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Mitral Stenosis, Complications

PASTRI
Pulm BP, A fib, Systemic embolism, Tricuspid regurg, Right
heart failure, Infective
endocarditis

Myocardial infarct, complications


ABCDE x2
Arrhythmias / Aneurysm
Bradycardia / BP
Cardiac failure / cardiac tamponade
Dresslers / Death!
Embolism / Extra (VSD, pap muscle rupture)

Postural Hypotension
HANDI
Hypovolaemia / hypopituitarism, Addisons, Neuropathy
(autonomic), Drugs (vasodilators /
TCADs, diuretics, antipsychotics), Idiopathic

Splinter haemorrhages
TRIP SAM
Trauma, RA, Infective Endo, PAN
SLE / Sepsis, Anaemia (profound), Malignancy
(haematological)

ST elevation
ELEVATION
Electrolytes, LBBB, Early Repolarization, Ventricular
hypertrophy, Aneurysm, Treatment (eg
pericardiocentesis), Injury (AMI, contusion), Osborne waves
(hypothermia), Non-occlusive
vasospasm (prinzmetal's)

Symptoms of aortic stenosis


ASD
Angina 2 years }
Syncope 1 year } prognosis
Dyspnoea 6/12 }

No apex beat

DOPES
Dextrocardia (don't say this first!), Obesity,
Pleural/Pericardial effusion, Emphysema, Shoc

3rd Heart Soun


d FIPPY
Failure, Incompetence (mitral/tricuspid),
Pregnancy/Pill/PE/Pericarditis, Yout

4th Heart Sound


****
Stenosis (aortic/pulmonary), Hypertension/Heart Block,
Ischaemic HD, Tamponade

Arrhythmias
ARHYTHMIAL 4PC
Atrial Myxoma, Rh heart dis, HYpertension, THyrotoxicosis,
Mitral valve dis, IHD,
ALcohol
Pneumonia / PE / Pericardial eff, cardiomyopathy

Atrial Fibrillation
ARITHMATIC
Alcohol, Rh fever, IHD, Thyrotoxicosis, Hypertension, Mitral
stenosis / MI / Myxoma
(atrial)
ASD, Toxins, Idiopathic/Infective endocarditis
Cardiomyopathy/Constrictive pericarditis

Shock
HEN SCAM
Hypovolaemia, Endocrine (adrenal, thyroid), Neuropathic
(autonomic)
Spinal cord injury/ Sepsis, Cardiac, anapyhlaxis/
anaesthesia, anti HPT, Massive PE

Treatment of Heart Failure


ABCDE
ACE inhibitors; Beta-blockers; Calcium channel blockers;
Diuretics; Endothelin-converting enzyme inhibitors

Basic MI Management
BOOMAR
Bed rest, Oxygen, Opiate, Monitoring, Anticoagulation,
Reduce clot size

Treatment for Acute MI


M.O.N.A
Morphine, Oxygen, Nitrate, Aspirin

JVP Wave form


ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium

Heart Failure Signs


TAPED TORCH:
Tachycardia
Ascites
Pulsus alternans
Elevated jugular venous pressure
Displaced apex beat
Third heart sound
Oedema
Right ventricular heave
Crepitations or wheeze
Hepatomegaly (tender)

Heart Failure
causes HEART FAILED:
Hypertension
Endocrine
Anemia
Rheumatic heart disease
Toxins
Failure to take meds
Arrythmia
Infection
Lung (PE, pneumonia)
Electrolytes
Diet

EKG 12 lead quick interpretation of v1-v6 MI


V1-V6 SSAALL:
Elevations matched with their classic location of MI:
V1 Septal
V2 Septal
V3 Anterior

V4 Anterior
V5 Lateral
V6 Lateral

MI: Signs and symptoms


PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating

Right to Left Shunt


5 T's
Truncus arteriosus (1 vessel)
Transposition of great arteries (2 vessels transposed)
Tricuspid atresia (3 =Tri)
Tetralogy of fallot (4 =Tetra)
Total anomalous pulmonary venous return (5 =5 words)

Tetrology of Fallot
PROVe you're TOF
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect

Whas is the mechanism oof Arrhythmias?


HARD heart
Heart Block -- no AV node conduction --> prolonged PR
interval, more P than QRS waves, indepent action of Atria
and Ventricles
Abnormal Pacemaker Activity: normal pace maker activity in
phase 4; during ischemia/catecholamine activation, APs
else where inthe heart become more likely
Re-entry: circular (circus) movement of a wave of
depolarization; in order for APs to maintain a circular
movement, the refractory period must be short enough for
the action potential to continue to propagate without
running into the back of itself and extinguish, e.g. if there's
a dilated ventricle: lengthens path geometrically, slow

conduction: lengths path Time


Delayed after depolarizing: increased intracellular Ca2+ -->
increased resting potential --> spontaneous rhythm,
prominent mechanism for severe ischemia

Factors Favoring or predispoint to Thrombus


Virchow's or VirCHIs Triad
Changes in Blood flow: stasis/turbulence
Hypercoagulability: primary (genetic), secondary (acquired
changes in coagulent or anticoagulent factors
Injury to Endothelium: atherosclerosis, hypertensive drugs,
cigarette smoking, hypercholesteremia

Atherosclerosis Risk Factors


SHIFT MAID:
Smoking
Hypertension
(N)IDDM
Family history
Triglycerdides & fats
Male
Age
Inactivity
Diet / Drink

Heart Failure Causes


"HEART MAy DIE":
Hypertension
Embolism
Anemia
Rheumatic heart disease
Thyrotoxicosis (incl. pregnancy)
Myocardial infarct
Arrythmia
Y
Diet & lifestyle
Infection
Endocarditis

MI emergency treatment drugs


MOAN:
Morphine: analgesia for severe pain
Oxygen: not harmful adn may help if V/Q mismatch
Asprin: inhibit furtherplatelet aggregation

Nitrates: peripheral vasodilation --> reduced preload -->


reduced workload (o2 demand) of thee heart

Myocardial Infarct Complications


ABCDE x2
Arrhythmias / Aneurysm
Bradycardia / BP
Cardiac failure / cardiac tamponade
Dresslers / Death!
Embolism / Extra (VSD, pap muscle rupture)

MI: basic management


BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size

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

Pericarditis: causes
CARDIAC RINDS:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as Isoniazid, procainamide, hydralazine)
Infections
Acute renal failure (uremia)
Cardiac infarction
Rheumatic fever
Injury/Invasion (amyloid/sarcoidosis)
Neoplasms
Dressler's syndrome
SLE/Scleroderma

MI: signs and symptoms


PULSE:
Persistent chest pains

Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating

Heart compensatory mechanisms that 'save' organ blood


flow during shock
"Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
In all 5, system is activated/factor is released

Murmurs: right vs. left loudness


"RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration

ST elevation causes in ECG


ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm

Beck's triad (cardiac tamponade)


3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure

MI: therapeutic treatment


"O BATMAN!": or MONAH
Oxygen
Beta blocker
ASA
Thrombolytics (eg heparin)
Morphine

ACE prn
Nitroglycerin

CHF: causes of exacerbation


FAILURE:
Forgot medication
Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary

Pericarditis: EKG
"PericarditiS":
PR depression in precordial leads.
ST elevation

Depressed ST-segment: causes


DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine

Coronary artery bypass graft: indications


DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

Peripheral vascular insufficiency: inspection criteria


SICVD:
Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair

Rheumatic fever: Revised Jones criteria


JONES PEACE:
Major criteria:
Joints: migratory
O (heart shaped) Carditis: new onset murmur
Nodules, subcutaneous: extensor surfaces
Erythema marginatum
Sydenham's chorea
Minor criteria:
PR interval, prolonged
ESR elevated
Arthralgias
CRP elevated
Elevated temperature (fever)
Need 2 major or 1 major and 2 minor criteria, plus
evidence of recent GAS infection (throat cx, rapid antigen
test, or rising strep antibody titer).

Pulseless electrical activity: causes


PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/
Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs

Exercise ramp ECG: contraindications


RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension

ECG: T wave inversion causes


INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]

Myocardial infarctions: treatment


INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners

Atrial fibrillation: causes


PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome

Atrial fibrillation: management


ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin

Aortic dissection: risk factors


ABC:
Atherosclerosis/ Aging/ Aortic aneurysm
Blood pressure high/ Baby (pregnancy)
Connective tissue disorders (eg Marfan's, Ehlers-Danlos)/
Cystic medial necrosis

Heart failure: causes


HEART FAILED:
Hypertension
Endocrine
Anemia
Rheumatic heart disease
Toxins

Failure to take meds


Arrythmia
Infection
Lung (PE, pneumonia)
Electrolytes
Diet

Bacterial Endocarditis: Duke's criteria


Bacterial Endocarditis FIVE PM:
Major Criteria
B : Blood culture +ve x2
E : Endocardial involvement
+ve echocardiogram (vegetation, abscess or valve
dehiscence) or
New valvular regurgitation
Minor criteria
Fever > 38 oC
Immunologic phenomena (glomerulonephritis, Osler's
nodes, Roth's spots, Rheumatoid factor)
Vascular phenomena (major arterial emboli, septic
pulmonary infarcts, mycotic aneurysm, intracranial
hemorrhage, conjuntival hemorrhage, Janeway lesions)
Echocardiography findings (suggestive but not definitive)
Predisposition (heart condition or IV drug user)
Microbiologic evidence (Positive blood culture but not
meeting major criteria)
Definitive Diagnosis requires 2 Major
or 3 Minor + 1 Major
or 5 Minor

Bacterial Endocarditis: features


F-Fever
R-Roth's spots (retinal hemmorrhages with white or pale
centers)
O-Osler's Nodes (Painful palpable pads fingers/toes)
M-Murmur (usually regurg in mitral/aortic)
J-Janeway lesions (non-tender macular lesions palms/soles)
A-Anemia
N-Nail bed hemorrhage
E-emboli