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Flashcards in Cardiology Deck (257)
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1

State the arterial supply to the lateral leads

Circumflex

2

Name the leads that correlate to the lateral area of the heart

I
aVL
V5
V6

3

State the arterial supply to the inferior leads

right coronary artery

4

State the arterial supply to the anteroseptal leads

LAD

5

Name the leads that correlate to the inferior area of the heart

II
III
aVF

6

Name the leads that correlate to the anteroseptal area of the heart

VI
V2
V3
V4

7

What is the initial management of ACS?

o2 if <94%
12 lead ECG
IV access
sublingual GTN spray
aspirin 300mg
diamorphine IV + metaclopramide IV

?ticagrelor, clopidogrel or prasugrel

Glycoprotein IIb/IIIa inhibitors

8

What investigations would you do in ACS?

Bedside: ECG
Bloods: FBC U+E LFTs glucose lipids troponin I
Imaging: portable CXR

9

What are the indications for thrombolysis or PCI in STEMI?

<12hrs pain

+ any of
ST elevation >1mm in 2 limb leads
ST elevation >2mm in 2 chest leads
posterior infarct
new onset LBBB

10

What are the absolute contraindications for thrombolysis?

stroke <6m
CNS neoplasia
recent trauma or surgery
GI bleed <1m
bleeding disorder
aortic dissection

11

What are the relative contraindications for thrombolysis?

warfarin
pregnancy
advanced liver disease
infective endocarditis

12

State the complications of thrombolysis

bleeding
hypotension
ICH
reperfusion arrhythmias
systemic embolisation of thrombus
allergic reaction

13

What drug is used for thrombolysis in STEMI?

reteplase

14

What are the complications of a STEMI?

S udden death
P ericarditis
R upture papillary muscles
E mbolism
A rrhythmias
D ressler's syndrome

15

What drugs should a patient be prescribed post MI?

Aspirin
ACEi
Beta blocker
Clopidogrel/prasugrel (STEMI)/ticegralor (NSTEMI)
Statin

16

In terms of work and driving, what should a patient be advised post MI?

off work for 1 month
need to inform DVLA - no driving for 1 month

17

How can you distinguish between NSTEMI and unstable angina?

troponin I 12hrs after onset
+ve for NSTEMI
-ve for unstable angina

18

How is an NSTEMI treated?

MONA

LMWH - fondaparinux
Beta blocker or calcium chanel blocker
nitrates

19

When should PCI be considered in a patient with NSTEMI?

rise in troponin I
recurrent angina/ischaemic ECG changes despite therapy
heart failure develops
poor LV function
haemodynamically unstable
PCI <6m
previous CABG

20

Name some narrow complex tachycardias

regular:
sinus tachy
accessory pathway
atrial tachy
junctional tachy - - AVNRT/AVRT
multifocal atrial tachycardia

irregular:
AF

21

How do you manage a regular narrow complex tachycardia?

ABC
O2
IV access

vagal manoeuvres
adenosine 6mg IV bolus
monitor ECG

22

How does adenosine work?

inhibition SAN and AVN
Leads to AV block

23

What are the vagal manouevres?

carotid sinus massage
Valsalva - hold breath and bear down

24

If adenosine fails, and the patient is haemodynamically compromised in regular SVT, what next?

Senior help!!!

Amiodarone 300mg IV
DC cardioversion

25

If adenosine fails, and the patient is haemodynamically stable in regular SVT, what next?

senior help!!!

B blocker
digoxin

26

What could cause a broad complex tachycardia?

VT - most common! until proven otherwise

SVT with BBB
SVT with aberrancy
WPW antidromic

27

If the patient is unstable, how should a VT be managed?

senior help!
sedation
DC cardioversion
amiodarone

28

If the patient is stable, how should a VT be managed?

amiodarone 300mg IV

If SVT, give adenosine

29

What is the most common organism to cause endocarditis?

Streptococcus viridans

Staph aureus in IVDU
Staphylococcus epidermidis in valve surgery <2m ago

30

What are the key features of infective endocarditis?

fever
new heart murmur