Sponsored by HOPE4HEALTH Revision Tutorial Sponsored by HOPE4HEALTH

Case 1 57 year old gentleman presents to the Emergency Department at Gold Coast Hospital with Shortness of breath Chest pain

What further questions from the history would you ask?

History He has a background history of hypertension, dyslipidemia and diabetes mellitus The chest pain was substernal and radiated to his left arm. Associated with diaphoresis and shortness of breath. He has vomited twice and now is intermittently feeling lightheaded.

What would you look for in the clinical examination?

His temperature is 37.4, heart rate 70, blood pressure 110/70, and respiratory rate 24. His physical exam shows mild bilateral crackles on lung exam His heart sounds are regularly irregular, and an S4 heart sound is present.

What Investigations would you order

Other Investigations??

Management

Case 2 A 91 year old male with no significant past medical history presents with generalized weakness one episode of syncope while sitting down to dinner.

What further history would you ask?

What findings would you look for in the clinical examination?

His blood pressure is 132/58, heart rate 40, respirations 12, Oxygen saturation 95% on room air. Jugular venous pulsations: cannon A waves Heart sounds are bradycardic with varying intensities of the S1 heart sound, no S3 or S4 heard.

What further investigations would you request?

What would your management of this patient be?

Case 1 - History A 60 year old man with STEMI 6 weeks ago, suddenly collapsed while working in the backyard He was brought into ED by ambulance with his wife and remained unconscious What further questions would you ask about this history

Examination What would you look for on examination?

Findings His BP was 60/30 Pulse was not felt Breathing spontaneously with rapid shallow breaths Chest clear, HS difficult to auscultate

Investigations A 12 lead ECG was performed

Answer VT

Investigations What other investigations would you organise?

What would your management of this patient be?

History A 19 year old male was playing football when he felt chest tightness then suddenly collapsed He has no previous medical history but has some family history ‘heart problems’ What other questions would you ask on history?

Family History His mother mentions that her father had a history of collapsing from his teenage years and died in his mid fifties from sudden cardiac death. They never investigated it further Diabetes also runs in the family along with high cholesterol and hypertension

A 12 lead ECG was performed

Answer Brugada

Examination Would you expect to find anything significant on physical examination?

Management What is the general management of this condition? Would you order any further investigations on him or his family members?

History A 66 year old lady was brought in with sudden onset of palpitations and chest pain She reports having a MI 12 years ago What further questions would you ask on history?

Investigations An ECG was performed…

Answer SVT with RBBB What other investigations would you order in someone with new onset palpitations?

Results TFT – normal ELFT – normal FBC – normal What else could be triggering these palpitations? What other tests would you organise to further investiggate this?

Management What is the management of this condition?

Example One Please interpret the following ECG and discuss management

Example Two Please interpret the following ECG and discuss management

Example Three Please interpret the following ECG and discuss management

Example Four Please interpret the following ECG and discuss management