical or with IV amiodarone)
Chronic — rate control (betablocker, CCB, digoxin (HF)), rhythm control (cardioversion – electrical/amiodarone), anticoagulation (warfarin – post TIA/stroke)
Q. Describe the differences between atrial fibrillation and atrial flutter on ECG
A. Atrial fibrillation: Irregularly irregular rhythm, no P waves, absence of isoelectric baseline, narrow QRS (unless BBB, aberrant pathway, WPW), coarse/fine fibrillatory walls (mimic p walls) VR – 110-160bpm
A. Atrial flutter: Sawtooth pattern – best seen in II/III/VF, narrow complex QRS, usually 2:1 conduction ratio
Q. What is the management of angina?
A. Ix: ECG, FBC, others: kidneys, LFTs, RBG, TFTs, cholesterol, troponins
B. Mx: lifestyle, GTN (immediate, wait 5mins, again, 5 mins, ambulance), aspirin daily, statins, CaCB/BB or both, long acting nitrate, revascularization if high risk or persistent
Q. What is the management of an ACS/MI?
A. Ix: ECG, cardiac enzymes (at 6-12hours), FBC, other bloods, coronary angiography
B. Mx: ABCDE, MONA (morphine, oxygen, nitroglycerin and aspirin) for suspected ACS
C. Aspirin and ticreglor, fondaparinux/LMWH, PCI, GTN/CaCB/BB/Statins/ACE-I
D. Complications: shock, HF, arrhythmia
Q. Name 5 compensatory changes in heart failure
A. Ventricular dilatation B. Myocyte hypertrophy C. Increased collagen synthesis D. Salt and water retention increased preload E. Sympathetic stimulation F. Peripheral vasoconstriction
Q. What seen in HF investigation?
A. Alveolar oedema (bat wings) B. Kerley B lines (interstitial oedema) C. Cardiomegaly D. Dilated prominent upper lobe vessels E. Pleural Effusion
Q. Name four symptoms and 4 signs of cardiac failure
A. Symptoms: exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue
B. Signs: cardiomegaly, elevated JVP, tachycardia, hypotension, bi-basal crackles, peripheral oedema, ascites, added heart sounds
Q. Describe management of HF
A. Lifestyle: RF reduction
B. Diuretics: symptom relief, improve exercise tolerance (loop - furosemide, thiazide - metolazone)
C. ACE inhibitors (lisinopril)
D. Beta-blockers (bisoprolol, carvedilol, metoprolol)
E. ARB (candesartan, valsartan)
F. Calcium glycosides (digoxin if AF)
G. Other: coronary artery bypass, PCI, valvular replacement
Q. 5 causes of shock
A. Haemorrhagic – can withstand half a litre of blood loss with no ill effect A. Anaphylaxis: IgE B. Septic C. Cardiogenic D. Hypovolaemic
Q. Name 5 signs and symptoms of shock
A. Low BP B. High HR C. High RR D. Confusion E. Pallor F. Clammy G. Pale peripheries H. Reduced urine output
Q. Name 5 signs and symptoms of anaphylaxis shock
A. Itching, urticaria (hives), angioedema, wheezing, stridor, n+v, abdominal pain, cyanosis, low BP etc.
B. Triggers: nuts, milk, eggs, fish
C. Mx: ABCDE, oxygen, adrenaline (IM/IV)
Q. What are the sepsis 6?
A. 1. Give high-flow oxygen (via non-rebreathe bag)
B. 2. Take blood cultures (and consider source control)
C. 3. Give IV antibiotics (according to local protocol)
D. 4. Start IV fluid resuscitation (Hartmann’s or equivalent)
E. 5. Check lactate
F. 6. Monitor hourly urine output
Q. What is the CHADS2VASc Score for?
A. Atrial fibrillation management: aim for 2-3
B. Congestive HF, HTN, age >=75 (2), 65-74, DM, stroke/TIA, vascular disease, female
C. 0= np anticoag, 1= oral anticoagulatant or aspirin, 2= oral anticoagulation (warfarin, rivaroxaban)
Q. What occurs in Wolff-Parkinson-White syndrome?
A. Atrioventricular re-entry tachycardia (AVRT)
B. P wave seen between QRS and T wave – with short PR interval, wide QRS and δ waves)
C. History of palpitations.
D. Broad complex tachycardia
