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Amir Sam Lectures > Cardiology Cases > Flashcards

Cardiology Cases Flashcards

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1
Q

Case
Hx: 60 yo man, chest pain, tight, 4h, nausea and sweating, HTN, DH: amlodipine.
O/E: temp 37, S1 + S2, BP 120/80 (L), 118/75 (R), clear chest, abdomen SNT
What is it?
Pneumonia, Pericarditis, Myocardial infarction, Aortic dissection, Costochondritis

A

Myocardial infarction

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2
Q

What are the three layers of investigation for MI?

A
  1. ECG
  2. Troponin
  3. Echocardiogram
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3
Q

Why is an ECG important for MI?

A

To find out if it is a STEMI or NSTEMI as they have different treatments

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4
Q

What do if troponin comes back as postive or negative?

A

+ve - coronary angiogram (whether STEMI/NSTEMI)

-ve - exercise tolerance test

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5
Q

Why do an Echocardiogram?

A

To check for ventricular dysfunction and regional wall motion abnormality, blockage of one of the coronaries can be seen in a territory (RWMA)

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6
Q

Management of STEMI/NSTEMI?

A

Both you give aspirin and clopidogrel
STEMI - and then send to cath lab to do percutanous coronary intervention to do balloon angioplasty or stenting
NSTEMI - add LMWH and then risk-stratify and sent for an angioplasty

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7
Q

Differential diagnosis of chest pain (cardiac)

A

Ischaemic heart disease
Aortic Dissection
Pericarditis

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8
Q

Differential diagnosis of chest pain (Respiratory)

A

Pulmonary embolism
Pneumonia
Pneumothorax

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9
Q

Characteristics of Ischaemic heart disease

A

radiation to jaw, left arm
pressure-like pain
Associated symptoms: sweating, nausea

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10
Q

Characteristics of Aortic Dissection

A

Chest pain radiates to back
BP difference in both arms (>20)
Aortic Regurgitation murmur

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11
Q

Characteristics of Pericarditis

A

pleurtic pain (worse when breathing in, sharp)
relieved when leaning forward
flu-like illness
(young person with no other risk factors)

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12
Q

Characteristics of PE

A 
Pleuritic
Sudden SOB
Swollen leg
Haemoptysis
Risk factors: immbolility or pill
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13
Q

Characteristics of Pneumonia

A

Pleuritics chest pain
cough
sputum
Temp

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14
Q

Characteristics of Pneumothorax

A

Sudden onset of SOB

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15
Q

Differential diagnosis of chest pain (GI, Musculoskeletal)

A

GI - Oesophageal spasm
Oesophagitis
Gastritis
Musc - Costochondritis

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16
Q

Cause of pleurtic pain (all Ps)

A 
PE
Pericarditis
Pneumonia 
Pneumothorax
Pleural pathology
Sub-diaphragmatic pathology 
(could also be due connective tissue disease e.g. sjogren's, SLE or pleurtic tumour)
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17
Q

Cardiac Chest pain associated symptoms

A

Pain, palpitations, dizziness, breathlessness, ankle swelling

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18
Q

ECG features of Anteriolateral STEMI

A

ST elevation V2-4, V5,6 + I, aVL

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19
Q

ECG features of inferior STEMI

A

ST elevation in II, III, aVF

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20
Q

Artery supply of heart anterior, lateral, inferior

A

Anterior -Left anterior descending
Lateral - Circumflex (branch of left main stem)
Inferior - Right coronary artery

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21
Q

Causes of collapse

A

Hypoglycaemia
Cardiac - Vasovagal, Arrhythmia, Outflow obstruction, postural hypotension
CNS-seizures

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22
Q

Features of Vasovagal (3P)

A

Posture
Prodrome
Provoking factors - hot weather, dehydration, cough refelx, micturition reflex

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23
Q

Features of Arrhytmia (causes, requirements etc)

A

Either brady or tachy
ECG-long QT predisposes to VT - abnormal ventricular repolarisation
Causes: congenital - mutations in K channels (depolarisation porblems), FH of sudden death Acquired: low K/Mg, drugs
Cardiace monitor and 24h tape required to catch an episode

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24
Q

How to measure QT interva

Study These Flashcards
A

Draw line between two R waves, then draw a line half way and the T-wave shoudl finish before half way point, if not long QT

25
Examples of Outflow obstruction
Left-Aortic Stenosis, Hypertrophic cardiomyopathy | Right- PE
26
O/E and Investigations for outflow obstruction
Exam: low volume/slow rising pulse (thrill under fingers on the carotid pulse), ESM Echo-to see stenosis and pressure gradient across valve
27
O/E and Investigations for postural hypotension
Lying and standing blood pressure
28
Differential diagnosis of raised JVP
R-heart failures Tricuspid Regurgitation Constrictive pericarditis
29
Cause of R heart failure
Secondary to left - CCF, previous ischaemic heart disease, MI Pulmonary hypertension - PE, COPD,
30
Causes of Tricuspid regurgitations
carcinoid, valve leaflet damage due infective endocarditis, R-ventricle dilation of the valve ring
31
Causes of Constrictive pericarditis
calcification of the pericardium due TB seen on CX Infection - TB Inflammation - Connective tissues disorder lupus, sarcoid Malignancy
32
Differential Diagnosis of a Systolic murmur
Aortic Stenosis Mitral Regurgitation Tricuspid Regurgitation Ventricular septal defect
33
Why could troponin be raised?
``` MI Sepsis Pneumonia Fall Renal Impairment ```
34
3 things an ECG can tell?
Suggests structural problems, conduction problems, ischaemia
35
4 things ECG can show with a tachycardia/palpitations
Sinus Tachycardia Supraventricular tachycardia Atrial fibrillation/Flutter Ventricular tachycardia
36
DDx of Sinus tachycardia
Sepsis (hypotension causing reflex tachy) Hypovolemia Endocrine: thyrotoxicosis, phaeochromocytoma Can be physiological
37
Features sinus tachycardia
Narrow QRS and p waves seen
38
Features of SVT
missing p wave fast and regular QRS-T pattern narrow complex (<3 sml squares)
39
DDx of SVT
AVNRT - re-entry circuit at the AV node (in circles) | AVRT (Wolff Parkinson White) - big accessory bundle
40
Features of AF
Irregular, no p-waves, narrow QRS
41
Features of Atrial Flutter
Chaotic atrial activity, no p-waves, saw-tooth baseline
42
DDx of AF/atrial flutter
Metabolic - Thyrotoxicosis. alcohol Heart (by layer): pericarditis, muscle (CM, IHD, HTN, myocarditis). valves (MS, MR) Lungs: pneumonia, PE, cancer
43
Features of a ventricular tachycardia
Broad QRS comples (you can see pink paper between the two limbs if complex) Regular
44
DDx of VT
``` Ischaemia - collapse with MI due to arrhythmia Electrolyte abnormality (Check K, Mg) Congenital: long QT (look at previous old ECG) ```
45
Management of SVT
Whatever the rhytmn is if haemodynamically compromised (hypotension) -> DC cardioversion Otherwise: start with vagal manoeuvres (immers in cold water, valsalva, massage carotid) Give adenosine with cardiac monitor (contraindication if asthma or pt cold), print rhytmn strp and mark when adenosine given
46
Management of AF
Treat underlyning cause Control rate with beta-blockers or digoxin Prevent stroke (CHADVASC) Think of complications (anticoagulation - warfarin) Rhytmn control: if onset >48h, do not perform cardioversion as patietn is of risk of thrombus, which may cause a stroke, hence anticoagulate for 3-4weeks before cardioversion If less than 48h oppurtunity to do cardioversion
47
Management of VT
If haemodynamically not compromised, give IV amiodarone (if they are speaking etc) Look for and treat underlying cause ICD if pulseless VT: defibrillate
48
What is the difference between cardioversion and defibrillation
Cardioversion is synchromised adn defibrillation is not
49
What is the criteria of left ventricular hypertrophy by ECG
SIR: Deep S waves in V1, V2, tall R waves in V5,V6 ->suggestive of hypertension S in V1 + R in V5/6 (which ever is bigger) ≥ 7 large squares
50
DDx of left ventricular hypertrophy
Hypertension - as it is working high resistance Aortic Stenosis - working against a narrow gradient (hypertension more common tho)
51
Features of 1st, 2nd, 3rd degree heart block
1.Prolonged PR interval (> 1 lrg sqr) 2.Missed QRS after P waves 3. Complete dissociation of atria and ventricles, (broad QRS)
52
Heart sounds: | S1, S2, fixed wide splitting of S2, S3, S4
S1 - closure of mitral valve S2 - closure of aortic valve Fixed wide splitting of S2 - atrial septal defect S3 - associated with ventricular filling S4 - associated with ventricular hypertrophy (atria have to constrict against stiff ventricle)
53
Mangement for acute heart failure
1. Sit up 2. 60 -100% O2 3. Furosemide(IV)- not for diuresis, venodilator as well) a. Given IV because they have gut oedema they will not absorb the drug orally b. daily weights needed 4.Treat the underlying cause GTN spray are only used in rare cases, e.g. if heart failure + MI/angina
54
Management of chronic heart failure
indicated by reduced exercise-tolerance test Tx: Beta-blockers ACEi & spironolactone
55
Cause of cardiac arrest
``` Hypoxia Hypothermia Hypovolaemia Hypo/hyperkalaemia Tamponade Tension pneumothorax Thromboembolism Toxins/metabolic disorders: drugs, therapeutic agents, sepsis ```
56
Management for VF/pulselessVT
``` Shock Do CPR for 2min Re-assess rhytmn Adrenaline every 3-5min Amiodarone after 3 shocks Correct reversible causes ```
57
Managemenr of asystole/pulseless electrical activity
ECG looks fine bu pt has no pulse CPR (2min) Correct reversible causes Adrenaline every 3-5min
58
ECg changes for Pericarditis and management
Global saddle-shaped ST elevation, diffuse coronary disease better when leaning forward Mx: analgesics and reassurance

Amir Sam Lectures (2 decks)

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