Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency medicine > Emergency cardiology > Flashcards

Emergency cardiology Flashcards

1
Q

What are the potential rhythms in a pulseless patient?

A

Shockable - VT or VF
Non shockable - PEA, asystole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define narrow complex tachycardia

A

QRS < 0.12 seconds or 3 small squares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the differentials for narrow complex tachycardia?

A
  • Sinus tachycardia
  • SVT
  • AF
  • Atrial flutter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some causes of sinus tachycardia?

A

> 100 BPM
- Fever
- Normal response - pain, anxiety, exercise, dehydration
- Hyperthyroid
- Anaemia
- Shock - septic, hypovolaemia/hypotension
- PE
- Cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sinus tachy vs SVT

A

Presenting complaint for SVT = very sudden (paroxysmal), no reason
Sinus tachy normally has an explaination and gradually increases in speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management of SVT for HISS patients?

A

Pt w adverse features (HISS) need synchronised DC shock
HF
Ischaemia
Shock
Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of stable SVT patients?

A

Regular = vagal manoeuvres eg. blowing into an empty plastic syringe (valsalva), carotid sinus massage
If this fails:
IV adenosine 6mg (can do 12mg and 18mg after as well)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is important to remember when using adenosine?

A
  • Have arrest trolley nearby
  • Impending doom sensation
  • CI in asthmatics -> use verapamil
  • Give 20ml IV NaCl bolus after
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some complications of SVT?

A

Syncope
DVT
PE
Cardiac tamponade
HF
MI
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you prevent SVT?

A

B blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the ECG appearance of AF?

A

Fast = >100bpm
Slow = <60bpm
Irregular
No P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some causes of AF?

A

IHD (most common)
HTN
Inflam of heart
Dehydration
Hyperthyroid
Sepsis
PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the sx of narrow complex tachycardia?

A
  • Palpitations
  • Chest pain
  • SOB
  • Lightheadedness
  • Syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AF vs A flutter

A

AF = fibrillatory waves on ECG
A flutter = sawtooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of acute AF?

A

Adverse signs (HISS) = synchronised DC cardioversion +/- amiodarone
Stable:
<48 hours = rate or rhythm control
>48 hours = rate control only
Need to anticoagulate for 3 weeks before starting cardioversion due to risk of throwing off clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is used for rate control?

A

B blockers
CCB eg. diltiazem (CI in HF)
Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is used for rhythm control?

A

B blockers
Dronedarone = 2nd line in pt following cardioversion
Amiodarone, especially if HF
Flecainide = younger pt w normal hearts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is catheter ablation?

A

Remove electrical pathways causing AF, used in pt who don’t response to medication or want to avoid
Anticoag 4 weeks before and during procedure
Pt still require anticoagulation after procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the anticoag options in AF?

A

1st line = DOAC eg. apixaban
Warfarin w LMWH cover for 5 days
LMWH eg. enoxaparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the CF of digoxin poisoning?

A
  1. Heart signs - palpitations, bradycardia
  2. Visual signs - haloes and yellow -> green
  3. Autonomic dysreg - dizzy, N+V, sweat and clammy

Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the Ix into digoxin poisoining?

A

Immediate digoxin level
U+Es - so can correct abnormalities
Cont cardiac monitoring - to resus or ITU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the management of digoxin poisoning?

A

IV fluids
Correct electrolyte abnorm
Cont cardiac monitoring
+/- Digibind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is digibind and what are the indications for using it?

A

Digoxin specific ab = antidote - if level >15ng/ml >6 hours last dose or >10ng/ml <6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is cardiac tamponade?

A

Accumulation of fluid (normally blood) in the pericardial sac.
Fluid increases intrapericardial pressure = reduces cardiac filling during diastole = reduced cardiac output.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Causes of cardiac tamponade

A

Stab wounds!!!!
Other trauma eg. RTA
Pericarditis
Malignancies
SLE
Myocardial rupture following MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the CF of cardiac tamponade?

A

Becks triad:
1. Raised JVP
2. Hypotension
3. Muffled HS
Kussmaul’s sign = paradoxical rise in JVP during inspiration
Dyspnea and fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the ix into cardiac tamponade?

A

Echo
ECG - tall QRS, alt QRS amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the management of cardiac tamponade?

A

Pericardiocentesis - fluid removed to relieve pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the MOA of amiodarone?

A

Blocks K+ so reduces heart speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the MOA of adenosine?

A

Transient AVN block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is broad complex tachycardia?

A

QRS >0.12 secs or 3 small squares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some examples of broad complex tachycardia?

A

VT
PVT eg. torsades de pointes
AF w BBB
SVT w BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does VT look like on ECG?

A

Regular broad QRS complex, no other waves

34
Q

Causes of VT

A

Hypokalaemia or hypomg
MI
Brugada syndrome

35
Q

What is the management of VT?

A

Adverse features HISS = synchronised DC shock
Stable pt = IV amiodarone

36
Q

What is polymorphic VT?

A

VT twists, like up and down, like sound waves
Torsades de pointes is a type - life threatening and can cause sudden cardiac death

37
Q

What is the acute management of TdP?

A

HISS = DC cardioversion
Stable = 2mg IV Mg sulphate
Address triggers

38
Q

What are the ECG features of BBB?

A

Right = little bunny ear, big bunny ear
Left = tooth/M ????

39
Q

What are the ECG features of axis deviation?

A

Right - reaching to each other
Left - away from each other
Normal - both up

40
Q

Causes of LBBB

A

MI !!!!!

41
Q

Define prolonged QT

A

> 440 ms

42
Q

What are some causes of prolonged QT?

A
  • Long QT syndrome, inherited
  • Meds eg. clarithromycin, erythromycin, antipsychotics, citalopram
  • Electrolyte imbalances (hypo)
43
Q

What is the management of prolonged QT interval?

A

Stop offending meds
Correct electrolytes
B blockers but not sotalol
Pacemakers or ICD

44
Q

What does a ventricular ectopic look like on ECG?

A

Isolated, random, broad QRS complex on otherwise normal ECG

45
Q

What is bigeminy?

A

every other beat is a ventricular ectopic - this is abnormal, needs specialist advice

46
Q

What are the different types of heart block?

A

1st degree - PR interval >0.2 seconds/ >5small squares but QRS always follows
2nd degree - type 1 = progressively longer PR then QRS fails or type 2 = fixed prolonged PR and sudden drop QRS
3rd degree - no relationship between P waves or QRS complexes
2:1 block - 2 p waves for every QRS

47
Q

Which heart blocks are most dangerous?

A

2nd degree Mobitz type 2 - risk of asystole
3rd degree - significant risk of asystole

48
Q

When is bradycardia a medical emergency?

A

<60 bpm and haemodynamic compromise - hypotension, cerebral hypoperfusion, HF or angina

49
Q

Causes of bradycardia

A

Electrolyte disturb
Hypothyroid
MI
Sepsis
B blockers
Increased ICP
Heart block

50
Q

What is the management of bradycardia w adverse features?

A

IV atropine - inhibits parasympathetics
Adrenaline
Dopamine
If don’t respond to meds = temporary pacing - transcutaneous or transvenous

51
Q

What is sick sinus syndrome?

A

Clinical manifestations of sinus node dysfunc, may need a pacemaker if v symptomatic

52
Q

What are the CF of pericarditis?

A
  • Sharp pleuritic chest pain relieved by leaning forward
  • Flu like prodrome
  • Pericardial rub (like walking in snow)
  • ECG = saddled shaped ST elevation
  • Troponin +/- elevated
53
Q

What is the management of pericarditis?

A

NSAIDs
Bed rest
+/- colchicine and steroids
Treat underlying cause eg. MI, trauma, malignancy, SLE, drug

54
Q

What are the CVS causes of raised troponin?

A

MI (cardiac ischaemia)
Arrhythmia
Coronary artery spasms
Aortic dissection
HTN

55
Q

What are the non CVS causes of raised troponin?

A

CKD
PE
Sepsis

56
Q

What is dissection?

A

Tear in the tunica intima of the aorta = blood flows between the inner and outer layers of the walls of the aorta

57
Q

What are the RF of aortic dissection?

A

HTN
Connective tissue disease eg. Marfan’s
Valvular HD
Cocaine

58
Q

What is the classification of aortic dissection?

A

Stanford Type A - ascending aorta and arch, more common
Standford Type B - descending aorta

59
Q

What are the CF of aortic dissection?

A

Sudden onset tearing chest pain or interscapular pain radiating to the back
+/- bowel/limb ischaemia, renal failure, syncope

O/E - radio radial delay, radio femoral delay, BP different between arms

60
Q

What are the ix into aortic dissection?

A

CT angiogram = gold standard
- ECG = ischaemia?
- Echo
- CXR = widened mediastinum
- Raised troponin and +ve Ddimer

61
Q

What is the management of aortic dissection?

A

Need to prevent rupture = 80% mortality
Initial - resus, cardiac monitoring, BP control eg. IV metoprolol infusion
Type A - surgical management
Type B - bed rest, blood pressure control eg. IV labetalol

62
Q

What are the complications of aortic dissection?

A

Rupture and death
End organ damage
Cardiac tamponade
Stroke
Limb and mesenteric ischaemia

63
Q

What are the signs of AAA?

A

Pulsatile abdo mass
Sudden severe abdo or back pain - pain = late sign, indicates impending rupture
Rupture = sudden severe pain, signs of shock

64
Q

What is the management of AAA?

A

Open repair and endovascular aneurysm repair are the two options.
Indications = >5.5cm or rapid expansion

65
Q

What are the 3 ACS?

A
  1. Unstable angina - partial occlusion, troponin -ve, ECG -ve, chest pain +ve
  2. NSTEMI - severe occlusion, troponin +ve, chest pain +ve, ST depression or T wave inversion
  3. STEMI - complete occlusion, troponin +ve, chest pain +ve, ECG ST elevation
66
Q

What is a type 2 myocardial infarction?

A

MI due to cardiac hypoperfusion eg. sepsis, hypotension, hypovolaemia or coronary artery spasm

67
Q

CF of MI

A

Chest pain - central, sudden, crushing, radiating to L arm and jaw, N+V, clammy, sweaty, SOB, constant, better w GTN worse w exercise

Atypical - epigastric pain or no pain - syncope SOB or palpitations

68
Q

What are the Ix into MI?

A

ECG - LBBB, ST elevation or other ST abnorm
Bloods - troponin, U+E, HbA1c, lipids, FBC and CRP, D dimer
CXR

69
Q

ECG and MI - what vessel affected?

A

II III and aVF - inferior = right coronary artery
V1 and V2 - septal = proximal LAD
V3 and V4 - ant = LAD
V5 and V6 - apex = distal LAD
I and aVL - lat = left circumflex
V7-V9 - post lat = right coronary or L circumflex

70
Q

What is the management of a STEMI?

A
  1. O2
  2. Loading dose aspirin 300mg
  3. GTN
  4. IV morphine
  5. PCI <12 hours of pain and <2 hours in hospital - need clopidogrel 300mg
71
Q

Management of NSTEMI and unstable angina

A
  1. O2
  2. 300mg aspirin, calc 6month mortality = if med/high = prasugrel
  3. GTN
  4. IV morphine
  5. LMWH or fondaparinux
  6. Angiogram
72
Q

What is the post MI management?

A
  1. Aspirin 75mg
  2. Clopidogrel 75mg
  3. B blocker
  4. ACEi
  5. Atorvastatin 80mg

Have an echo and cardiac rehab.

73
Q

What is Dressler’s syndrome?

A

Persistent fever and pleuritic chest pain 2-3 weeks post MI
Sx resolve in few days
Manage w high dose aspirin

74
Q

What are some distinguishing features of the different causes of collapse?

A

Cardiac syncope - before = lightheaded, chest pain, SOB, palpitations, rapid recovery after
Vasovagal - clear trigger, narrowing of vision, sweating and nausea, can sometimes lower self to floor
Seizure - tongue biting, incontinence, post ictal, neuro deficit, seizure movements

75
Q

What are the ix into collapse?

A

ECG
Bloods - U+E, FBC, BM
Echo - look for structural cause of cardiac syncope

76
Q

What are the regulations of unexplained syncope?

A

6 months off driving and have to inform DVLA
NO baths, don’t lock doors

77
Q

What are the different types of shock?

A

Hypovolaemic
Septic
Anaphylactic
Cardiogenic - reduced cardiac output
Neurogenic
Obstructive

78
Q

What is trifasicular blcok?

A

Incomplete - RBBB, L axis deviation and 1st degree heart block
Complete - RBBB, L axis deviation and 3rd degree heart block

79
Q

What is bifasicular block?

A

RBBB and axis deviation (L or R)

80
Q
A

Emergency medicine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions