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Flashcards in Interactive cases CVS Deck (48)
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1

what are the top 3 differentials for cardiac chest pain?

- IHD
- aortic dissection
- pericarditis

2

what are the top 3 respiratory differentials for chest pain?

- PE
- pneumonia
- pneumothorax

3

what are the differentials in the GI system for chest pain?

- oesophageal spasm
- oesophagitis
- gastritis

4

what are the differentials in the musculooskeletal system for chest pain?

costochondritis

5

what investigations do you do for chest pain?

- ECG (if all chest leads involved, probably antero-lateral MI)
- troponin
- echo

6

what do you do if the troponin is +ve? or -ve?

+ve = coronary angiography
-ve = exercise tolerance test

7

what artery and ECG leads are involved in an anterior MI?

- left anterior descending artery
- V1-V4

8

what artery and ECG leads are involved in a lateral MI?

- circumflex
- V5, V6, I, aVL

9

what artery and ECG leads are involved in an inferior MI?

- right coronary artery
- I, II, aVF

10

what is a metabolic cause of collapse?

hypoglycaemia

11

what are cardiac causes of collapse?

- vasovagal
- arrhythmia
- outflow obstruction (e.g. aortic stenosis)
- postural hypotension

12

what is a brain cause of collapse?

seizure

13

what O/E and investigations do you do for suspected arrhythmia? (tachy, brady)

- ECG (Long QT?)
- cardiac monitor
- 24hr tape

14

what are the left and right sided causes of outflow obstruction?

- Left: aortic stenosis, hypertrophic obstructive cardiomyopathy
- Right: PE

15

What O/E and investigations should you do for suspected outflow obstruction?

- low volume/ slow rising pulse
- ejection systolic murmur
- Echocardiogram

16

what investigation is essential to do in suspected postural hypotension?

lying/ standing BP

17

what is the pathophysiology of long QT syndrome?

abdnormal ventricular repolarisation

18

what are the causes of long QT?

- congenital: mutations in K+ channels (will have FHx of sudden death)
- acquired: low K/Mg, drugs

19

how do you work out if they have long QT on ECG?

- draw a line between 2 R peaks (RR interval)
- draw a vertical line in the middle of the RR interval
- normal: t wave completed before the vertical line
- long QT: t wave not finished by the red line

20

what are the differentials of a raised JVP?

- R heart failure
- tricuspid regurgitation (sounds will be louder on inspiration)
- constrictive pericarditis

21

what are the causes of R heart failure?

- secondary to Left heart failure (congestive cardiac failure)
- pulmonary hypertension (PE, COPD etc) --> cor pulmonale

22

what are the causes of tricuspid regurgitation?

- valve leaflets
- R ventricle dilatation

23

what are the causes of constrictive pericarditis?

- infection e.g. TB
- inflammation e.g. connective tissue disease
- malignancy

24

what are the differentials for a systolic murmur?

- aortic stenosis
- mitral regurgitation
- tricuspid regurgitation
- ventricular septal defect

25

how can you tell these different causes apart?

- where is sound loudest?
- where does it radiate to?
- associated features

26

what are the characteristics of the systolic murmur in aortic stenosis?

radiates to carotids, loudest in aortic area, slow rising pulse

27

what are the characteristics of the systolic murmur in mitral regurgitation?

radiates to axilla, loudest in mitral area

28

What is sinus tachycardia? what are the DDx?

- P wave before every QRS
DDx:
- sepsis
- hypovolaemia
- endocrine (thyrotoxicosis, phae)

29

what is the difference between AF and SVT?

- both don't have P waves
- both fast
- AF = irregular
- SVT = regular

30

what are the DDx of AF?

- thyrotoxicosis, alcohol
- Heart: muscle, valve, pericardium
- Lungs: pneumonia, PE, cancer