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ICM Revision > CVS > Flashcards

CVS Flashcards

1
Q

ECG changes in myocardial ischaemia include….

A

….
hyperacute T waves - first sign but persists for few mins

ST elevation - persists for 20mins in 2 contiguous leads
- 2.5mm in men and 1.5mm in women

New onset LBBB

ST depression - posterior MI

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2
Q

Territory for ECG changes in V1-4?

A

left anterior descending

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3
Q

Territory for ECG changes in I, II, aVF

A

right coronary / (inferior aspect of heart)

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4
Q

Territory for ECG changes in I, V4-6, aVL?

A

LAD, left circumflex

anterolateral

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5
Q

Territory for ECG changes in I, aVL +/- V5&6

A

Left circumflex

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6
Q

changes in V1-3

A

posterior

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7
Q

posterior aspect?

A

Horizontal ST depression
tall, broad R waves
Upright T waves
dominant R wave in V2

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8
Q

ECG changes in Hypokalaemia?

A 
U waves 
small/abent T waves 
prolonged PR interval 
ST depression 
long QT
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9
Q

ECG changes in LBBB?

A

W shaped QRS in V1

M shaped QRS in V6

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10
Q

ECG changes in RBBB?

A

M shaped QRS in V1

W shaped QRS in V6

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11
Q

ECG changes in Hyperkalaemia?

A

peaked/tall tented t waves
Loss/flattening of P waves
Broad QRS complexes
Sinusoidal wave pattern

can develop into VF

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12
Q

causes of prolonged PR interval?

A 
Ischaemic heart disease 
digoxin toxicity 
hypokalaemia 
rheumatic fever 
lyme disease
sarcoidosis
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13
Q

short PR intervals

A

wolff-parkinson-white syndrome (congenital acessrory conducting pathway between atria and ventricles - AVRT)

AF can degenerate to VF rapidly

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14
Q

ECG changes in Wolff-Parkinson White?

A

short PR interval
delta wave - wide QRS with slurred upstroke
left or right Axis deviation

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15
Q

Investigation in suspected aortic stenosis?

A

ECHO

- angiogram is done if symptomatic valve replacement is being considered

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16
Q

Investigation in suspected aortic regurg?

A

ECHO

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17
Q

Investigation in suspected mitral stenosis?

A

CXR - Left atrial enlargement
ECG - AF
ECHO

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18
Q

Investigation in suspected Mitral Regurgitation?

A

ECHO is diagnostic
CXR - finding cardiomegaly
ECG - broad p waves

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19
Q

Investigation in suspected Mitral valve Prolapse?

A

ECHO - usually an accidental finding

20
Q

Investigation in suspected Patent ductus arteriosus?

A

ECHO

21
Q

Investigation in suspected Rheumatic Fever?

A 
Throat Swabs - culture 
Bloods - raised ASO titre, ESR and CRP 
ECG - prolonged PR interval 
CXR
ECHO - valvulitis
22
Q

Investigation in suspected Hypertrophic Cardiomyopathy ?

A

ECHO - mitral regurg, hypertrophy

ECG - LVH, non-specific ST and T wave changes, D Q waves

23
Q

Investigation in suspected dilated cardiomyopathy?

A

ECHO, CXR

24
Q

Investigation in suspected Heart Failure?

A

BNP levels raised , routine others done include FBC, U&Es, CRP
CXR - cardiomegaly, pulmonary oedema
ECHO - pericardial effusion, tamponade

25
Q

Investigation in suspected Hypertension

A

Fundoscopy - papilloedema, retinal haemorrhages

Bloods - routine , good to check lipids, TFTs, U&Es, LFTs etc

Urine - Albumin-creatinine ratio and urine protein levels

ECG

26
Q

Investigation in suspected LBBB?

A

ECG - W in V1 and M in V6

If new onset LBBB - think MI

27
Q

Investigation in suspected RBBB?

A

ECG - M in V1 and W in V6

- usually broad complex tachycardia

28
Q

Investigation in suspected atrioventricular Blocks?

A

ECG

1st Degree = persistent prolonged PR interval

2nd/Mobitz I = increasing PR interval till a missed beat

2nd/Mobitx II = constant PR interval followed by a missed beat

3rd Degree = No relation between p and Q waves

29
Q

Investigation in suspected Atrial Fibrillation and findings?

A

ECG - absence of p waves, irregular rate

30
Q

Scoring systems to think about in Atrial Fibrillation?

A

CHA2DS2VASC score = if 2 or more then offer anticoag
- if 1 - consider anticoag

ORBIT score - now used to asses bleeding risk
0-2 = low risk
3 = medium risk
4-7 = low risk

31
Q

Investigation in suspected Atrial Flutter?

A

ECG - ‘sawtooth appearance’ - in particular in II, III, aVF

CXR, TFTs can be done to exclude other causes

32
Q

Investigation in suspected Ventricular Tachycardia?

A

ECG - broad QRS complexes, tachycardic

33
Q

Investigation in suspected Supraventricular tachycardia?

A

ECG - narrow complex QRS, Tachycardix, Absent and unclear p waves

34
Q

Investigation in suspected Ventricular fibrillation?

A

ECG
Chaotic irregular deflections of varying amplitude

No identifiable P waves, QRS complexes, or T waves

Rate 150 to 500 per minute

35
Q

Investigation in suspected Myocardial infarction?

A

ECG - ST elevation, ST/T wave changes

Troponin levels -

36
Q

If patient with an suspected MI presents within 12hrs of symptoms onset what procedure can be done?

A

PCI - has to be done withine 2hrs (120mins) of presentation

If unable to do PCI within 2hrs - fibrinolysis

37
Q

Investigation in suspected Prinzmetal/variant angina?

A

ECG - transient ST elevation during eps of chest pain

38
Q

Investigation in suspected thrombo/phlebitis?

A

O/E - worm like mass, tender to palpation, firm surrounding tissue/vein and felt superficially- below skin

US - exclude concurrent DVT
potentially check D-Dimer level

39
Q

Investigation in suspected Acute rheumatic fever?

A

Bloods - raised strep antibodies, Raised CRP/ESR

Positive Throat swabs

ECG - prolonged PR interval

40
Q

Investigation in suspected Acute pericarditis?

A

ECG - widespread ‘saddle-shaped’ ST elevation
most specific ECG change = PR depression

All patients must have a TOE ECHO

41
Q

Investigation in suspected infective Endocarditis?

A

Blood cultures
ECHO - checking for growth/vegetation
U&Es - check renal function

Diagnosis uses DUKE Criteria = persistent bacteraemia found on blood cultures

42
Q

Investigation in suspected cardiac tamponade?

A

ECG - electical alternans (changing QRS amplitude with beats)

43
Q

Investigation in suspected Pericardial Effusion?

A

ECG - small QRS voltage
CXR - water bottle sign
ECHO - movement of the heart - floating/dancing appearance

44
Q

Investigation in suspected Atrial septal Defect?

A

ECG
ostium primum = RBBB and left axis deviation, prolonged PR

ostium secundum = RBBB and right axis deviation

45
Q

Investigation in suspected Ventricular Septal Defect?

A

ECHO

CXR and cardiac catheterisation also considered in some cases

46
Q

Investigation in suspected Coarctation of the aorta?

A

ECHO

47
Q

Investigation in suspected Tetralogy of fallot?

A 
CXR = boot shaped heart 
ECG = RVH

ICM Revision (19 decks)

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