Sunday, 18 September 2011

Supraventricular tachycardia


Supraventricular tachycardia: causes
SNAP
S inus tachy
N odal tachy
A fib
P aroxysmal atrial tachy
Supraventricular tachycardia: treatment
ABCDE
A denosine
B eta-blocker
C alcium channel antagonist
D igoxin
E xcitation (vagal stimulation)
Ventricular tachycardia: treatment
LAMB
L idocaine
A miodarone
M exiltene/ Magnesium
B eta-blocker

Splinter haemorrhages


Splinter haemorrhages
TRIP SAM
T rauma
R A
I nfective Endo
P AN
S LE / Sepsis
A naemia (profound)
M alignancy (haematological)

Rheumatic fever:criteria


Rheumatic fever: Jones major criteria
CASES
C arditis
A rthritis (migratory)
S ubcut nodules
E rythema marginatum
S yndenhams chorea
Rheumatic fever: Jones major criteria
JONES
J oints (migrating polyarthritis)
O bvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)
N odes (subcutaneous nodules)
E rythema marginatum
S ydenham's chorea
Rheumatic fever: Jones minor criteria
4PA
P yrexia
P rolonged PR
P ast Hx
P ositive (ie ?)ESR/CRP
A rthralgia
Rheumatic fever: Jones minor criteria
CAFE PAL
C RP increased
A rthralgia
F ever
E levated ESR
P rolonged PR interval
A namnesis of rheumatism
L eucocytosis

Rheumatic fever: Jones major criteria


Rheumatic fever: Jones major criteria
CASES
C arditis
A rthritis (migratory)
S ubcut nodules
E rythema marginatum
S yndenhams chorea

Postural hypotension


Postural hypotension
HANDI
H ypovolaemia / hypopituitarism
A ddisons
N europathy (autonomic)
D rugs (vasodilators / TCADs, diuretics, antipsychotics)
I diopathic

Pericarditis


Pericarditis
DRUMSTICX
D resslers
R h fever /R A
U raemia
M I
S LE
T rauma
I diopathic
C oxsackie
X –ray

Occlusive arterial disease


Occlusive arterial disease
6Ps
P ain
P allor
P ulseless
P arasthesia
P aralysis
P erishing with cold

Myocardial infarction


Myocardial infarction: symptoms
PULSE
P ersistant chest pain
U pset stomach
L ightheadedness
S hortness of breath
E xcessive sweating
Myocardial infarction: treatment of acute MI
COAG
C yclomorph
O xygen
A spirin
G lycerol trinitrate
Myocardial infarction: therapeutic treatment
ROAMBAL
R eassure
O xygen
A spirin
M orphine (diamorphine)
B eta blocker
A rthroplasty
L ignocaine

Myocardial infarction: basic management


Myocardial infarction: basic management
BOOMAR
B ed rest
O xygen
O piate
M onitor
A nticoagulate
R educe clot size

Myocardial infarction: treatment


Myocardial infarction: treatment
INFARCTIONS
I V access
N arcotic analgesics (e.g. morphine, pethidine)
F acilities for defibrillation (DF)
A spirin/A nticoagulant (heparin)
R est
C onverting enzyme inhibitor
T hrombolysis
I V beta-blocker
O xygen 60%
N itrates
S tool softeners

Myocardial infarction: complications


Myocardial infarction: complications
ABCDE x2
A rrhythmias/A neurysm
B radycardia/BP lower
C ardiac failure/C ardiac tamponade
D resslers /D eath
E mbolism /E xtra (VSD, pap muscle rupture)

Murmurs: questions to ask


Murmurs: questions to ask
SCRIPT
S ite
C haracter (e.g. harsh, soft, blowing)
R adiation
I ntensity
P itch
T iming

Murmur attributes


Murmur attributes
IL PQRST ("Person has ill PQRST heart waves")
I ntensity
L ocation
P itch
Q uality
R adiation
S hape
T iming

Mitral stenosis


Mitral stenosis (MS) vs. mitral regurgitation (MR): epidemiology
MS is a female title (Ms.) and it is female predominant.
MR is a male title (Mr.) and it is male predominant.

Mitral stenosis: complications


Mitral stenosis: complications
PASTRI
P ulm BP up
A fib
S ystemic embolism
T ricuspid regurg
R ight heart failure
I nfective endocarditis

LVF: management


LVF: management
FOAM
F rusemide 40mg iv
O xygen
A trovent (& Ventolin) nebs
M orphine 2.5 – 5 mg

JVP: characteristics of


JVP: characteristics of
MOP HAIR
M ultiple wave form
O ccludable
P ostural changes
H epatojugular reflex
A bove (fills from)
I mpalpable
R espiratory changes

JVP: wave form


JVP: wave form
ASK ME
A trial contraction
S ystole (ventricular contraction)
K losure (closure) of tricusps, so atrial filling
M aximal atrial filling
E mptying of atrium

Heart valves


Heart valves
LAB RAT
Left Atrium: Bicuspid
Right Atrium:Tricuspid
In case of high LDL
STArT with STATins

Heart sounds: 4th heart sound


Heart sounds: 4th heart sound
SHIT
S tenosis (aortic/pulmonary)
H ypertension/Heart Block
I schaemic HD
T amponade

Heart sounds: 3rd heart sound


Heart sounds: 3rd heart sound
FIPPY
F ailure
I ncompetence (mitral/tricuspid)
P regnancy/Pill
P E/Pericarditis
Y outh

Heart compensatory mechanisms that "save" organ blood flow during shock


Heart compensatory mechanisms that "save" organ blood flow during shock
"Heart SAVER"
S ymphatoadrenal system
A trial natriuretic factor
V asopressin
E ndogenous digitalis-like factor
R enin-angiotensin-aldosterone system

EMD arrest


EMD arrest
4Hs 4Ts
H ypothermia
H ypo & hyper-electrolytes
H ypovolaemia
H ypoxia
T oxic (including drugs)
T rauma
T amponade
T ension pneumothorax

ECG: exercise ramp contraindications


ECG: exercise ramp contraindications
RAMP
R ecent MI
A ortic stenosis
M I in the last 7 days
P ulmonary hypertension

ECG: pulseless electrical activity causes


ECG: pulseless electrical activity causes
PATCH MED
P ulmonary embolus
A cidosis
T ension pneumothorax
C ardiac tamponade
H ypokalemia/H yperkalemia/H ypoxia/H ypothermia/H ypovolemia
M yocardial infarction
E lectrolyte derangements
D rugs

ECG: ST elevation


ECG: ST elevation
ELEVATION
E lectrolytes
L BBB (Left Bundle Branch Block)
E arly Repolarization
V entricular hypertrophy
A neurysm
T reatment (eg pacemaker, pericardiocentesis)
I njury (AMI, contusion)
O sborne waves (hypothermia)
N on-occlusive vasospasm (prinzmetal’s)

ECG: dominant R wave in V1


ECG: dominant R wave in V1
WORD
W PW
O ld MI
R BBB
D extrocardia

ECG: T-wave inversion causes


ECG: T-wave inversion causes
INVERT
I schemia
N ormality [esp. young, black]
V entricular hypertrophy
E ctopic foci [eg calcified plaques]
R BBB, LBBB
T reatments [digoxin]

ECG: left vs. right bundle block


ECG: left vs. right bundle block
"WiLLiaM MaRRoW"
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block.
Note: consider bundle branch blocks when QRS complex is wide

ECG: causes of ST-segment depression


ECG: causes of ST-segment depression
DEPRESSED ST
D rooping valve (MVP)
E nlargement of LV with strain
P otassium loss (hypokalemia)
R eciprocal ST-depression (in I/W AMI)
E mbolism in lungs (pulmonary embolism)
S ubendocardial ischemia
S ubendocardial infarct
E ncephalon haemorrhage (intracranial haemorrhage)
D ilated cardiomyopathy
S hock
T oxicity of digitalis, quinidine

Cyanotic heart diseases


Cyanotic heart diseases
1-2-3-4-5-T's
Truncus Arteriosus (1 vessel)
Transposition of the 2 great vessels
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return (has 5 words)

Coronary artery disease: risk factors


Coronary artery disease: risk factors
HOPEFULSSS
H TN
O besity
P VD
E levated LDL
F MH
U p glucose - DM
L ow HDL
S moking
S ex - male
S edentary life style

Coronary artery bypass graft: indications


Coronary artery bypass graft: indications
DUST
D epressed ventricular function
U nstable angina
S tenosis of the left main stem
T riple vessel disease

Congestive heart failure: causes of exacerbation


Congestive heart failure: causes of exacerbation
FAILURE
F orgot medication
A rrhythmia/A naemia
I schemia/I nfarction/I nfection
L ifestyle: taking too much salt
U pregulation of CO: pregnancy, hyperthyroidism
R enal failure
E mbolism: pulmonary

Bradycardia: regular



PAD HIM
P hysiological (athlete, sleep) /p aroxysmal
A V block (2°II, 3°)
D rugs (beta, dig, amiodarone)
H ypothyroid /h ypothermia
I cteric (severe)
M I

betareceptor activity


Beta receptor activity
"1 heart, 2 lungs"
Beta-1 receptors are primarily on the heart, and the airway is Beta-2 receptors

betablockers


Beta-blockers: cardioselective beta-blockers
"Beta-blockers Acting Exclusively AMyocardium"
B etaxolol
A cebutelol
E smolol
A tenolol
M etoprolol

becks triad


Beck's triad (cardiac tamponade)
3Ds
D istant heart sounds
D istended jugular veins
D ecreased arterial pressure

atropine


Atropine use: tachycardia or bradycardia
"A goes with B"
Atropine is used clinically to treat Bradycardia

Atrial fibrillation: management


Atrial fibrillation: management
ABCD
A nti-coagulate
B eta-blocker to control rate
C ardiovert
D igoxin

Atrial fibrillation: causes


Atrial fibrillation: causes
ARITHMATIC
A lcohol
R h fever
I HD
T hyrotoxicosis
H ypertension
M itral stenosis/M I /M yxoma (atrial)
A SD
T oxins
I diopathic/I nfective endocarditis
C ardiomyopathy/Constrictive pericarditis

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