tall R waves and ST depression in leads V1 and V2.
posterior STEMI
see tall R waves? right behind you !
A 73-year-old man is seen in the clinic with persisting shortness of breath on exertion and peripheral oedema over the last month. At night, he sometimes wakes up short of breath and has had poor sleep as a result. His past medical history includes a myocardial infarction 4 years previously and he is currently taking aspirin, ramipril, bisoprolol, and atorvastatin.
An echocardiogram shows a left ventricular ejection fraction of 38%.
What is the best drug to prescribe that both improves symptoms and prognosis?
Spironolactone
Offer a mineralcorticoid receptor antagonist, in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure
A 53-year-old man is brought to the Emergency Department by ambulance after collapsing at home. The paramedics report that he was found unresponsive and apnoeic. Upon arrival, he remains unconscious with an absent pulse. At the same time, the cardiac monitor displays a regular monomorphic rhythm at a rate of 218 beats per minute and a QRS duration of 150 ms. The medical team has initiated chest compressions.
What is the most appropriate immediate intervention?
shock - pulseless VT
weird symptom of mitral stenosis
haemoptysis
HF when to admit
If new BP >= 180/120 mmHg + new-onset confusion, chest pain, signs of heart failure, or acute kidney injury then admit for specialist assessment
A 65-year-old woman presents to the emergency department with palpitations. An ECG shows a regular narrow complex tachycardia with a rate of 178 bpm. Despite the administration of 6 mg adenosine via rapid IV bolus, her symptoms persist. Following administration of adenosine, her vital signs show a heart rate of 174 bpm, respiratory rate of 28 breaths per minute, and blood pressure of 86/64 mmHg.
What is the most appropriate next step in management?
In the context of a tachyarrhythmia, a systolic BP < 90 mmHg → DC cardioversion
mechanical heart valves anticoagulation
warfarin, recheck 4 weeks
Acute heart failure not responding to treatment - consider
CPAP
can you have statin when pregnant
no
Acute heart failure with hypotension -
inotropes (e.g. dobutamine) be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock
If vagal manoeuvres and adenosine ineffective for SVT
→ verapamil or beta-blocker
Pulmonary embolism and renal impairment →
V/Q scan is the investigation of choice
poor prognosis in MI
low bp - Cardiogenic shock is a poor prognostic indicator in acute coronary syndrome
dabigatran and bleeding- reversal agent?
idarucizumab
In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation do
an echo to exclude valvular heart disease
The main ECG abnormality seen with hypercalcaemia is
shortening of the QT interval
Recent sore throat, rash, arthritis, murmur →
Rheumatic fever
IM benzylpenicillin or oral penicillin V
Sacubitril-valsartan should be initiated following
ACEi or ARB wash-out period
most common cause of secondary hypertension
Primary hyperaldosteronism is the most common cause of secondary hypertension
you get muscle weakness and low K+
angina not controlled with B blocker?
add CCB
If thrombolytic drugs are given during ALS then
a prolonged period of CPR (e.g. 60-90 mins) should be considered
what is RSR
An RSR’ pattern is a specific ECG finding (an “M-shaped” or “rabbit ear” wave) that is a key component of a Right Bundle Branch Block (RBBB). Therefore, the RSR’ pattern is a part of the definition of RBBB, not a different condition, though an incomplete or benign version can exist as a normal variant.
RSR’ pattern
What it is: A specific waveform in the right precordial leads (V1 and V2) of an ECG, consisting of an initial small upward wave (r), a large downward wave (S), and a second, larger upward wave (R’).
pericarditis - ecg
widepspread ST elevation and pr depression
sinus rhythm, lead 2 shows sinus arrhythmia (irregularities due to breathing but still normal)
HR changes in VF and V3 due to this
normal PR, normal axis, QRS normal, ST normal, T wave inversion in lead VR but no other lead
NORMAL
