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Cardio Flashcards

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1
Q

What can cause a false positive elevation of TropI

A

Advanced renal failure
Large PE

Aortic stenosis
HOCM
Severe sepsis
Stroke

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2
Q

What can new LBBB inidcate

A

STEMI

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3
Q

When do you take trop levels (timings)

A

On admission and then 1 hr after
If sx longer than 3 hrs then only take trop on admission

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4
Q

Which leads can be added to see posterior stemi

A

V7-9

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5
Q

Spotting a posterior stemi on an ecg

A

Suspicion if following in V1-3 :
- ST depression -(horizontal)
- upright T waves

(Bc reciprocal changes so basically opposite of what you see in a stemi)

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6
Q

In which stemi territories should you be also checking for posterior infarct

A

Lateral or inferior stemi

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7
Q

In which stemi territories should you also check for posterior infarct and how

A

Inferior and lateral
Leads V7-9

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8
Q

In which stemi territories should you have high suspiscion of posterior infarct?
How would you confirm

A

Lateral and inferior

Add leads v7-9

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9
Q

In which stemi territories should you have jigh suspiscion of posterior infarct?
How would you confirm

A

Lateral and inferior

Add leads v7-9

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10
Q

ECG territories leads and arteries

A

Inferior - II, III, aVF. RCA
Lateral - I, aVL, V5, V6 LCx or LAD
Anterior - V3, V4 LAD
Septal - V1, V2 LAD

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11
Q

ECG territories and arteries

A

Inferior - II,III, aVF RCA
Lateral - I, aVL, V5,V6 LCx
Anterior - V3, V4 LAD
Septal - V1, V2 LAD

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12
Q

Calculating rate on ecg

A

300/number of big squares
OR if irregular count number of QRS in 50 squares and x6

(50 large squares = 10s)

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13
Q

Axis deviation interpretation

A

If I and II are pointing away from each other they are LEAVING - Left deviation

If I and II are pointing towards each other they are RETURNING - Right deviation

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14
Q

Causes of right axis deviation

A

Anterolateral MI
RVH
PE

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15
Q

Causes of LAD

A

Inferior MI
LVH

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16
Q

Normal PR interval

A

120-200ms from start of P to start of QRS
3-5 little squares

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17
Q

Normal QTc

A

380-440 from start of QRS to end of T wave

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18
Q

Drug Causes of a long QTc

A

Antipsychotics -
TCAs
Citalopram
Macrolides - erythro, clarithro

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19
Q

Mobitz Type 1 vs type 2 HB

A

1 - Progressive lengthening of PR interval then dropped QRS

2 - constant PR then dropped QRS

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20
Q

RBBB vs LBBB Ecg

A

R - MaRRoW - wide QRS, positive V1!! (Normally negative)
L - WiLLiaM - V6 M

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21
Q

Beck’s triad

A

For cardiac tamponade

Raised JVP
Muffled heart sounds
Low BP

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22
Q

What is bifascicular block
What is trifascicular block

Study These Flashcards
A

RBBB + R/L Axis deviation

RBBB + R/L Axis deviation + 1st degree HB

23
Q

WPW on ECG

24
Q

What can long Qt lead to

Study These Flashcards
A

Torsades de pointes

25
What is torsades de pointes
Polymorphic VT
26
What is p mitrale and what is it indicative of
Bifid P waves Mitral stenosis
27
Hyperkalaemia ECG
Tall tented t waves Broad qrs Absent p waves ‘Pulled up image’
28
Side effects of adenosine
Teansient chest tightness Dyspnoea Flushing Headache Bronchospasm (CI in asthmatics)
29
Causes of VT (Im QVICK)
Infarction Myocarditis QTc Valve abnormalities Iatrogenic - digoxin, antiarrythmics Cardiomyopathy Kaleami - HYPOKALAEMIA most important!!
30
Causes of AF
IHD Rheumatic heart disease Throtoxicosis HTN Alcohol PE Pneumonia Hypokalaemia Post op
31
Rx of AF
If any life threatening features or haemodynamically unstable - synchronised DC Otherwise beta blocker Or digoxin/amiodarone if heart failure Consider anti coag
32
CHA2DS2VASc
CCF HTN Age >75 DM Stroke/TIA Vascular disease Age 65-75 Sex: female
33
What does the HAS BLED score predict
Likelihood of haemorrhage and anti coag bleeding risk
34
How can a silent MI present and who is it more likely in
Reflux like symptoms in an older female diabetic
35
Management of a STEMI nice algorithm
MONA If present within 12hrs and PCI possible in next 120 mins, offer PCI and then prasugrel with aspirin (or ticagrelor if high bleeding risk) If present within 12 hrs but PCI not possible in 120mins then give fibrinolysis and give ticagrelor with aspirin if>12 - dual antiplatelet therapy
36
NSTEMI rx NICE guidelines
Mona give 300mg aspirin + fondaparinux calculate grace score if score >3% consider PCI within 72hrs if stable or immediately if unstable if score <3% offer aspirin and ticagrelor (or aspirin and clopidogrel if high risk of bleeding)
37
stemi + bradycardia. what artery is affected
right coronary artery
38
rx of STEMI
MONA 300mg aspirin offer PCI if presenting <12hrs and PCI available in <120 mins offer fibrinolysis if presenting in 12hrs but no PCI available in <120 mins otherwise medical management with ticagrelor (or clopidogrel if high bleed risk)
39
Next step in rx if ECG still shows STEMI despite fibrinolysis
PCI immediately
40
what drugs are offered alongside PCI if - pt is not on oral anticoags - pt is on oral anticoags
Prasugrel and aspirin (dual therapy) if on oral anticoagulants if not on anticoags, give clopidogrel with aspirin instead
41
complications of MI
DREAD Death Rupture of papillary muscles/ventricle oEdema (heart failure) Arrythmias Dresslers - pericarditis
42
first line imaging for stable angina
CT coronary angiogram
43
rx of stable angina
aspirin, statin and GTN + either beta blocker or CCB if not controlled on one add the other but must be amlodipine, nifedipine etc. NOT verapamil
44
when are Nitrates CI
in hypotensive patients
45
drugs which may be used to pharmacologically cardiovert patients with paroxysmal atrial fibrillation
flecainide or amiodarone
46
what drug should not be used in VT
verapamil
47
how long must pt be orally anti coagulated for before electrical cardio version
3 weeks
48
rx of unstable bradycardia
atropine 500micrograms up to 3mg then transcutaneous pacing
49
rx of dresslers
nsaids and course of colchicine or steroids
50
other features of cardiac tamponade apart from becks triad
dyspnoea pulses paradoxus electrical alternans tachycardia
51
ix for acute pericarditis
transthoracic echocardiogram
52
difference between nstemi and unstable angina
nstemi has raised trop
53
moa of alteplase
Activates plasminogen to form plasmin
54

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