Flashcards in Interactive cases CVS Deck (48)
what are the top 3 differentials for cardiac chest pain?
- aortic dissection
what are the top 3 respiratory differentials for chest pain?
what are the differentials in the GI system for chest pain?
- oesophageal spasm
what are the differentials in the musculooskeletal system for chest pain?
what investigations do you do for chest pain?
- ECG (if all chest leads involved, probably antero-lateral MI)
what do you do if the troponin is +ve? or -ve?
+ve = coronary angiography
-ve = exercise tolerance test
what artery and ECG leads are involved in an anterior MI?
- left anterior descending artery
what artery and ECG leads are involved in a lateral MI?
- V5, V6, I, aVL
what artery and ECG leads are involved in an inferior MI?
- right coronary artery
- I, II, aVF
what is a metabolic cause of collapse?
what are cardiac causes of collapse?
- outflow obstruction (e.g. aortic stenosis)
- postural hypotension
what is a brain cause of collapse?
what O/E and investigations do you do for suspected arrhythmia? (tachy, brady)
- ECG (Long QT?)
- cardiac monitor
- 24hr tape
what are the left and right sided causes of outflow obstruction?
- Left: aortic stenosis, hypertrophic obstructive cardiomyopathy
- Right: PE
What O/E and investigations should you do for suspected outflow obstruction?
- low volume/ slow rising pulse
- ejection systolic murmur
what investigation is essential to do in suspected postural hypotension?
lying/ standing BP
what is the pathophysiology of long QT syndrome?
abdnormal ventricular repolarisation
what are the causes of long QT?
- congenital: mutations in K+ channels (will have FHx of sudden death)
- acquired: low K/Mg, drugs
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
what are the differentials of a raised JVP?
- R heart failure
- tricuspid regurgitation (sounds will be louder on inspiration)
- constrictive pericarditis
what are the causes of R heart failure?
- secondary to Left heart failure (congestive cardiac failure)
- pulmonary hypertension (PE, COPD etc) --> cor pulmonale
what are the causes of tricuspid regurgitation?
- valve leaflets
- R ventricle dilatation
what are the causes of constrictive pericarditis?
- infection e.g. TB
- inflammation e.g. connective tissue disease
what are the differentials for a systolic murmur?
- aortic stenosis
- mitral regurgitation
- tricuspid regurgitation
- ventricular septal defect
how can you tell these different causes apart?
- where is sound loudest?
- where does it radiate to?
- associated features
what are the characteristics of the systolic murmur in aortic stenosis?
radiates to carotids, loudest in aortic area, slow rising pulse
what are the characteristics of the systolic murmur in mitral regurgitation?
radiates to axilla, loudest in mitral area
What is sinus tachycardia? what are the DDx?
- P wave before every QRS
- endocrine (thyrotoxicosis, phae)
what is the difference between AF and SVT?
- both don't have P waves
- both fast
- AF = irregular
- SVT = regular