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1

name the drugs for heart failure

- beta blockers
- ACE/ARBs
- spironolactone/ furosemide

2

Describe the macroscopic appearance of the MI - 0-12 hours
- 12-24 hours
- 24-72 hours
- 3-10 days
- weeks - months

- 0-12 hours = no changes
- 12-24 hours = pale with blotchy discolouration
- 24-72 hours = soft, pale and yellow
- 3-10 days = soft, yellow-brown with hyperaemic border
- weeks - months = white fibrous scar

3

Describe the histology appearance of the MI
- 0-12 hours
- 12-24 hours
- 24-72 hours
- 3-10 days
- weeks - months

- 0-12 hours = No changes
- 12-24 hours = bright eosinophilia of muscle fibres reflecting onset of coagulation necrosis; intracellular oedema
- 24-72 hours = coagulative necrosis with loss of nuclei and striations, beginning of acute inflammatory response with heavy interstitial neutrophil infiltrate
- 3-10 days = replacement of infarcted area by granulation tissue
- weeks - months = collagenous scar tissue

4

What are the symptoms of right sided heart failure

Liver
- pure liver congested - nutmeg
- centrilobular necrossi and firbosis
- portal vein pressure increase - splenomegaly, ascities, kidneys and brain hypoxia, peripheral oedema
- biventricular - plus LVF

5

what are the causes of secondary hypertension

Renal
- Chronic renal disease
- glomerulonephritis
- renal artery stenosis

Neurological
- stress including surgery
- psychogenic
- raised intracranial pressure

Cardiovascular
- coarctation of the aorta
- systemic vasculitis
- increased intravascular volume

Endocrine
- cushings
- conns
- exogenous hormones
- pheochromocytoma
- acromegaly
- thyroid disease
- pregnancy

6

What can cause pulmonary hypertension

- diseases of the lung parenchyma such as COPD, cystic fibrosis, diffuse interstitial fibrosis
- diseases of the pulmonary vessels such as recurrent, PEs, primary PH, severe vasculiits
- Disorders affecting chest movement such as kyphoscoliosis, neuromuscular disease
- disorders causing arterial constriction such as hypoxaemia, chronic altitude sickness

7

How do you work out the QTc

QT/ square root of RR

8

what is the axis in left axis deviation and right axis deviation

Left axis deviation is when the axis is greater than -30

right axis deviation is when the axis is greater than +120

9

What can cause right axis deviation

– children and tall thin adults
– RVH
– chronic lung disease/ pulmonary embolus
– left posterior hemiblock
– atrial septal defect/ ventricular septal defect
– Wolff-Parkinson-White syndrome - left sided accessory pathway

10

What can cause left axis deviation

– LVH
– LBBB and left anterior hemiblock
– Q waves of inferior myocardial infarction
– Wolff-Parkinson-White syndrome - right sided accessory pathway

11

What causes P pulmonale

- peaked P wave
- Right atrial hypertrophy (tall and thin)

12

What causes P mitrale

- Bifid P wave
- Left atrial hypertrophy (M shape)

13

what is wolf parkinson white syndrome associated with

- pre excitation through an accessory pathway

14

What does an ECG of wolf parkinsons white syndrome look like

- Short P-R interval
- delta wave
- Wide QRS complex

15

what leads look at which part of the wall
- inferior
- anterior
- lateral

- inferior - II/III/aVF
- anterior - V2-4
- lateral - V5-6/I/aVL

16

Wellens syndrome

Antero-lateral T wave inversion
- anterior NSTEMI pending troponin
- LAD syndrome - LAD can involve the lateral wall as well as the anterior wall
- this patient should be treated as an MI
- Sign of an LAD lesion

17

What ECG changes happen in hypokalaemia

- small T waves
- Prominent U waves
- Peaked P waves

18

What ECG changes happen in hyperkalemia

- Tall Tented T waves
- wide QRS complex
- Absent P waves
- Sine wave appearance

19

What ECG changes happen in hypercalcaemia

- short QT interval

20

What ECG changes happen in hypocalcaemia

- long QT interval
- small T waves

21

What can cause a prolonged QT interval

- Congenital – Romano-Ward syndrome, Jervell and Lange-Nielsen syndrome
- Cardiac – MI, ischaemia, mitral valve prolapse
- HIV – direct effect of virus or protease inhibitors
- Metabolic – hypokalaemia, hypomagnesaemia, hypocalcaemia, starvation, hypothyroidism, hypothermia
- Toxic – organophosphates
- Anti-arrhythmic drugs – quinidine, amiodarone, procainamide, sotalol
- Antimicrobials – erythromycin, levofloxacin, pentamide, halofantrine
- Antihistamines – terfenadine, astimazole
- Motility drugs – domperidone
- Psychoactive drugs – haloperidol, risperidone, TCAs, SSRIs
- Connective disease disorders – Anto-RO/SSA Abs
- Herbalism – Chinese folk remedies (arsenic), cocaine, quinine, artemisinins (antimalarials)

22

What can cause AF

- IHD
- thyrotoxicosis
- hypertension
- obesity
- CCF
- alcohol

23

What is bifasciular block

LBBB+RBBB: manifests as an axis deviation

24

What is trifascicular block

bifasciular block + 1st degree Heart block

25

What does left ventricular hypertrophy look like

R-wave in V6 >25mm OR sum of S-wave in V1 and R-wave in V6 >35mm

26

What does right ventricular hypertrophy look like

Dominant R-wave in V1, T-wave inversion in V1-V3 or V4, deep S-wave in V6, RAD

27

How do you assess the patient with tachycardia and what do you do in unstable tachycardia

- Monitor SpO2 and give oxygen if they are hypoxic
- monitor ECG and BP and record 12 lead ECG
- obtain IV access
- identify and treat reversible causes

adverse features
- shock
- MI
- heart failure
- Syncope

- if you have these adverse features then this means that the tachycardia is unstable
- if the tachycardia is unstable you should administer a synchronised DC shock up to 3 times

28

What are the adverse features of tachycardia

- shock
- MI
- heart failure
- Syncope

29

What are the risk factors for stroke (CHADSVASC score) in AF

- Congestive heart failure - 1 point
- hypertension - 1 point
- age 65-74 - 1 point, age 75 years of older - 2 points
- diabetes mellitius - 1 point
- previous stroke, transient ischaemic attack/thromboembolism - 2 points
- vascular disease - 1 point
- female - 1 point

30

What is the difference between orthodromic and antidromic AVRT

Orthodromic AVRT
- the ventricle is activated down the pukinje his pathway and then goes up the accessory pathway
- Narrow QRS complex

Antidromic AVRT
- the ventricles are activated by the accessory pathway therefore the right side of the ventricle is activated first, the pathway then goes back up the bundle of His
- Broad QRS complex