Read without ads and support Scribd by becoming a Scribd Premium Reader.
See Premium Plans
 
•
Tricuspid regurgitation
-
Pulsatile Hepatomegaly
-
+ve abdominojugular reflux sign
-
Large systolic v wave with earlobe movement
-
PSM the left lower sternal border 
•
Pulmonary stenosis
-
 Left parasternal heave
-
Large a wave
-
Soft wide splitting P
2
-
ESM in left upper sternal border, 2
nd
ICS
•
Pulmonary Hypertension
-
Large a wave
-
Loud P
2
•
Pulmonary Embolism
-
Sinus tachycardia (>100bpm)
-
RAD
-
V
1
-V
3
T inversion (RVH)
-
S
I
Q
III
T
III
- Deep S
I
, Pathological Q
III
, Inverted T
III
-
Low voltage QRS (<5mm)
•
Mitral stenosis
-
Tapping apex beat (Palpable S
1
)
-
Mid-Diastolic
murmur at the
apex
accentuated in the
left lateral position
best heard with the
bell
(
low pitch
murmur)
-
CXR findings;i)LAE manifested by a density behind the right atrial border (
double atrial shadow
)ii)Elevation of the
left main stem bronchus
iii)
 Pulmonary oedema
-Redistribution of blood flow to the
upper lung fields
is frequent, and Kerley B-lines (
 short peripheral lines, perpendicular to the pleura
); Kerley A-lines (
long, dense lines radiating  from the hilum
) are seen in patients with severe, chronic mitral stenosis.iv)Mitral valve calcification
-
Significant stenosis exists if the valve orifice is
<1cm²/m² 
body surface area
•
Mitral regurgitation
-
 Heaving 
apex beat
-
PSM at the apex radiating to the
left axilla
if the
 posterior valve
is involved or towards the
tricuspid area
if the
anterior valve
is involved.
-
Soft S
1
; Wide splitting S
2
; Loud S
3
•
Aortic stenosis
-
Small volume anacrotic (slow rising) pulse/ Pulsus alternans
-
 Narrow pulse pressure
-
Thrusting 
apex beat
-
Soft A
2
; Reversed splitting of P
2
-
ESM at the right upper sternal border, 2
nd
ICS, radiating to the carotids
•
Aortic regurgitation
-
Quincke's sign - marked capillary pulsation in the nail bed
-
Collapsing pulse
-
Wide pulse pressure
-
 Heaving 
apex beat
-
EDM in the right upper sternal edge, 2
nd
ICS, when patient is seated; leaning forwards accentuates the murmur on
expiration
Cardiology
Medicine Page 1
 
•
PDA
The aortic end of the ductus is just distal to the origin of the
left subclavian artery
, and the ductus enters the
 pulmonary artery at its bifurcation
. Commonly associated with
maternal rubella infection
during early pregnancyand
preterms
as a result of 
hypoxia
and
immaturity
. Closes in the
1
st
weeks of life
failure to which there is
↑
bloodflow to the lungs
→
 
pulmonary plethora
& congestion
→
fibrosis of the vessels with narrowing & reduced blood flowto the lungs leading to
cyanosis.C/P:
-
Persistent apnoea for unexplained reasons in an infant recovering from Hyaline Membrane Disease;
-
CVS
*
Collapsing pulse
*
'Pistol shot' pulse in the femorals (Traube's Sign)
*
Wide pulse pressures
*
Reversed splitting of P
2
*
An active heaving praecordium, a
continuous systolic
or
to-and-fro murmur 
that may be localizedto the
2
nd
left ICS
or 
radiate
down the left sternal border 
or to
the left clavicle
-
Carbon dioxide retention - Cyanosis
-
Increasing oxygen dependency
-
Hepatomegaly
CXR 
- Cardiomegaly and increased pulmonary vascular markings
Echocardiographic
visualization of a PDA with Doppler flow evidence of left-to-right shunting.
Rx:
-
Supportive measures, including
diuretics and fluid restriction.
-
If spontaneous closure does not occur within a few weeks post partum;
*
Indomethacin IV, 0.2 mg/kg BD/OD - 3 doses
;
induces pharmacologic closure by inhibiting  prostaglandin synthesis.
OR 
0.1 mg/kg/d for 6 days
.Contraindications to indomethacin:- Thrombocytopenia (<50,000/mm
3
),- Bleeding disorders- Oliguria (
<0.5ml/kg/d
)- Elevated plasma creatinine level (
>80µmol/L
)- Necrotizing enterocolitis (NEC)
-
Indications for 
surgical closure
are
 failure to close the ductus following indomethacin therapy
with
 persistent heart failure
and
ventilator dependence
.
•
RAE
-
P pulmonale - Peaked P waves
•
LAE
-
P mitrale - Bifid P waves
•
ASD
-
Left parasternal heave
-
Wide fixed splitting of P
2
•
Atrial fibrillation
-
 Irregularly irregular 
pulse
-
Absent a wave
-
Absent P wave with Irregularly irregular QRS complexes
•
Atrial flutter
-
Regularly
Irregular 
pulse
-
'Canon' a waves
-
Saw tooth baseline (300/s) with
 Regular 
QRS complexes
•
RVH
-
Left parasternal heave
-
Dominant RV
1
-
Deep SV
6
-
T wave inversion in V
1
-V
3/4
-
RAD
-
QRS enlargement
Medicine Page 2
 
•
Right Ventricular Failure
-
Raised JVP -
normal wave form
•
LVH
-
RV
6
>25mm or SV
1
+RV
6
= >35mm
-
QRS enlargement
-
T inversion in V
4
-V
6
, I & aVL
•
Left Ventricular Failure
-
Diffuse apex beat
-
Pulses alternans
•
Ventricular fibrillation
-
'Canon' a wave
-
Irregular rhythm
-
No
QRS complexes
•
VSD
-
Heaving apex beat
-
PSM in left lower sternal edge
-
Single S
2
; Loud S
3
•
Myocardial Ischemia
-
Prolonged QT interval (in Anterior MI)
-
ST depression >0.5mm
-
T inversion in V
4
-V
6
& aVL
•
Myocardial Infarction
-
Acute
*
Hrs
▫
Peaked T waves
▫
ST elevation >1mm
*
24hrs
▫
T wave inversion
▫
ST resolution
*
Days
▫
T wave inversion or normal
▫
ST normal
▫
Pathological Q waves (Normal Q waves - <0.04s/<2mm)
-
Posterior (V
1
, V
2
)
*
Tall R 
*
ST depression
-
Anteroseptal (V
1
-V
4
)
-
Anterolateral (V
4
-V
6
, I, aVL)
*
RAD
-
 Non Q wave infarcts (Subendocardial) (V
2
-V
5
)
*
 No pathological Q waves
-
Inferior (II, III, aVF)
*
Sinus bradycardia (<60bpm)
*
LAD
•
Myocarditis
-
Prolonged QT
-
Low voltage QRS complex
•
Pericardial effusion
-
Small volume pulses
-
Low voltage QRS complex
•
Pericarditis
-
High plateau JVP which
increases
on inspiration (
Kussmaul's sign
) with
deep x & y descents
-
Pulsus paradoxicus (systolic pressure weakens in inspiration by >10mmHg)
-
ST elevation (
 saddle shaped 
)
-
Low voltage QRS complex
Medicine Page 3
Search
Search History:
Searching...
Result 00 of 00
00 results for result for
  • p.
    • Notes
    Load more