1 / 89

Cardiology Revision 2014

Cardiology Revision 2014. Dr P Banerjee Consultant Cardiologist University Hospitals Coventry & Warwickshire. Format of the revision. Picture slides ECG reading How to examine the CVS Assessment of patient with breathlessness, chest pain, palpitations, syncope. Clinical scenario.

tallis
Download Presentation

Cardiology Revision 2014

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cardiology Revision 2014 Dr P Banerjee Consultant Cardiologist University Hospitals Coventry & Warwickshire

  2. Format of the revision • Picture slides • ECG reading • How to examine the CVS • Assessment of patient with breathlessness, chest pain, palpitations, syncope

  3. Clinical scenario • 51 yr old man • Admitted with pyrexia, shivering and feeling unwell • Has a heart murmur on examination

  4. Infective Endocarditis • Murmur with pyrexia • Positive blood cultures • Splinter hge, Roth spot, Oslers nodes, Janeway lesions, splenomegaly, microscopic haematuria • Strep Viridans, Staph Aureus, others • IV antibiotics via Hickman line for 6 weeks • Valve surgery • Prosthetic valve endocarditis • Tricuspid valve affected in IVDA

  5. Clinical scenario • 53 yr old lady • Presents to clinic with SOBOE • Has Hx of rheumatic fever • Cardiac murmur audible on auscultation

  6. Malar Flush- Mitral Stenosis • Rheumatic almost always • Loud SI and MDM • Early pulmonary hypertension and secondary TR • AF common • Remember that all valvular heart disease has rheumatic fever as a cause except isolated AS.

  7. Clinical scenario • 70 yr old lady Presents to clinic • Has been hypertensive for years • SOBOE for 3 years- didn’t see doctors • Orthopnoea and more recently PND

  8. Heart Failure with cachexia • CCF signs: raised JVP, ankle oedema, enlarged liver • Left heart failure signs: S3 gallop, basal crackles, pulsus alternans • Ascites, bilateral pleural effusions in advanced CCF • Echocardiography, CXR, BNP • Loop diuretic, ACE/ARB, B blocker, Spironolactone/eplerenone

  9. ECGs

  10. Clinical Scenario 1 • 65 yr old • Admitted with severe central CP for 2 hrs • Sweaty and clammy • BP 90/60, Pulse 50/min, SR

  11. ECG 1

  12. Inferior STEMI • Aspirin 300mg + Prasugrel 60 mg loading • IV morphine • Primary PCI

  13. Scenario 2 • 49 yr old smoker • CP for 30 min, improved with IV Morphine • Now comfortable, normal BP and pulse • Troponin T elevated

  14. ECG 2

  15. NSTEMI • Therapeutic clexane • Aspirin + clopidpgrel • Atorvastatin 80 mg od • Beta blocker • IV Nitrates and Tirofiban if needed • PCI within max 72 hrs

  16. Scenario 3 • 76 yr old man • Severe CP 7 days ago for 3 hrs • Admitted now with SOB, no CP

  17. ECG 3

  18. Recent STEMI • Needs coronary angio but more electively • PCI may not be needed • Discharge on secondary prevention drugs: BB, aspirin, clopidogrel (1 month if no stent and missed STEMI), statin, ACE, eplerenone (if LVEF<40%)

  19. Scenario 4 • 25 yr old lady, non smoker • Flu like illness for 7 days • Sharp CP on inspiration for 24 hrs, better on sitting forward

  20. Compare with previous ECG

  21. Pericarditis • Usually viral • Check viral titres, inflammatory markers (CRP), autoimmune profile • Echo to excluse pericardial effusion • Treat with NSAIDS like Ibuprofen, naproxen etc for 7 days

  22. Scenario 5 • 75 yr old man collapsed at Tesco • CPR given by Tesco staff • Ambulance arrives in 3 mins • Man breathing spontaneously, BP 110/70, Pulse 70 min irregular • ECGS X 2 done by ambulance personnel

  23. ECG 4

  24. ECG 5

  25. Ventricular Tachycardia • If haemdynamic compromise DC shock • If stable IV Metoprolol/Esmolol, IV Amiodarone via a central line followed by oral • Check for QT prolongation on ECG • Check electrolytes to exclude hypokalaemia, hypomagnesaemia and hypocalcaemia • Assess LV function by echo • Only Amio and BB safe if LV function poor • Troponin T, Coronary angio even if Trop T normal • Consider ICD

  26. Scenario 6 • Gentleman suddenly has cardiac arrest again

  27. ECG 6

  28. Ventricular Fibrillation • Emergency DC shock • Check all as for VT • ICD

  29. Scenario 7 • 28 yr old lady admitted with sudden onset palpitations • No CP or SOB • Has had such episodes before- usually has them terminated by IV injection in A&E.

  30. ECG 7

  31. SVT/AVNRT • Carotid sinus massage, valsalva • IV Adenosine, IV Verapamil • DC shock-usually not required

  32. Scenario 8 • 74 yr old man • Severe central CP for 2 hrs with sweating • Stable BP and pulse

  33. ECG 8

  34. LBBB + Prolonged chest pain • Treat as STEMI

  35. Scenario 9 • 63 yr old hypertensive lady • Has had on and off palpitations for months • This morning noticed palpitations • Later developed slurred speech with weakness on the right side

  36. ECG 9

  37. Atrial Flutter • Rate control • Anticoagulate (CHADS2 VASC SCORE) • Consider cardioversion • If onset less than 72 hrs direct cardioversion • If onset>72 hrs or unclear TOE+CV or elective CV after at least 4 weeks of anticoagulation

  38. CHA2DS2-VASc score for stroke risk in atrial fibrillation

  39. Scenario 10 • Later her ECG changed • ? Any change in management

  40. ECG 10

  41. Atrial Fibrillation • Management same as for atrial flutter • New agents for oral anticoagulation in non valvular AF: Dabigatran, Rivaroxaban

  42. Scenario 11 • Asymptomatic young and fit man has had these ECGs as part of his employment check

  43. ECG 11

  44. ECG 12

  45. First and Mobitz Type 1 AV block • Not indications for pacing

  46. Scenario 12 • 81 yr old gentleman with recurrent cardiac sounding syncope • Not on any AV blocking drugs • Clinically NAD • Next 2 ECGs are taken as strips from his 4 hr tape

More Related