Week 5 Flashcards
What is acute coronary syndrome?
Any acute presentation of coronary artery disease e.g angina, MI
How can ACS occur?
Due to rupture of the atheromatus plaque, from lipid content of plaque, thickness of fibrous cap, change in pressure, twisting of arteries, mechanical injury
Man presents acutely with MI what is your treatment?
MONA T
Morphine (antiametic)
Oxygen
Nitrates (GTN)
Aspirin (300mg)
Ticagrelor
Man presents with ST elevation MI, its been less than 20 minutes, what is the treatment?
MONA plus T
Coronary angioplasty
If more than 4 hours give thrombolysis
Man presents with non-ST elevation MI, treatment?
Mona plus T
In the capillaries what is the main starling force that governs entry and exit of materials from capillary to lumen?
Outwards; capillary hydrostatic pressure (result of BP in capillary)
Inwards; capillary osmotic pressure (due to pressure of plasma proteins in the blood)
What are some of the causes of left sided heart failure?
Ischaemic heart disease
Dilated Cardiomyopathy
Valvular disease
Man presents with dysponea on exertion, orthopnoea, paroxysmal dyspnoea, pulmonary oedema. On examination, has tachycardia, crepitations and a third heart sound with galloping rhythm. What is the diagnosis?
Left sided heart failure
What is the treatment for left sided heart failure?
Sit them up Give oxygen IV Furosemide (diuretic) IV Diamorphine IV nitrates
LMNOP (loop diuretic, morphine, nitrates, oxygen, position),
Women present with oedema in ankles, a raised JVP, enlarged liver, ascites. She is known to have COPD
Right sided heart failure
What are the drugs in the ACE inhibitors
Captopril
Enalapril
Lisinopril
You suspect an MI, what blood tests would you order?
Troponin
CK
Define an ectopic beat
Beats of rhythms that originate in places other than the SA node
What is wolf parkinson white syndrome?
Where there is more than one conduction pathway of the heart with a different speed of depolarisation causing delta waves to be present ( on the qrs complex it has two different gradients)
What factors can increase phase 4 of the cardiac myocyte action potential? AKA increase heart rate
Hyperthermia Hypoxia Hypercapnia Cardiac dilation Hypokalaemia (prolonging repolariszation)
What is the arrhythmia torsades de pointes
A type of ventricular tachycardia in people with long QT intervals. Will look like quick irregular QRS complexes. This can progress to VF
What would you use a 24 hr holter ECG to investigate?
Paroxysmal arrhythmia
Patient is classed as bradycardic, what is his heart rate?
Less than 60
AV nodal re-entrant tachycardia, Av reciprocating tachycardia and ectopic atrial tachycardia. Are all causes of what arrythmia?
Regular supraventricular tachycardia
Describe the treatment for a supraventricular tachycardia
Increase vagal tone by the valsava maneouvre (closing nose and breathing against it), carotid massage
Slowing down AVN conduction by adenosine IV or verapamil IV
What is radiofrequency catheter ablation?
Selective cauterisation of cardiac tissue to prevent tachycardia- targeting an automatic focus of re-entry circuit
What is lenegres disease? Who does it commonly effect?
Acquired complete heart block due to idiopathic fibrosis and calcification of the electrical conduction system of the heart.
Commonly seen in elderly
Describe 1st degree heart block
Where PR interval is longer than 0.2 s
Describe 2nd degree heart block
Where there is progressive lengthening of PR interval then dropping QRS
Describe 3rd degree heart block
Where there is no action potentials going from SA node to AV node, P waves and QRS dissociated
What are dual chamber pacemakers used for?
Maintaining Atrio-ventricular synchrony, used in atrio ventricular disease
Which arrythmia is shockable with a defib?
Ventricular fibrillation
What is the treatment for ventricular tachycardia?
Adenosine IV
VT catheter ablation
Cardiovertor defibrillators
Man 70 presents with an irregularly irregular heart beat that is paroxysmal (comes and goes). He is also obese with hypertension. what is this likely to be?
Atrial fibrillation
What are some of the causes of atrial fibrillation?
Hypertension Heart failure Coronary heart disease Obesity Thyropid disease Cardiac valve disease Alcohol abuse Heart disease COPD Pneumonia Pericardiits
What are the risk factors for thrombo-embolism?
CHAD’S VAS
Congenital heart failure Hypertension Age over 75 Diabetes Stroke Vascular disease Age 65-74 Sex female
What are some rate controlling anti-arrhythmia drugs?
Digoxin
Beta blockers
Verapamil or diltiazem
What are the 4 H’s that can reversibly cause cardiac arrest?
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
What are the 4 T’s that can reversibly cause cardiac arrest? How would you treat them?
Thrombosis; thrombolysis
Tension pneumothorax; needle thoracentesis
Cardiac tamponade; needble cardiocentesis
Toxins; specific
How do you determine the axis of the heart on an ECG?
Looking at the limb leads
If lead I has higher QRS than lead III then axis lying to the left
Someone presents with STEMI 45 minutes after the event, what is the treatment?
MONA plus C
Morphine, oxygen, nitroglycerin (GTN), aspirin (300mg), clopidogrel (600mg)
PCI
Patient presents with pulmonary oedema following right sided heart failure, what is the treatment>
LMNOP
Lasix (frusemide) Morphine Nitrates Oxygen Position (Sit up)
Post MI what is the likely medication a patient will be given
LMWH Aspirin and clopidogrel ACE inhibitor Spironolactone Furosemide Beta blocker Statin
What is the normal PR interval?
0.12-0.2s
What is the usual time interval for QRS complex?
0.1s or less
What is the usual time interval for atrial depolarisation?
P wave should be 0.08-0.1s
There is ST elevation in leads II, III, and aVF. What part of the heart is this?
Inferior
There is ST elevation in leads V3 and V4. What part of the heart is this?
Anterior
There is ST elevation in leads V1 and V2. What part of the heart is this?
Septal
There is ST elevation in leads I, aVL, V5, V6. What part of the heart is this?
Lateral
There is ST elevation in leads V1, V2, V3, V4. What part of the heart is this?
Anterior septal
How would you calculate the heart rate from an ECG?
Count no of QRS in 30 large squares then x10
What does the presence of an inverted T wave suggest?
Indicative of a past MI
You suspect an inferior MI. What changes would you expect on ecg?
ST elevation of leads II, III and AVF
You suspect an anterolateral MI what changes would you see on ECG?
I, AvL, V1-V6
ST elevation
Define the four different types of heart block
Type 1; PR is long but doesnt effect QRS
Type 2a; PR intervals get longer and longer then drop QRS
Type 2b; Long PR interval with regular QRS drops
Type 3; P waves and QRS are unrelated
What symptoms would you expect of someone with an arrhythmia?
Palpitations SOB Dizziness Loss of consciousness (syncope) Faintness (presyncope) Angina/ heart failure Death
What are the two shockable rhythms?
Ventricular tachycardia
Ventricular fibrillation
(If ventricle problem then wide QRS complex
What would you expect to see on ECG in somoene with left axis deviated heart?
High QRS in lead I with negative QRS in lead III