Cardiovascular

Front 1

Prolonged Qt - Causes

Back 1

Think head first and work down
Brain - CNS event
Hypothyroidism
Heart - Ischaemia
Electrolytes (Low K, Mg, Ca)
Drugs

- Class Ia, Ic and III anti-arrythmic

- Organophosphate

- TCA
- antihistamine

- antipyshotic agent (both typical and atypical)

Congenital/Idiopathic

Front 2

Osbourne wave - Causes

Back 2

Hypothermia (Temp <32'C)
Neurological insult
Drugs
Electrolyte (Ca)
Normal

Front 3

Dominant R wave - Definition

Back 3

R:S ratio >1 in V1 and V2

Front 4

Dominant R wave - causes

Back 4

x3 R
RVH/Strain
RBBB
Dextrocardia

Posterior infarct
WPW type A
Normal (usually in children/adlorescents, normal variant in only 1% of adult patient)
Misplaced lead

3 Righteous men ****** on the Wall and Teenagers. How wrong!!

Front 5

Scarbossa criteria - Definition

Back 5

used to dx MI in those with LBBB or Paced

ONLY Need 1 LEAD

1) Concordant ST elevation >1mm with POSITIVE QRS
2) Concordant ST depression >1mm with NEGATIVE QRS in lead V1-3 only
3) Excessively discordant ST elevation >5mm in lead with negative QRS

NB: 3rd criteria - only if clinically sick as well

Front 6

Scarbossa criteria - sensitivity and specificity

Back 6

Sensitivity - poor
Specificity - good

Front 7

Brugada criteria

Back 7

RBBB/Incomplete RBBB pattern with ST segment elevation, J point >2mm.

Type 1 - convex up, gradually descending with T wave inversion (This is potentially diagnostic)
Type 2 - concave upwards >1mm with Positive T wave
Type 3 - concave upwards <1mm with POsitive T wave

has to be accompanied by clinical history
- hx of VT/VF
- FHx of sudden cardiac death
- EPT induced VT
- syncope
- nocturla agonal respiration

Front 8

Definition of STEMI

Back 8

ST elevation elevation at J point >1mm in two contiguous lead
V2-V3
>2mm in men greater than 40 years old
>2.5mm in men less than 40 years old
>1.5mm in women

Front 9

Definition of NSTEMI

Back 9

New horizontal or downsloping depression 0.5mm in two contiguous lead
T wave inversion >1mm in contiguous lead

Front 10

Factors supporting heat failure as the cause of dyspnoea

Back 10

History of heart failure (LR 5.8)
S3 gallop (LR 11)
JVP distension and hepatojugular reflex (LR 6)
Pulmonary congestion, interstitial oedema, (LR 12)
Alveolar oedema (LR 6)

Presence of PND, orthopnoea, oedema (LR+ 2, but LR -2 also include 1 in CI)

Front 11

BNP

Back 11

<100picogram/mL --> LR - 0.14
>400picogram/mL --> LR 5
between 100 and 400 picogram/mL --> not decisive

Front 12

ECG features likely to be VT

Back 12

1. Absence of typical BBB criteria
2. Fusion beat
3. Capture beat
4. Brugada sigh (RS interval in praecordial leads >100ms)
5. Josephson's sign (Notching near nadir of S wave)
6. Extreme axis deviation
7. Positive/negative concordance throughout chest leads
8. wide QRS extreme 160ms
9. AV dissocation
10. RSR' with first R taller than R'

Front 13

Brugada algorithm

Back 13

1. Positive or negative concordance in chest lads
2. Presence of Brugada wave (RS distance 100ms)
3. AV dissociation
4. LBBB pattern or RBBB consistent with VT
i) Joseph's sign
ii) RSR' with first R taller than R'

Front 14

Low voltage criteria

Back 14

All
Limb leads <5mm
Precordial leads <10mm

Front 15

TIMI score original design

Back 15

To predict adverse outcome and need for early invasive management T

Front 16

TIMI score calculation

Back 16

Age

Risk factors for DM

Aspirin use in the past 7 days

Ast least 2 angina episide within last 24 hours

Known coronary artery disease (Coronary stenosis 50% or more)

ECG changes >0.5mm

ELevated serum cardiac markers

Front 17

TIMI score interpretation

Back 17

% of risk of mortality at 14 days

0-1 4.7%

2 8.3%

3 13%

4 20%

5 25%

6-7 40%

Front 18

WHAT % OF AMI HAVE NORMAL OR NON DIAGNOSTIC ECG

Back 18

50%

Front 19

ANTERIOR STEMI

Back 19

MOST COMMON STEMI

WORST PROGNOSIS

Front 20

Lateral infarct

Back 20

ST elevation V5, V6, aVL,

Secondary to blockage of LAD or circumflex

Front 21

Adesnosine efficacy for SVT

Back 21

90% revert!!

But approximately 1/3 who coverted to SR can be reversed to SVT secondary to short half life

Front 22

Magnesium efficacy for SVT

Back 22

17%

Front 23

What drugs are contrainidcated in AF with pre-excitation

Back 23

Adenosine

Beta blocker

Calcium channelb locker

Digoxin

Front 24

Drugs of choice for AF with preexcitation

Back 24

Flecanide (not avaible in Australia)

Amiodarone (not affective)

Front 25

SVT causes

Back 25

60% AVnRT

20% AVRT (accesory pathway)

Front 26

WPW SVT

Back 26

85% orthodromic

Mostly AVRT 80%

Rest AF and Aflutter

NB: only 1-2% present with arrythmia

Front 27

Rate control of patienst with AF and heart failure who do not have an accessory pathway

Back 27

Amiodarone is recommended

Front 28

Types of Calcium channel blocker

Back 28

1. Dihydropyridine (e.g. Amodipine)

- decrease vascular tone

- can cause reflex tachycardia

2, Non dihydropyridine

- e.g. verapamil, diltiazem

- slow down heart rate

Front 29

AF cardioversion

Back 29

- not rercommended after 48 horus

- 90% will self revert in 48 hours

- 60% will rever with <100J

Front 30

Anticoagulation for AF

Back 30

Not well defined in de novo paroxysmal presentaiton

If <48 hours

- still risk of stunning and thrombus

- clexane 1mg/kg bd, one pre procedure and second 12 hours later

- reasonable to dishcarge on aspirin until cardiology review

- note this is not usually done in low risk patient

if >48 hours

- anti-coagulate for 4 weeks OR

- TOE prior to anticoagulation to exclude thrombus

- however becuase of stunning, anticoaulation shoudl be continued for bit longer

Front 31

Criteria for Infective endocarditis

Back 31

Blood culture x2 positive

ECHO - vegetation, new regurge

Fever >38

Immunological (e.g Osler's node, Roth's spot)

Vascular (spiner haemorrhage)

ECHO that does not meet major criteria

Predisposition

Micro culture that does not meet major

2 Major

1 Major and 3 minor

Front 32

Critera for Rheumatic heart disease

Back 32

JONES crITERIA

2 major or 1 major and 2 minor

Joint pain - poly, migratory

Obvious heart - carditis, myocarditis

Nodules (Subcut)

Erythema marginatum (marching getting bigger rash)

Sydenhan's chorea

Inflammatory cells WCC

Temperature >38

ESR/CRP

Raised PR interval

Itself - history of RHD

Arthralgia

Front 33

Inferior leads

Back 33

II III aVF

Inferior wall of left ventricle