Cardiology Flashcards
(56 cards)
Which ECG leads give a lateral view of the heart?
Lateral = Left
I, avL, v6
Which ECG leads give an inferior view of the heart?
II, III, avF
Which ECG leads give an anterior view of the heart?
V2, V3, V4
What are the lateral ECG leads and which coronary artery do they correspond to?
I, avL, V6
Lateral Circumflex or diagonal branch of LAD
What are the inferior ECG leads and which coronary artery do they correspond to?
II, III, avF
Right Coronary Artery
What are the anterior ECG leads and which coronary artery do they correspond to?
V2, V3, V4
Left Anterior Descending (LAD)
How do a STEMI and an NSTEMI differ?
- STEMI = ST elevation +/- Q wave formation OR NEW ONSET LBBB i.e. specific ECG changes
- NSTEMI = Symptoms but non-specific ECG changes + elevated cardiac enzymes
Define Acute Coronary Syndrome
A collection of symptoms that can be due to one of either:
Unstable Angina
MI (STEMI OR NSTEMI)
What are the 5 categories of MI?
Due to acute ischaemia =
1 - Spontaneous, due to primary coronary event e.g. plaque rupture or dissection
2 - Secondary to ischaemia from ↑ o2 demand or ↓ o2 supply e.g. severe HTN or tachyarrhythmia
Other
3 - Sudden Cardiac Death
4 - Associated with PCI or Stenting
5 - Associated with cardiac surgery
How can unstable angina be differed from an MI?
Symptomatically
unstable angina = -ve trops
MI = +ve trops
What are the classic symptoms of an MI?
Central, crushing chest pain +/- radiates to left arm or jaw Sweating, N&V Pallor Palpitations Feeling of impending doom
What is the GRACE score?
Scoring system to estimate the risk of death following acute coronary syndrome
What is the medical management of a STEMI?
(MONAA B)
Morphine (5-10mg IV) and Metoclompramide (10mg IV)
Oxygen
Nitrates (more of a role in NSTEMI than STEMI)
Aspirin 300mg PO
Antiplatelet - Clopidogrel
B-Blocker - Atenolol
What is the management of an NSTEMI?
MONAA B
Do a GRACE score = high risk = angioplasty, low risk = observe + OP assessment
What is the surgical/definitive management of a STEMI and when can this be offered?
Primary Percutaneous Intervention
ONLY IF within 12hr of symptom onset OR can get to a PCI centre in 120 minutes
If not, do thrombolysis
Give 4 short term and 4 long term complications of an MI
◦ Short Term ‣ Death ‣ Cardiogenic Shock ‣ Thrombosis embolisation ‣ Pulmonary Oedema
◦ Long Term ‣ Heart Failure ‣ Arrhythmias ‣ Recurrence ‣ Psychosocial e.g. depression
What are the medications required for long term prevention of an MI?
- Dual anti platelet therapy - Aspirin and Clopidogrel
- Statin
- ACEI
- B-Blocker
What is a pathological Q wave? When does it become pathological?
ECG waves that occur when the myocardium becomes damaged to the point of no return. Shows as a negative deflection before the R wave
in V1-V3 >2mm deep >1mm/40s wide >5% of QRS = pathological
What are the classical features of heart failure on chest x ray?
A - alveolar oedema (bat wing opacities) B - Kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural effusion
What are the causes of left ventricular systolic dysfunction?
Things that impair proper contraction of the ventricle
Ischaemic heart disease
Hx MI
Cardiomyopathy
What are the causes of left ventricular diastolic dysfunction?
Things that impair proper relaxation and filling of the ventricle
Tamponade
Restrictive cardiomyopathy
Ventricular hypertrophy
What are the causes of right heart failure?
Left heart failure
Cor Pulmonale/Lung disease
Pulmonary stenosis
What is the management of acute heart failure?
◦ IV Furosemide
◦ Diamorphine + metoclompramide/anti-emetic
◦ GTN 2 puffs
What is the management of chronic heart failure?
Conservative - smoking cessation/ risk reduction, cardiac rehab
Medical - ACEI/ARB, B Blocker, Diuretic, Spironolactone can be used if still symptomatic
