Cardio. 1 ~ Short Answer

Question 1.

A 76 year old female with a history of controlled atrial fibrillation presents to the emergency department with severe central abdominal pain of 2 hours duration.

A. What are the aims of your assessment?

Show Answer

  • Signs of immediate life threat
    • Shock
    • Sepsis
  • Diagnosis
  • Complications
  • Comorbidities
    • May effect treatment options

(4 marks)

 

B. List your differential diagnosis, in order of priority in this patient?

Show Answer

Most life-threatening

  • Surgical
    • Ischaemic gut
    • AAA
  • Medical
    • Myocardial infarction

Most likely

  • Surgical
    • Diverticulitis
      • Perforation
      • Abscess formation/complication
    • Obstruction
    • Peptic ulcer disease
    • Biliary disease
    • Appendicitis
  • Medical
    • Gastroenteritis

Other

  • Surgical
    • Volvulus
    • Pancreatitis
    • Colitis
    • Bowel cancer
    • Renal calculi
  • Medical
    • Pneumonia
    • Pyelonephritis

Gynae

  • Torted ovary
  • Ovarian cancer
  • Uterine cancer

(5 marks) (must have bold items)

 

 C. List the aspects of history that you would except in ischaemic gut.

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  • Pain
    • Abrupt onset
    • Severe pain
    • Any site
    • Any radiation
    • Pain out of proportion to physical findings
  • Associated symptoms
    • Nausea
    • Vomiting
    • Diarrhoea
  • PMHx
    • AF
    • Other thrombotic source

(4 marks; bold + 1)

 

D. What investigations would be the most useful in the diagnosis of ischaemic gut and why?

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  • Lactate
    • Raised
    • Serial
    • 75-90% Se
  • CT with arterial phase
    • 96% Se
  • Blood gas
    • Metabolic acidosis

(3 marks; bold + some idea of Se)

 


 

Question 2.

A 72 year old man presents by ambulance to your ED with onset of tachycardia and shortness of breath.

Cardio 1 ECG Short Answer

A. List the main abnormalities in this ECG

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  • Regular
  • Narrow complex tachycardia
  • ST depression inferiorly and V3-V6 (widespread)
  • Unable to see p waves

(3 marks)

 

B. List your differential diagnosis for the origin of the tachycardia?

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Regular narrow complex tachycardia

  • Sinus tachycardia
  • Sinus node re-entry tachycardia
  • Atrial tachycardia
  • Atrial flutter with block
  • Junctional tachycardia
  • AV node re-entry tachycardia
  • AV re-entry tachycardia
  • Fascicular tachycardia

(3 marks bold + one other)

 

C. Describe your management to address the tachycardia.

Show Answer

  • Look for other causes of tachycardia in Hx, PEx, bedside investigation e.g. sepsis, MI
  • Adenosine to differentiate atrial origin from re-entry tachycardia
  • May terminate SVT
  • Once underlying rhythm exposed can treat.

(3 marks)

 


Author: J Haire

 

 

 

 

 

 

 

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