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55 Cards in this Set
- Front
- Back
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63 year old man, hx of high blood pressure presents to A&E with sudden onset TEARING chest pain , radiating to the back |
Aortic Dissection |
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40 year old Woman, sudden onset dyspnoea at rest following hip replacement surgery. On examination she is tachycardia and her ECG shows right axis deviation (RAD) |
Pulmonary Embolus |
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60 year old man, central CRUSHING chest pain radiating to both arms after running to catch a bus. Pain was relieved by rest and his ECG 1 hour later was unremarkable |
Angina |
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21 year old high jumper presents with acute onset dyspnoea right sided pleuritic chest pain. Examination : increased resonance and reduced expansion on right side |
Pneumothorax |
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23 year old woman presents with localized left sided chest pain exacerbated by coughing and is particularly painful on light pressure to that area. Pain relieved by aspirin, the ECG unremarkable |
Idiopathic Costochondritis ( Tietze's Syndrome ) |
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Slow rising pulse, Narrow pulse pressure Heaving apex beat Fourth heart sound Absent/ quiet second heart sound Ejection Systolic murmur radiation to carotid |
Aortic Stenosis |
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Angina , Shortness of Breath. (SOB ) dizziness syncope on exertion |
Aortic Stenosis |
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Collapsing pulse Wide pulse pressure 'Pistol Shot " sound over Femoral Arteries |
Aortic Regurgitation (Traube's Sign) |
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Signs of Aortic Regurgitaion |
Corinna's pulse De Musset's sign Muller' Sign Quince's Sign Traube's sign Duroziez's sign hill's Sign Shelly's sign Rosenback's sign Becker' sign Gerhardt's sign Mayne's Sign Landolfi's Sign |
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Radiofemoral Delay in a patient with hypertension |
Coarctation of Aorta |
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Pulsus paradoxus JVP rises on inspiration Heart sounds muffled Decreased BP |
Cardiac Temponade (Beck's Triad) |
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Bounding pulse in a patient who is short of breath |
Acute CO2 Retention |
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Tapping apex beat Loud S1 Mid-diastolic murmur Loudest at apex, In Expiration Lying on left side |
Mitral stenosis |
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Pansystolic murmur Heard best at lower left sternal edge During inspiration In a pt with pulsatile hepatomegaly Giant Systolic V waves in JVP |
Tricuspid Regurgitation Causes Infective Endocarditis of tricuspid valve |
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Displaced Volume overload apex Soft S1 Pansystolic murmur at apex Radiating to Axilla |
Mitral Regurgitaion |
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Causes of Mitral Regurgitaion |
( Rheumatic Heart Disease ) in developing countries
( Mitral valve prolapse ) in USA and Europe MI 2ry to papillary muscle rupture Rarer causes: Connective Tissue disease ( Marfan's Syndrome & Ehlers-Danlos Syndrome ) |
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Left Parasternal heave Harsh Pansystolic murmur At lower left sternal edge Also audible at apex |
Ventricular Septal Defect |
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Management of VSD |
Small VSD ( Maladie de Roger ) : Asymptomatic , no treatment , prophylaxis antibiotic against endocarditis in dental works. Large VSD: Spontanious closure still possible Complication managed medically in the short term. ( Dierutics to treat heart failure & elevated Pulmonary artery pressure ) |
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Early morning headache ( fullness in head) Facial congestion Oedema upper limbs |
Bronchial Carncinoma |
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Giant systolic 'V' wave in JVP |
Tricuspid Regurgitaion (Giant v = regurgitant blood ejected from R vent at Systole ) |
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Large 'a' waves Slow 'y' descent in JVP Pt has Ascites |
Tricuspid Stenosis. |
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Cannon 'a' waves |
Atrioventricular dissociation (I.e. -ANSWER- Complete heart block, Other answers- Ventricular tachycardia, Single chamber pacemaker) Cannon a wave = Atrium contracting against a closed tricuspid |
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Raised JVP that rise on inspiration |
Constrictive Pericarditis a.k.a Kussmaul's sign ( seen in Cardiac Temponade) |
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A 26 year old woman , acute unwell with SOB. ECG sinus tachycardia Deep 's' wave in Lead I Inverted T wave in III Q wave in III |
Right Axis Deviation Or Pulmonary Embolus |
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Dominant R in V1 Inverted T V1-3 Deep wide S waves in V6 |
Right Bundle Branch Block Atrial Septal Defect Pulmonary Embolus |
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Prolonged P-R interval Depressed ST Flattened T Waves Prominent U waves |
Hypokalamia ( possible causes : Loop/thiazide diuretics ) |
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Sinus Rythm Bifold 'p' waves best seen in II , V3 & V4 |
Ans : Mitral Stenosis Cause Left Atrial hypertrophy (A.k.a. P Mirtale ) PS: ( Peaked p wave a.k.a. P Pulmonale = Right atrial Hypertrophy ) |
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65 year old man, Chest pain radiating to jaw ECG: ST elevation in II III aVF T inversion in V5 & V6 |
Inferior Myocardial Infarction |
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Elevated JVP Absent pulsation |
Superior Vena Cava Obstruction |
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ECG of a 55 y old being treated for HTN shows tall tented T waves |
Hyperkalemia
Causes : K- sparing Diuretics , ACE inhibitors , Renal failure, metabolic acidosis |
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34 y old man presents to A&E after a road traffic accident. The ECG shows pulseless electrical activity (PEA) |
Cardiac Temponade |
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85 y old man with pneumonia complains of palpitations. ECG : shows absent P waves |
Atrial Fibrillation Complication/Risk: Embolic event/ stroke! Causes: Hyperthyroidism INV: Thyroid function test, Echo : structural abnormalities ( i.e. Left Atrial Enlargment due to Mitral Valve disease |
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45 y man with sarcoidosis ECG: 'M' Pattern V5 and inverted T wave in I, aVL, and V5-V6 |
Left Bundle Branch Block (LBBB) 'M' Pattern a.k.a. WILLIAM pattern in V5 Due to delayed L.vent depolarization |
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ECG of an 8 y girl shows normal P waves and QRS complexes but shows T-wave inversion in V1 |
Normal ECG T Inversion in V1-V3 is normal in kids! |
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Left Bundle Branch Block : ( Pathology) |
-Normally the septum is activated from left to right, producing small Q waves in the lateral leads.(I, aVL, V5-V^)
-In LBBB, the normal direction of septal depolarisation is reversed (becomes right to left), as the impulse spreads first to the RV via the right bundle branch and then to the LV via the septum. -This sequence of activation extends the QRS duration to > 120 ms and eliminates the normal septal Q waves in the lateral leads. -The overall direction of depolarisation (from right to left) produces tall R waves in the lateral leads (I, V5-6) and deep S waves in the right precordial leads (V1-3), and usually leads to left axis deviation. -As the ventricles are activated sequentially (right, then left) rather than simultaneously, this produces a broad or notched (‘M’-shaped) /WILLIAM's pattern R wave in the lateral leads. |
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30 y woman Presenting with HTN is found to have Hypokalemia and a mild metabolic Alkalosis |
Conn's Syndrome: Unilateral adrenocortical adenoma / Primary (hyper) Aldosteronism ( which causes HTN + HypoK +Metabolic Alkalosis ) |
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Anxious 26 y woman has ep of chest pain and palpitations precipitated by stress and smoking, Her 24 hr urine shows elevated catecholamines |
Phaeochromocytoma: A Catecholamine secreting Tumor ( very rare) ECG: LVH Rarely: Inheritied in Autosomal Dominant MEN type IIa |
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45 y woman presents with weight gain, muscle weakness and hirsuitism . She HTN and has pedal edema |
Cushing's Syndrome |
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40 y man is brought to A&E with severe headache Ex: Papillodema and fungal haemorrhage BP: 220/145 mmHG |
Malignant HTN Assx with Acute End-organ failure with grade III-IV changes Mx: careful reduction in BP over several days with oral therapy, & Avoid deep quick reduction in BP b/c it may lead to watershed infarction . |
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HTN in 75 y heavy smoker with widespread peripheral vascular disease |
Renal Artery Stenosis: (Most common cause of 2ry HTN) Mx: reducing blood pressure and preserving renal function, Revascularization may be done |
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65 y man with Heart failure requires rate control to treat coexisting atrial fibrillation . Mx |
Digoxin Toxicity Sx: Confusion , nausea, arrhythmia, visual disturbance Precipitated by hypoK, hypoMg, Renal Impairment, HyperCa. |
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65 y woman being treated with large doses of loop diuretics requires add-on therapy for oedema refractory to treatment. Mx |
Metalozons; (A Thiazides-like Diuretics that lessens the water absorption in kidneys - lessens BP ) They are added to to loop diuretics in resistant oedema b/c a synergistic mechanism of action. Melazone is Drug of choice (DOF) it remains effective envelope in the presence of significant renal impairment |
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69 y woman with asthma being treated with loop diuretics ACE inhibition and long-acting Nitrate is prescribed a drug to reduce long-term mortality |
Spironolactone (A Steroid derivative that is aldosterone antagonist - promotes Na excretion - Mx of edema and HTN) It was proven in a study ( RALES: Randomized Aldactone evaluation Study ) Trial. It was between Spironolactone / placebo. Abandoned early due to results of 30 % reduction in risk of death spironolactone group. |
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70 y woman with history of chronic heart failure presents with severe pulmonary oedema. Mx |
100 % O2 , IV Diamorphine , IV furosemide( frusemide) , SL Glyceral Trinitrate ( GTN) |
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Mx of mild sx of SOB and ankle of OEdema in a 65 y man with Left ventricular dysfunction caused by ischaemic. Heart disease. He is already taking ACE. Inhibitors |
Oral Furosamide (Loop diuretic ) Usually ACEI is enough if Sx not controlled add Loop-D |
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Mx of a 65 y man with AF of longer than 48 h before DC Cardioversion |
Digoxin + Warfarin for 1 month (Lowers HR working on the Na/P channels in the heart ) + (Anticoagulant) Af for longer than 48 h is at risk of thromboembolism . Unless pt is severely compromised pt is put on anticoagulant for 1 month before DC, and hr is controlled by Digoxin |
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Initial Therapy in a 60 y woman presenting severely compromised with acute persistent AF |
Direct current (DC) shock + Heparin Pt is severely compromised => IMMEDIATE DC Heparin to decrease ( but does not abolish) risk of thromboembolism after cardioversion |
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55 y man admitted with an acute myocardial infarction develops a short run of VT.He requires mx for prophylaxis against recurrent ventricular Tachycardia |
IV Amiodarone (Class III antiarrythmic drug - prolonged phase 3 'Repolorlization' in caridac AP ) M/A: Beta-blocker like, Ca channel -like It is drug of choice for VT. S/E are not an issue in an acute scenario. S/E: bradycardia , pulmonary fibrosis, hepatic fibrosis, corneal micro deposits , Photosensitive rash , thyroid dysfunction |
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Drug to aid diagnosis in a 50 y man presenting with an unidentifiable regular narrow complex Tachycardia |
IV Adenosine (short term AV block = Terminates Tachycardia involving AV re-entry circuit. It is used in Unidentified Arrhythmias. S/E: bronchoconstrictions. Stimulates nociceptive afferent neurons in the heart. Pt should be warned of chest pain after drug |
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Prophylaxis of ventricular Tachycardia ina. Pt with varying QRS axis and prolonged Q-T interval |
IV mg+ Ventricular pacing Sx of TORSADES DE POINTS ( a Polymorphic Ventricular trachycardia that can cause Sudden Death ) Causes: Drugs , electrolyte imbalance, congenital Q-T syndrome MX: IV mg sulphate and ventricular pacing at high rate Ps: conventional anti-arrythmia make condition worse |
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57 y businessman presents with a 4h hx of crushing chest pain. ECG : ST elevation in II, III, aVF Mx: |
Aspirin, Streptokinase Dx: Inferior MI, Thrombolysis indicated. Streptokinase early within hours to reduce mortality. C/I or thrombolysis is head trauma, pregnancy , internal bleeding, cerebral malignancy , acute pancreatitis, recent haemorrhagic stroke , oespohageal varices . Urgent primary Angioplasty a good alternative in such cases |
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65 y man presenting with chest pain becomes unresponsive . ECG: Ventricular Fibrillation Mx |
DC shock + Adrenaline DC shock indicated by ACLS, DC should be done EARLY DC should not be denied to give adrenaline. Adrenaline given after three unsuccessful DC ( 200 J, 200j, 360J) or if DC is C/I |
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40 y woman collapses after a flight with a breathlessness and right sided pleuritic Chest pain Mx |
100 % O2, SC LMV heparin, IV fluids Dx: PE Streptokinase is also successful after a major embolism. Open Embolectomy is indicated following a massive PE if thrombolysis is unsuccessful/CI |
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A 45 y man with chronic glomerulonephritis presents with a. Severe headache. Ex: papillodema and bilateral retinal haemorrhages. BP: 240/132 Mx |
Labetalol ( alpha / beta adrénergic antagonist ) Dx: Malignant Htn
Therapeutic aim : controllable reduction of BP . oral or IV can be used
ps : SL Nifedipine ( ca antagonist - Coronary Vasodilator) is ContraIndicated B/c it may cause profound reduction in BP too quickly -> compromise cerebral perfusion
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55 y man requires immediate pharmacological mx for severe symptomatic sinus bradycardia |
Atropine ( muscarinic acetlycholine receptor antagonist) => increases HR by inhibiting Vagal tone of heart. If pt does not respond, cardiac pacing should be instituted |
