Test Your Cardiovascular Knowledge

The above ECG tracing demonstrates asystole, which is the absence of any electrical activity in the heart. This is indicated by a flat line on the ECG, indicating that there is no contraction or pumping of the heart. Asystole is a life-threatening condition and immediate intervention, such as CPR and administration of medications, is required to restore normal heart rhythm and function.

The rhythm strip shown in the question indicates ventricular tachycardia (VT). VT is a rapid heart rhythm originating from the ventricles, the lower chambers of the heart. It is characterized by wide QRS complexes and a rate usually greater than 100 beats per minute. VT can be life-threatening and may cause symptoms such as palpitations, dizziness, and chest pain. Prompt medical intervention is necessary to manage VT and prevent complications.

The given ECG shows atrial fibrillation (AF). AF is a cardiac arrhythmia characterized by irregular and rapid atrial electrical activity, resulting in an irregular ventricular response. It is commonly seen as chaotic, irregular, and rapid fibrillatory waves without discrete P waves on the ECG. The absence of distinct P waves and the presence of irregular QRS complexes in this ECG suggest atrial fibrillation.

The higher systolic reading of the left and right arm brachial artery is generally used in the assessment. The pressures in each foot's posterior tibial artery and dorsalis pedis artery are measured with the higher of the two values used as the ABI for that leg.[2]

ABPI = PLeg/PArm

Where PLeg is the systolic blood pressure of dorsalis pedis or posterior tibial arteries
and PArm is the highest of the left and right arm brachial systolic blood pressure

>0.9 is acceptable
0.8-0.9 suggests mild disease and risk factors should be addressed
0.5-0.8 suggests moderate PVD and warrants specialist referral

(http://en.wikipedia.org/wiki/Ankle_brachial_pressure_index)

Smoking, diabetes mellitus, and a family history of angina/myocardial infarction are risk factors for cardiovascular disease. Smoking is a well-known risk factor as it damages the blood vessels and increases the risk of plaque buildup. Diabetes mellitus, especially if poorly controlled, can lead to high blood sugar levels that damage the blood vessels and increase the risk of heart disease. A family history of angina/myocardial infarction indicates a genetic predisposition to cardiovascular disease, increasing the individual's risk. Hypotension (low blood pressure) and low cholesterol are not typically considered risk factors for cardiovascular disease.

The correct combination is "Pain, pallor, parasthaesia, paralysis, pulselessness, perishingly cold." These symptoms are indicative of acute limb ischemia, which occurs when there is a sudden decrease in blood flow to a limb. Pain is the first symptom and is usually severe. Pallor refers to the paleness of the limb due to lack of blood flow. Parasthesia refers to abnormal sensations such as tingling or numbness. Paralysis occurs when there is complete loss of motor function in the limb. Pulselessness means that there is no detectable pulse in the affected limb. Perishingly cold describes the extreme coldness of the limb due to lack of blood supply.

The clues in the question include the narrow pulse pressure (15mmHg), the slow-rising pulse and the murmur radiating to the carotids. The murmur would be an ejection systolic murmur and would be loudest in the aortic region (2nd intercostal space, right sternal edge).
Other important examination findings may include:
Heaving apex beat (which may be laterally displaced if left ventricular dysfunction is present).
Evidence of cardiac failure.

This ECG shows an anterolateral ST-elevation myocardial infarction (STEMI). Anterolateral STEMI refers to the presence of ST-segment elevation in the anterior and lateral leads of the ECG, indicating a blockage in the coronary arteries supplying the anterior and lateral walls of the heart. This is a serious condition that requires immediate medical intervention to restore blood flow to the affected area of the heart.

Medicine, and especially Cardiology, is full of eponymous signs/syndromes. It is important to have an idea of some of the more common ones.

Levines sign - clenching of the fist over the sternum when the patient is describing angina pain.

Hamman's sign - crackle/crunching sound heard over the precordium/mediastinum in synchronisation with the heartbeat, not respiration, due to mediastinal emphysaema (pneumomediastinum), seen with oesophageal rupture (Boerhaave's syndrome).

Buerger's sign - in peripheral vascular disease, red foot becomes pale with elevation.

Becker's sign - visible pulsations of the retinal arterioles seen in aortic regurgitation

Breathlessness on exertion, orthopnoea, ankle swelling, and bibasal crackles are all signs and symptoms consistent with heart failure. Breathlessness on exertion occurs because the heart is unable to pump enough blood to meet the body's demands during physical activity. Orthopnoea refers to difficulty breathing while lying flat and is a common symptom of heart failure. Ankle swelling, also known as edema, is caused by fluid buildup in the body due to the heart's inability to pump effectively. Bibasal crackles are abnormal lung sounds that can be heard with a stethoscope and are indicative of fluid in the lungs, a common finding in heart failure.