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Emergency cardiology Flashcards

(80 cards)

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1
Q

What are the potential rhythms in a pulseless patient?

A

Shockable - VT or VF
Non shockable - PEA, asystole

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2
Q

Define narrow complex tachycardia

A

QRS < 0.12 seconds or 3 small squares

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3
Q

What are the differentials for narrow complex tachycardia?

A
  • Sinus tachycardia
  • SVT
  • AF
  • Atrial flutter
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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

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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

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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

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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)

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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
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9
Q

What are some complications of SVT?

A

Syncope
DVT
PE
Cardiac tamponade
HF
MI
Death

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10
Q

How do you prevent SVT?

A

B blockers

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11
Q

What is the ECG appearance of AF?

A

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

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12
Q

What are some causes of AF?

A

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

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13
Q

What are the sx of narrow complex tachycardia?

A
  • Palpitations
  • Chest pain
  • SOB
  • Lightheadedness
  • Syncope
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14
Q

AF vs A flutter

A

AF = fibrillatory waves on ECG
A flutter = sawtooth

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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

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16
Q

What is used for rate control?

A

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

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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

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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

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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

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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

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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

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22
Q

What is the management of digoxin poisoning?

A

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

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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

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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.

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25
Causes of cardiac tamponade
Stab wounds!!!! Other trauma eg. RTA Pericarditis Malignancies SLE Myocardial rupture following MI
26
What are the CF of cardiac tamponade?
Becks triad: 1. Raised JVP 2. Hypotension 3. Muffled HS Kussmaul's sign = paradoxical rise in JVP during inspiration Dyspnea and fatigue
27
What are the ix into cardiac tamponade?
Echo ECG - tall QRS, alt QRS amplitude
28
What is the management of cardiac tamponade?
Pericardiocentesis - fluid removed to relieve pressure
29
What is the MOA of amiodarone?
Blocks K+ so reduces heart speed
30
What is the MOA of adenosine?
Transient AVN block
31
What is broad complex tachycardia?
QRS >0.12 secs or 3 small squares
32
What are some examples of broad complex tachycardia?
VT PVT eg. torsades de pointes AF w BBB SVT w BBB
33
What does VT look like on ECG?
Regular broad QRS complex, no other waves
34
Causes of VT
Hypokalaemia or hypomg MI Brugada syndrome
35
What is the management of VT?
Adverse features HISS = synchronised DC shock Stable pt = IV amiodarone
36
What is polymorphic VT?
VT twists, like up and down, like sound waves Torsades de pointes is a type - life threatening and can cause sudden cardiac death
37
What is the acute management of TdP?
HISS = DC cardioversion Stable = 2mg IV Mg sulphate Address triggers
38
What are the ECG features of BBB?
Right = little bunny ear, big bunny ear Left = tooth/M ????
39
What are the ECG features of axis deviation?
Right - reaching to each other Left - away from each other Normal - both up
40
Causes of LBBB
MI !!!!!
41
Define prolonged QT
>440 ms
42
What are some causes of prolonged QT?
- Long QT syndrome, inherited - Meds eg. clarithromycin, erythromycin, antipsychotics, citalopram - Electrolyte imbalances (hypo)
43
What is the management of prolonged QT interval?
Stop offending meds Correct electrolytes B blockers but not sotalol Pacemakers or ICD
44
What does a ventricular ectopic look like on ECG?
Isolated, random, broad QRS complex on otherwise normal ECG
45
What is bigeminy?
every other beat is a ventricular ectopic - this is abnormal, needs specialist advice
46
What are the different types of heart block?
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
Which heart blocks are most dangerous?
2nd degree Mobitz type 2 - risk of asystole 3rd degree - significant risk of asystole
48
When is bradycardia a medical emergency?
<60 bpm and haemodynamic compromise - hypotension, cerebral hypoperfusion, HF or angina
49
Causes of bradycardia
Electrolyte disturb Hypothyroid MI Sepsis B blockers Increased ICP Heart block
50
What is the management of bradycardia w adverse features?
IV atropine - inhibits parasympathetics Adrenaline Dopamine If don't respond to meds = temporary pacing - transcutaneous or transvenous
51
What is sick sinus syndrome?
Clinical manifestations of sinus node dysfunc, may need a pacemaker if v symptomatic
52
What are the CF of pericarditis?
- 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
What is the management of pericarditis?
NSAIDs Bed rest +/- colchicine and steroids Treat underlying cause eg. MI, trauma, malignancy, SLE, drug
54
What are the CVS causes of raised troponin?
MI (cardiac ischaemia) Arrhythmia Coronary artery spasms Aortic dissection HTN
55
What are the non CVS causes of raised troponin?
CKD PE Sepsis
56
What is dissection?
Tear in the tunica intima of the aorta = blood flows between the inner and outer layers of the walls of the aorta
57
What are the RF of aortic dissection?
HTN Connective tissue disease eg. Marfan's Valvular HD Cocaine
58
What is the classification of aortic dissection?
Stanford Type A - ascending aorta and arch, more common Standford Type B - descending aorta
59
What are the CF of aortic dissection?
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
What are the ix into aortic dissection?
CT angiogram = gold standard - ECG = ischaemia? - Echo - CXR = widened mediastinum - Raised troponin and +ve Ddimer
61
What is the management of aortic dissection?
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
What are the complications of aortic dissection?
Rupture and death End organ damage Cardiac tamponade Stroke Limb and mesenteric ischaemia
63
What are the signs of AAA?
Pulsatile abdo mass Sudden severe abdo or back pain - pain = late sign, indicates impending rupture Rupture = sudden severe pain, signs of shock
64
What is the management of AAA?
Open repair and endovascular aneurysm repair are the two options. Indications = >5.5cm or rapid expansion
65
What are the 3 ACS?
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
What is a type 2 myocardial infarction?
MI due to cardiac hypoperfusion eg. sepsis, hypotension, hypovolaemia or coronary artery spasm
67
CF of MI
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
What are the Ix into MI?
ECG - LBBB, ST elevation or other ST abnorm Bloods - troponin, U+E, HbA1c, lipids, FBC and CRP, D dimer CXR
69
ECG and MI - what vessel affected?
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
What is the management of a STEMI?
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
Management of NSTEMI and unstable angina
1. O2 2. 300mg aspirin, calc 6month mortality = if med/high = prasugrel 3. GTN 4. IV morphine 5. LMWH or fondaparinux 6. Angiogram
72
What is the post MI management?
1. Aspirin 75mg 2. Clopidogrel 75mg 3. B blocker 4. ACEi 5. Atorvastatin 80mg Have an echo and cardiac rehab.
73
What is Dressler's syndrome?
Persistent fever and pleuritic chest pain 2-3 weeks post MI Sx resolve in few days Manage w high dose aspirin
74
What are some distinguishing features of the different causes of collapse?
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
What are the ix into collapse?
ECG Bloods - U+E, FBC, BM Echo - look for structural cause of cardiac syncope
76
What are the regulations of unexplained syncope?
6 months off driving and have to inform DVLA NO baths, don't lock doors
77
What are the different types of shock?
Hypovolaemic Septic Anaphylactic Cardiogenic - reduced cardiac output Neurogenic Obstructive
78
What is trifasicular blcok?
Incomplete - RBBB, L axis deviation and 1st degree heart block Complete - RBBB, L axis deviation and 3rd degree heart block
79
What is bifasicular block?
RBBB and axis deviation (L or R)
80

Emergency medicine (8 decks)

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