Cardiology WorkBook

Medicine
WHERE THE ART OF MEDICINE

IS LOVED, THERE IS ALSO LOVE
FOR HUMANITY.
HIPPOCRATES
DR. PRIYANSH JAIN

Cardiology
DR. PRIYANSH JAIN

DR. PRIYANSH JAIN
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®DRPRIYANSHJAIN
I a Dr. Priyansh Jain I

@MEDICINEDRP
RIVNASHJAIN
• MBBS (Gold Medalist)

• MO (General Medicine) - JLN Medical college
• Consultant Physician & Assistant Professor
• USMLE/MRCP qualified
• 7 International Publications
• National Level Faculty - NEET-PG, FMGE/NExT
• President's Award (Scouts)
• Selected for Research and Training at NIH, USA
(sponsored by USA Government)
• Delivered lectures in International and National
Medical Colleges
• Instagram: drpriyanshjain
• Contactno.: +91 704-236-3461
Index
INDEX OF CARDIOLOGY WORKBOOK

CHAPTER 1: HYPERTENSION………………………………….…..3
CHAPTER 2: RVF & LVF………………………………….………….9
CHAPTER 3: HEART FAILURE……………………………………..12
CHAPTER 4: CORONARY ARTERY DISEASE……………….18
CHAPTER 5: JUGULAR VENOUS PRESSURE……………….35
CHAPTER 6: PERICARDIAL DISORDERS…………………….39
CHAPTER 7: CARDIOMYOPATHY…………..…………………….45
CHAPTER 8: RHEUMATIC FEVER………………………………..54
CHAPTER 9: INFECTIVE ENDOCARDITIS……………………59
CHAPTER 10: ECG ……………………………………………………..62
CHAPTER 10: MITRAL STENOSIS………………………………84
CHAPTER 11: AORTIC REGURGITATION……………………86
CHAPTER 12: MURMUR………………………………………………88
DR. PRIYANSH JAIN MEDICINE 1

2 DR. PRIYANSH JAIN MEDICINE
CARDIOLOGY:HYPERTENSION
HYPERTENSION
DEFINITION:
Bladder Size
- width - ……% of arm circumference
—length - ……% of arm circumference

If cuff size is smaller than required -
180
(NO SOUND )
150
BP- BP-
So, ausculatatory gap can lead to
If only increase in systolic or

diastolic BP- ………………. HTN.
Cause of

CAUSES OF HYPERTENSION
↓
X
&
al
-
Na+ cl-
!
E Na C
TARGET ORGAN DAMAGE
RA LA
RV LV
-
#
-
AORTA
&
-

MANAGEMENT OF HYPERTENSION
120-129
Elevated
< 80
130-139
Stage - I
80-89
Stage - II ≥140
≥90
Extra point
HTN After 20 week of pregnancy + proteinuria - ………………………..
HTN After 20 week of pregnancy + proteinuria + seizure - ………………………..
Tumor of adrenal medulla - ………………………..
CARDIOLOGY:HYPERTERSION
ANTI-HTN MEDICATION
A-Angiotensin converting enzyme inhibitors [ACE#]
-Eg:
-Additional effect:
-So, preffered in:

-S/E
-Angiotensin Receptor Blocker [ARB]
-Eg:
-Additional effect:
-So, preffered in:
B-
-Eg:
-Preffered in:
C-
-Eg:
-S/E:
D-
-Eg:
-S/E:

Ist visit IInd visit IIIrd visit IVth visit

BP- BP- BP- BP-
Rx- Rx- Rx-
-If BP not controlled despite_____ classes of
anti-HTN drug including _______________.
C/a- -
Rx-
ORTHOSTATIC HYPOTENSION OR POSTURAL HYPOTENSION
BP on standing after ……. Min
supine BP
If SBP falls :
OR DBP falls :
Rx of Orthostatic Hypotension:

HYPERTENSIVE URGENCY vs HYPERTENSIVE EMERGENCY

If SBP > …………or /& DBP > ………..
Target organ damage
HYPERTENSIVE…………………. HYPERTENSIVE …………………….
Control the BP in next ……. Hrs
Control the BP in next …….Hr Control the BP

in next ……. Hrs
MALIGNANT HYPERTENSION
If BP more than ………………..

+
………………….
Associated with -
……………………..Appearance

🙇
🫀🫀🫀
SUMMARY FOR HYPERTENSION
Deflation rate = ______mm go Hg/sec. ( < 2 / <3 / <4 / <5 )
If small cuff is used = _____ _____ BP. ( false high / false low)
HTN pt. taking Allopurinol which anti-HTN should
be avoided __________. ( ACE# / ARB / Diuretic / B-blocker)
DM+HTN — _________. ( ACE# / ARB / Diuretic / B-blocker)
HTN+Protienuria( CKD) — _________. ( ACE# / ARB / Diuretic/ B-block
Post MI — HTN — Rx 1st line-
2nd line-
BP+Papilloedema — c/a — ______ ______.
Mean Arterial Pressure -
Pulse Pressure -
High pulse pressure -
Low pulse pressure -
permissive HTN -
DOC for scleroderma crisis - ( ACE# / ARB / Diuretic/ B-blocker)
DOC for u/l renal artery stenosis -( ACE# / ARB / Diuretic/ B-blocker)
If HTN is due to excessive sympathomimetic activity such as with the

use of cocaine - Rx will be - CCB/ PRAZOSINE/ ACE#
if diuretic is given with ACE # can lead to first DOSE HYPOTENSION

CARDIOLOGY:RVF vs LVF
CHAPTER 2
RIGHT VENTRICULAR FAILURE
vs
LEFT VENTRICULAR FAILURE
RIGHT VENTRICULAR FAILURE [RVF]
Jugular vein
RA LA Pul. Vein
RV LV
Hepatic vein
Pul. Artery
Portal vein
Cardiac output in RVF -

PCWP — pulmonary capillary wedge pressure
COR PULMONALE Chronic pulmonary pathology

RA LA
Lung becomes stiff
RV LV
Strain on ……….
P. Artery
Leads to ………
ULTIMATELY……….
CALLED AS ………. ……………
So corpulmonale is ……… cardiac output failure. DR. PRIYANSH JAIN MEDICINE 9

CARDIOLOGY:RVF vs LVF
LEFT VENTRICULAR FAILURE [LVF]
Pul vein
RA LA
RV LV
AORTA
Pul artery
C/F-
On auscultation- lungs -
Heart -
Pulse -
PAROXYSMAL NOCTURNAL DYSPNEA [PND]
60 yr
Uncontrolled HTN

💡
🙇
🫀
CARDIOLOGY: RVF vs LVF
ORTHOPNEA
..
EXTRA POINT
PLATYPNEA
Platypnea is seen in —
SUMMARY
Hepatojugular Reflex — __________. ( RVF / LVF )

JVP — ________. ( RVF / LVF )
PCWP — _______. ( RVF / LVF )
P. alternance — _________. ( RVF / LVF )
Hepatomegaly & Ascites — __________. ( RVF / LVF )
PND & ORTHOPNEA — _________. ( RVF / LVF )
Platypnea - seen in - _______ _______.
History of smoking + SOB+ pedal edema - ……………………….

CARDIOLOGY:HEART FAILURE
CHAPTER 3
HEART FAILURE
DEFINITION
Pumping of oxygenated blood Demand of body
ETIOPATHOGENESIS
Risk factor / ethology -
RA LA
RV LV
AORTA
CONCEPT OF EJECTION FRACTION
LA LA
DIASTOLE SYSTOLE
LV
LV
Aorta
Amount of blood in LV at the Blood pumped in aorta during systole -

end of diastole -

Type of Heart Failure based on EF
C/F
NYHA [NEW YORK HEART ASSOCIATION] STAGE FOR DYSPNEA
NYHA CLASS Level of Impairment

I No symptom limitation with ordinary physical activity
II Ordinary physical activity somewhat limited by dyspnea
(eg: long-distance walking, climbing flights of stairs)
III Exercise limited by Dyspnea with moderate workload
(eg: short-distance walking.
IV Dyspnea at rest with very little exertion
Objective Examination [O/E]

Investigation
Marker of HF -
ECHO -
STAGES OF HEART FAILURE

Risk factor for heart failure -
STAGE A STAGE B STAGE C STAGE D
RISK FACTOR
ECHO CHANGE
C/F
NYHA
MANAGEMENT OF HEART FAILURE

🫀🫀
EXTRA POINT
If - DM+HF — Prefferd anti-diabetic drug —
HF+Atrial fibrillation [AF] —
SUMMARY OF HEART FAILURE

MCC of LVF- ……………. ( HTN / RHD / CAD / CMP / RVF )
MCC OF RVF- ………………( HTN / RHD / CAD / CMP / LVF )
If — Risk factor + —
— Echo-LVH — HF STAGE -
— Asymptomatic -
Drugs which survival in HF — A
—B
cause of death IN- HFpEF - Cardio OR NON-cardiac

-HFrEF - Cardiac OR NON-cardiac

ACUTE DECOMPENSATION OF HEART FAILURE
Definition:
Goma Singh
— 55yr/M Pul. Vein
— Ch. smoker
— Uncontrolled HTN
RA LA
RV LV
AORTA
Pul artery
C/F —
O/E — Lungs auscultation —
— SpO2 —
CxR —

Rx - DOC —
But if the BP is low ( ……………………. ………) - then 1st - …………………………………. &

once BP is stable then …………………………..
Other ways to effective blood volume reaching to Heart
+ /- to decrease sympathetic activity - morphine can be used.
To improve oxygenation [SpO2]

CARDIOLOGY:CORONARY ARTERY DISEASE
CHAPTER 4
CORONARY ARTERY DISEASE
= (i
=>
00 · -
-33
↳ I
·
!
Cardiomyocyte Cardiomyocyte Cardiomyocyte
chest pain
Cardiac enzyme in blood

( TROPONIN)

RISK FACTORS OF CORONARY ARTERY DISEASE
Extra point
Alcohol
CHEST PAIN
1 - character -…….. ……………………………. Location - …………
- radiation to - ……………………………………………………
- associated with - ……………………………
2 - triggered by -……………
3. - relieved by -……………
Patient puts fist on chest c/a -

Investigation in CAD
ECG:
Pericardium
Myocardium
Endocardium
Endocardium Myocardium
Pericardium
Extra point - T wave inversion can also be seen in SAH .


LOCALISATION OF LESION VIA ECG

LMCA
RCA
ECG Leads Localisation of MI Artery involved
V1-V4
I/aVL/V5/V6
I/aVL/V1-V6
II/III/aVF
V1-V2
I/aVL
Options - anterior wall MI / lateral wall / high lateral wall

/ septal/ inferior / extensive
Blood vessel - LAD / LCX / LMCA / RCA

💡
EXTRA POINT
RCA
Inf. Wall MI
If V4R lead — showing changes —
CARDIAC MARKERS
Earliest to increase -
Best -
Marker of reinfraction -
Future predictor -
CT-SCAN — NCCT
Coronary artery Myocardium
Atherosclerosis
MC artery to undergo atherosclerosis

CONCEPT OF STRESS TEST
HR —
Myocardial ischemia -
Chest Pain -
Ischemia-
Stress -
Treadmill test
Protocol -
Target HR -
85 % of target HR
Achieved Not Achieved

2-D ECHO
LV LV
RWMA -Regional wall motion abnormality
Unfavourable condition Favourable condition
LV
LV
RWMA -
Myocardium viability -
LV
LV
RWMA -
Myocardium viability -
CORONARY ARTERY DISEASE/ISCHEMIC HEART DISEASE
Healthy Mild atherosclerosis Ischemia only if HR

(Asymptomatic)
Plaque disruption
&
Platelet aggregation
Ischemia even at normal HR
Infraction in myocardium but Infraction in myocardium

no ST elevation inECG With ST elevation inECG
Clot formation
Started
Chest Pain
ECG Troponin
STABLE ANGINA [ ]
C/F:
👩🦱
7th
6th
3rd floor
INV.
Rx —
Maximum mortality reduction by —
MC side effect of Nitrate —

USA [Unstable Angina] - NSTEMI COMPLEX
Pathogenesis:
C/F:
Investigation:
ECG -
Cardiac enzyme-
Rx:
So in USA-NSTEMI — plan for PCI if …………….score is………… ……
*PCI- Percutenous coronary intervention DR. PRIYANSH JAIN MEDICINE 27

ST-ELEVATED MI [STEMI]
&
))
Pathogenesis:
C/F:
Investigation: ECG -
TROPONIN -
Rx: =
=> * if PCI facility is more than ………. Hours away

Y
Then go for ……………………….
Door to needle time =< …. Min. Agents
Chest pain & ST elevation subsided in next 90 min
b
Yes #
No
Be
,
Plan for …………………… Plan for ……………….
-
= * if PCI facility is less than ………. Hours away

Y
Then go for ……………………….
Door to needle time

Other treatment - same as ……………….
EXTRA POINTS
After PCI — dual antiplatelet is given for — ___________.
Inf. Wall MI — RVMI — HR
— BP
So in Inf wall MI if patient in shock before doing
thrombolysis , give ………………
ANGIOGRAPHY
If single vessel disease [SVD] or double vessel disease [DVD]
PTCA-Percutenous transluminal coronary angioplasty*

If TVD ( triple vessel disease)
TYPES OF MI
Type 1 Type 2
Type 3
Type 4 Type 5

COMPLICATIONS OF MI
a) with 1st few hours
b) after 4 - 7 days of MI
RA LA RA LA
RV LV RV LV
c) after 4 - 7 days of MI
RA LA RA LA
RV LV RV LV
D after 4 - 7 days of MI
c)
Papillary muscle
RA LA RA LA Papillary muscle rupture
RV LV RV LV

d)
RA LA RA LA
RV LV RV LV
Pericardium
e)
Pul. Vein
RA LA
RV LV
AORTA
Pul. Artery
KILIP CLASSIFICATION
No sign of HF
B/L crep. in 50% lungs
Frank Pul. edema
Pul. edema + Shock

PRINZMETAL ANGINA
Pathogenesis:
Winter exposure
Coronary artery
Myocardium
C/F:
Associated with- …………………….. phenomenon /……………….intake.
ECG-
Rx-
Match the following
1) chest pain at rest + no st elevation + troponin A) stable angina

2) chest pain at exertion only + no st elevation + troponin N B) unstable angina
3) chest pain at rest + st elevation + troponin C) N-STE-MI
4) chest pain at rest + no st elevation + troponin D) STEMI
5) recurrent chest pain on winter exposure + ST elevation E) free wall rupture
6) chest pain after 4 weeks of MI F) prinzmetal angina
7) shock on 5th day POST MI G) dressler syn
1 .... 2….3……4……5…..6……7…..

🫀
🫀🙇
SU\MMARY OF CORONARY ARTERY DISEASE
ECG-Change — Transmural infarction - ST Elevation / ST depression
— Subendocardial ischemia -ST Elevation / ST depression
Localisation of MI — II/III/aVF-______wall. ( ant / inferior / lateral)
— I/aVL/V5/V6-_______wall (ant / inferior / lateral)
— V1-V4 -_______wall. (ant / inferior / lateral)
MI— associated with bradycardia— _____wall MI (ant / inferior / lateral)
Marker of reinfarction — ________ ___>___
Best viability test - ___________ ( PET scan / thallium scan)
TMT— is + if — ST depression ≥ ____mm for ___ms
Stable angina — max. Mobility by- nitrate / B-blocker / aspirin ‘ statin
Door to needle time - thrombolysis — < __min ( < 30/ <60/<90/ <120)
- 1 PCI — < __min ( < 30/ <60/<90/ <120)
PCI - after successfull thrombolysis - ____PCI ( check / rescue/ delayed)
- after unsuccessful thrombolysis - ____PCI (check / rescue/ delayed)
- after USA-NSTEMI - ______PCI ( check / rescue/ delayed)
Variant angina — Rx -1)________ 2)_________.
Pharma connection -
Heparin toxicity antidote - option - vit K / protamin sulphate
Warfarin toxicity antidote -option - vit K / protamin sulphate

CARDIOLOGY:JVP
CHAPTER 5
JUGULAR VENOUS PRESSURE
— Why -
R IJV L IJV
L EJV
— Where -
RA LA
— Normal JVP -
RV LV
— How -
Carotid artery pulsation are _______ & JV _______.
CAUSES OF RAISED JVP

R IJV R IJV R IJV R IJV
SVC SVC SVC SVC
RA RA RA RA
RV RV RV RV
P.A P.A P.A P.A
Lungs Lungs Lungs Lungs

CARDIOLOGY:JVP
JVP WAVE-FORM
-
Pressure
-
-
Time
RA RA RA RA
IVC IVC IVC IVC
TV TV TV TV
RV RV RV RV
PATHOLOGICAL JVP WAVE FORM

a-wave — Absent -
— Large -
R IJV
SVC
— Cannon - RA
RV
v wave P.A
Lungs
IVC Atrial septum IVC Atrial septum
RA LA RA LA
RV LV RV LV

CARDIOLOGY:JVP
X-Descent
In view of
Cardiac Temponade Constructive Pericarditis
Y-Descent
In view of

💡 🫀
CARDIOLOGY:JVP

X
Y
Prominent Y descent - is called friedrich’s sign
KUSSMAUL SIGN
— seen in —
— Not seen in —
EXTRA POINT
SUMMARY OF JVP
Measured in — __ ____. ( R IJV / R EJV / L IJV/ LEJV )
Method — ___ ____ technique.
C wave — d/t ___ ____ during _______ phase.
Large a wave — ____/____/____.
Cannon a wave — ____/________.
Large v wave — ____/_________.
Prominent Y —
Cardiac temponade — X _____ / Y_____.
Kussmaul sign NOT seen in _____ _____.
cv wave — ____.
CARDIOLOGY:PERICARDIAL DISORDERS
CHAPTER 6
PERICARDIAL DISORDERS
Outer Pericardial Layer
Inner Pericardial Layer

RA LA
RV LV
ACUTE PERICARDITIS
Etiopathogenesis:
RA LA RA LA
RV LV RV LV
Etiology — MCC -
— Other -

C/F —
Also know - friction rub in …………………

But On holding the breath -
O/E —
RA
RV
LA
LV
S
ECG — ut .........
Rx—
CONSTRICTIVE PERICARDITIS
RA LA RA LA
RV LV RV LV

Etiology —
C/F —
O/E — JVP …… -> X descent …………… …….. & Y descent ………………..

—> kussmaul sign -……………………..
Normally -On inspiration SBP ……………………. But not more than ………… mm of Hg.
If - On inspiration SBP ……………………. But more than ………… mm of Hg c/a -………………………………
Pulsus paradoxsus is also seen in ………………………………. & …………………. …………….. ……..
For ascites - ………………. ……………..test ……….

- ………………….. …………………
- ………………….. …………………
Atria On auscultation - during

………………. —>
Ventricle

Cxr Echo
Also seen in -
Rx—

PERICARDIAL EFFUSION
CARDIAC TEMPONADE
Etiology —

SVC
AORTA
RA LA
SVC
AORTA
RA LA
RV
RV
LV LV
C/F —
Without pulsation
O/E — Bulging in epigastric area -

On inspiration - SBP ………….. > ….mm of hg c/a -
But if patient in shock -
So While taking the BP in CT- patient should breath ………………
ECG —
JVP — X
—Y
Kussmaul sign -
CxR —
ECHO —

🙇
Rx —
SUMMARY OF PERICARDIAL DISEASE
CONSTRICTIVE PERICARDITIS CARDIAC TEMPONADE

Etiology
Etiology:
NOT a common C/F C/F - BP

-
-
JVP - X JVP - X
-Y
-Y
Kussmaul Sign ______ Kussmaul sign ____

Pulsus paradoxsus _________ Pulsus paradoxsus ___
CxR CxR:
Echo -
ECG:
-
Rx:
Rx

CARDIOLOGY:CARDIOMYOPATHY
CHAPTER 7
CARDIOMYOPATHY
DEFINITION
CLASSIFICATION BASED ON ETIOLOGY

—
1. STRESS CARDIOMYOPATHY
Pathogenesis:

C/F :
ECG :
Angiography:
Ventriculogram:
Rx:
Prognosis:
2. HYPERTROPHIC CARDIOMYOPATHY [H.CMP]

Pathogenesis - multiple mutations are associated but most common is
IVS FREE WALL IVS FREE WALL
RV
· LV RV LV

AORTA
LA
C/F — ________. Hypertrophy
LV cavity size ___

LV
………………………. Failure —> c/f —>
Progressive increase in hypertrophy leads to

AORTA
LA …………………….. so c/a
Leads to ……………………….. failure

LV So stroke volume ( blood in aorta) - ………………
Blood supply to hypertrophied muscle

Blood supply to brain
Hypertrophied ventricular muscle can lead to - ………………………………

Which can lead to ………………………………………………
O/E -
-'
Pressure Pressure
In In
Artery Artery
Time Time
MURMUR
AORTA
AORTA
LA
LA
LV
LV
Diastole Systole
Murmur of HOCM - On standing / valsalva - …………….
ECG -

AORTA
Echo — LV cavity size …………
LA
and shape looks like …………
LV
AORTA AORTA
LA LA
LV LV
Diastole Systole
Rx — To improve diastolic filling -

To decrease cardiac remodelling and disease progression -
To prevent arrhythmia -
If there is high risk of sudden cardiac death - such as - family

history or LV muscle thickness is >3 cm.
Implantable cardioverter defibrillator
MC S/E of ICD is —
pharma connection -
Drug C/I in HOCM-

Extra point
HOCM Aortic stenosis
AORTA AORTA
LA LA
Aortic Aortic
Valve Valve
LV LV
Systole Systole
S1 S2 S1 S2
At ………area & murmur At …………area

…………………..on valsalva / standing
C/f - SOB on exertion C/f - SOB on exertion

- chest pain/ heaviness - chest pain/ heaviness
- syncope - syncope
Age - …………. Age …………
History of sudden History of sudden

cardiac death in family - cardiac death in family -
S2 Abnormality - S2 abnormality -
3. ARRYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA [ARVD]
Pathology:
RA RA
RA
Can
RV RV RV
Lead to
…………………
C/f -
ECG- Rx -
4. RESTRICTIVE CARDIOMYOPATHY
Pathogenesis:
RA LA
RV LV
MCC —
Other Causes —
C/F -
LA
O/E -
Kussmaul sign -
ECHO - LV diastolic dimension=
LV
- LA size -
- If Amyloid deposited
Rx - DOC
- C/I
-

5. DILATED CARDIOMYOPATHY [DCMP]

Pathogenesis:
LA
LV
Etiology — MCC — 1)
— 2)
— 3)
— Other
Drugs —
- infection - parva virus / diphtheria
- vitamin deficiency- …………
- mineral deficiency- ……………..
- Duchenne muscular dystrophy.
Multinucleated myocardium -
💡
C/F —
O/E —
ECHO - LV cavity size

LA
- SV ______
- EF ______
LV
Rx -
EXTRA POINT
MCC of sudden cardiac death in young — 1)
— 2)
— 3)
Brugada syn
Pathology -
Feature -
Inv - ECHO / ELECTROPHYSIOLOGY STUDY
Rx -

🙇🫀
SUMMARY OF CARDIOMYOPATHY
Stress CMP - a/c/a ______ CMP/ _______ _______ syndrome.

- C/F— Trigger — F/b
- DOC —
HOCM - Ch. ____ - __ ____ _____ ______ mutation.
- ____________ Hypertrophy
- C/F - __________ failure — …………………………
F/b
__________ failure —……………………………
- O/E — S ____ + / P. ____________.
— _______ _______ murmur at _____ area.
- Echo - LV cavity ________ shape.
- _______ of MV
- Rx - DOC
- C/I - _______ / _______ / ________.
Restrictive CMP - MCC
- C/F — same as _____
- ECHO — _________ myocardium
Dilated CMP - MCC - 1)
- 2)
- 3)
- Drugs —
- Peri-partum is d/t ___________.
- C/F — same as HF __ EF.

CARDIOLOGY:RHEUMATIC FEVER
CHAPTER 8
RHEUMATIC FEVER
PATHOGENESIS
Age -
Antibody levels

CARDIOLOGY:RHEUMATIC FEVER👶 👶 👶 👶
C/F
a) Cardiac involvement
Pericardium
RA LA
Myocardium
Endocardium
RV LV
MC valve to be involved -
Most rare valve to be involved -
ENDOCARDITIS
Acute inflammation Chronic inflammation
LA LA
LA
Mitral valve
LV LV
LV
Thickened post wall of LA called as - …………………………
b) Joint Involvement

c) Neuronal Involvement
d) Skin Involvement
e) Subcutaneous tissue involvement
INVESTIGATION
CRITERIA FOR DIAGNOSIS

Revised JONES criteria for High Endemic Area
MAJOR 1)
2)
3)
4)
5)
MINOR 1)
2)
3)
4)
Rx — for joint pain -
- for carditis -
- for chorea -
- for skin rash/ subcutaneous nodule -
For prophylaxsis of B-H.G.A.streptococcus-
HOW LONG
RF without cardiac involvement —
RF+Cardiac involvement but Recovered —
RF+Residual cardiac involvement —
If allergic to penicillin. -

🙇 🫀
SUMMARY OF RHEUMATIC FEVER
Etiology — Infection of —
Antibody against — _____ protein cross reacts
Eg. Of type ___ Hypersensitivity Reaction
Cardiac involvement — Hallmark —
Acute endocarditis — leads to — Mirtal ____— ____ ____murmur
Ch. Endocarditis — leads to Mitral ______
Skin findings —
Neuronal Finding —
- __________ _______ Criteria
Prophylaxis — by ________ _______ every _____ day.
PHARMA CONNECTION.
INJ Benzathine penicillin is also used for treatment of cardiovascular
syphilis - 2.4 million unit once weekly for 3 weeks .

CARDIOLOGY:INFECTIVE ENDOCARDITIS
CHAPTER 9
INFECTIVE ENDOCARDITIS
RA LA
Endocardium
RV LV
Overall MCC —
Cardiac lesion with — Highest risk of I.E. —
— Lowest risk of I.E. —

Y
So ………. Patient doesnot require prophylaxis for IE
I.E. — after valvular Sx — < 2 month of surgery
— > 2 month of surgery -
For I/V drug abuser MC valve involved is -…………………. & MC organism is -

………………..
I/V drug abuser if left side heart involved then MCC-
For colon cancer patient MCC -

PATHOGENESIS
LA
LA
LV LV
LA
LV
LA
LV

VASCULAR PHENOMENON
& LA
( LV
AORTA
IMMUNOLOGICAL PHENOMENON
g
LA
LV
AORTA

🙇 🫀
For - Diagnosis — ________ ________ criteria.
MAJOR - 1)
2)
MINOR - 1)
2)
3)
4)
5)
Rx —
SUMMARY OF INFECTIVE ENDOCARDITIS

MCC —
Cardiac lesion — Highest risk — ______
— Least risk — _______
SABE - Etiology —
Vascular Phenomenon — Nails —
— Palm & sole — _____ _____ [pain____]
— Spleen —
Immunological phenomenon — Eye —
— Finger — _____ _____ [pain___]
_____ ______ criteria.

Malar rash + vegetation on both sides

&
LA
· LV

CARDIOLOGY:ECG
CHAPTER 10
ECG
1 Big Box = ______ small box
1 Small Box = ______mS.
ECG LEADS

CARDIOLOGY:ECG
CONDUCTION SYSTEM OF HEART
SA
·
AV
ECG NORMS
P
P wave
...................
P
PR interval i
P
q wave

CARDIOLOGY:ECG
R
p T
qRS complex
q s
T wave R
p T
q s
p T
R
qT interval
q s
CONDUCTION SYSTEM OF HEART
SA Conduction from SA
node till completion of
AV node is callled as
……………… interval .
AV
BoH Conduction through
bundle of his to Bundle
branches is callled as
BB ……………… interval .
PF

CARDIOLOGY:ECG
Calculation of Heart Rate
For Regular rythm

HR =
For IR-regular rythm
DR. PRIYANSH JAIN MEDICINE

CARDIOLOGY:ECG
ECG AXIS
Normal Left axis Right axis Extreme Axis
aVF
So — RVH —
— LVH —
Axis
— Uncontrolled HTN — LV
— Aortic Stenosis —
Aorta
— Pw. Artery HTN —
— Ch. Lung Pathology —
— Tetrology of Fallot —

CARDIOLOGY:ECG
Axis
R
p wave p T
q s
R
RA LA p
T
TV MV
RV LV q s
p R
RA LA
T
TV MV
RV LV q s
If tall P wave — without RA — c/a -

Hypertrophy

CARDIOLOGY:ECG
RA LA
TV MV
RV LV
PV AV
TTT
Closure of MV + Closure of TV -
I
In mitral stenosis -
S1 can be - narrow
- single :
- Reverse split ·
Extra point -
LOUD S1 is seen in - anemia / pregnancy / MS
SOFT S1 is seen in - MR / severe calcified MS

CARDIOLOGY:ECG
PR INTERVAL P
Normal =
PR interval = >
SA
·
AV
Etiology —
Ist DEGREE HEART BLOCK

— PR-Interval —
· ! iii

CARDIOLOGY:ECG
IInd DEGREE — MOBITZ I

T T T
P P P
PR-interval =
IInd DEGREE — MOBITZ II

T T T
P P P
PR - Interval =
IIIrd DEGREE [COMPLETE HEART BLOCK]
SA
AV

💡
CARDIOLOGY:ECG
Atrial rate Ventricular rate
SUMMARY OF HEART BLOCK

PR Interval Drop Beat
Ist Degree
Mobitz I
2°
Mobitz II
3rd Degree
EXTRA POINT
Pharma pearl- don’t give metoprolol with verapamil as that will increase
risk of ………………………. BLOCK hence leads to significant ……………….
CARDIOLOGY:ECG
LET’S PRACTICE — 1°/MOBITZ I /MOBITZ II /3° / 2:1

CARDIOLOGY:ECG
SHORT PR INTERVAL [< _____ mSec]
SA
AV
So, — •
— LA — LV
WPW Synd — Between —
— RA — RV
Accessory
Pathway
Rx ………………………. ……… or …………………………….
TMT in WPW syn is ………………

CARDIOLOGY:ECG
💡
q wave — Normally should fit in __ small box
If bigger
C/a —
Seen in
EXTRA POINT
Most common
Pul. Embolism
ECG change
Most specific
ECG change
III
Extra point -
Mostly in fever - HR increases but if there is decrease in HR
during fever called as - ……………. bradycardia is seen in
……………. / ………………………./…………….

CARDIOLOGY:ECG
qRS COMPLEX PATHOLOGY & ARRYTHMIA

A) Atrial Fibrillation [Af]
B) Atrial Flutter [AF]
C) Multifocal Atrial Tacchycardia [MAT]
D) Paroxysmal Supraventricular Tachycardia [PSVT]
E) Ventricular Tachycardia [VT]
F) Ventricular Flutter [VF]
G) Ventricular Fibrillation [Vf]
SA
If Arrhythmia originates from here
calls as -
………………………………….arrythmia.
AV
If Arrhythmia originates from

here calls as -
………………………………….arrythmia
SV arrythmia - ……………..qRS
Ventricular arrythmia - ……………..qRS

CARDIOLOGY:ECG
A) Atrial Fibrillation
Pathology -
Lead -
qRS -
Rythm- -
HR-
P wave -
C/f - syncope / palpitation
Can be seen with - ……………thyroidism.
Kussmaul sign - ………..seen .

( on inspiration fall in JVP)
Rx - rate control -
- rythm control - …………………./ ……………………( better)
- if recurrent -then for prophylaxis DR. PRIYANSH JAIN MEDICINE
CARDIOLOGY:ECG
B) Atrial Flutter
— ECG —
— Leads —
C) MULTI-FOCAL-ATRIAL-TACCHYCARDIA [MAT]
• Hint —
• ECG — Lead ___
• Pulse deficit —
D) PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA [PSVT]

— C/F —
— ECG — Lead —

CARDIOLOGY:ECG
Rx — Ist line
Other management - face ice pack

CAROTID SINUS MASSAGE
Ill
Pharma connection
Adenosine is C/I in — ______ ______.

D) VENTRICULAR TACHYCARDIA [VT]
VT= ≥ ___ continuous VPC + qRS > ___ mS + HR > ___/min.

If - ≥ ___ continuous VPC + qRS > ___mS + HR < ___/min.
c/a
CARDIOLOGY:ECG
Ventricular tachycardia
Shape of VPC
. .
Rx - unstable Rx - unstable
- stable - stable
Trigger of TDP —
(early after depolarisation)

EXTRA POINT
— <30sec -
VT —— Lasting
— >30sec -
Arrhythmia —— leading to Hypotension — Rx
For treatment of digoxin induced arrhythmia - inj ……………………
Ventricular premature contraction is also called as

extrasystole.
Extra point
Synchronised / DC shock is sync

cardioversion with R wave
DC SHOCK
DC shock is NOT sync
Non -Synchronised with R wave
/ defibrillation
DC shock
Delivered
Cardioversion Button press
DC SHOCK button
press and delivery
same time
Defibrillation
CARDIOLOGY:ECG
🙇
F) VENTRICULAR
🫀 FLUTTER [VF]
G) VENTRICULAR FIBRILLATION [Vf]
For management of ASYSTOLE - inj . …………………………
Blunt trauma to chest leading to arrhythmia - c/a -….
SUMMARY OF ARRYTHMIA
A. Fibrillation — ____ lead.
__ ____ R-R interval + No Identifiable __ wave.
A. Flutter —— ______ leads — _______ pattern
PSVT —— ______ lead —
— Rx — Ist —
— IInd —

🫀
CARDIOLOGY:ECG
MAT —— lead __ — ≥ __ morphology of ___ wave.
VT —— ≥ ___ VPC + qRS > ___mS + HR > ___/min.
180° Rotation same —— ________ ________.
LET’S PRACTICE
• A. Fibrillation
• A. Flutter
• PSVT
• VT
• A. Fibrillation
• MAT
• PSVT
• VT
• A. Fibrillation
• Monomorphic VT
• PSVT
• TDP
• A. Fibrillation
• MAT
• PSVT
• VT

CARDIOLOGY:ECG
ST - SEGMENT
— V1-V4 —
ST Elevation — 1) STEMI
— I/aVL/V5-V6 —
— II/III/aVF —
— 2) Acute pericarditis
— 3)
— 4)
— 5)
— 6)
— 7)
— 8)
Osborn wave (J wave) can also be seen in

hypercalcemia
ST Depression ——

💡
CARDIOLOGY:ECG
R
QT INTERVAL T
P
n QT —
S
QT interval
Prolong QT can lead to ——
Congenital prolong QT interval
— with deafness —
— without deafness —
QT interval
EXTRA POINT
Corrected QT interval [QTc] ——
ECG CHANGES OF HYPERKALEMIA [K > _____ mEq]

CARDIOLOGY:ECG
• Risk factor for Hyperkalemia —
• Rx of Hyperkalemia —
•
ECG CHANGES OF HYPoKALEMIA [K < _____ mEq]
• Risk factor of K l —
• Rx —
CHAMBER HYPERTROPHY
LVH
RVH

CARDIOLOGY:ECG
BUNDLE BRANCH BLOCK [BBB]

SA
— qRS —
AV
RV LV
— V1 —
SA
— qRS —
AV
RV LV
— V1 —
Rx - if symptomatic —
a) RBBB b) LBBB a) RBBB b) LBBB

CARDIOLOGY:Mitral stenosis
CHAPTER 10
MITRAL STENOSIS
N Mitral valve MV opening < ___

Orifice
& LA
_____cm
2
& -
LA
jj LV
( LV
So, during diastole — opening of pathological mitral valve
& LA
jj LV
S2 S1 S2
P. Vein
ECG
— L.A. — ______ ——— _____ _____.
g
LA
— P. Vein pressure —
LV — if MS+ASD —
— S1 —

CxR — Echo —
Rx - 1)
2- if severe calcified MS
3) M. Stenosis + Clot in LA
#
· Clot in LA
LV
Aorta
4 ) if MS is associated with A.fibrillation then to avoid risk of clot

formation - …………………….. should be added in treatment.

EXTRA POINT
So, LA enlargement can lead
Compression of
Left recurrent laryngeal nerve
Arch of aorta
LA hypertrophy
Severity of MS depends on ……

CARDIOLOGY:Aortic Regurgitation
CHAPTER 11
AORTIC REGURGITATION
AORTA AORTA
LA LA
LV LV
Systole Diastole
Etio- mcc
C/F . — P.
.
— Head Bobbing —
— Movement in Uvula —
— Murmur in Femoral Artery —
• capillary pulsation in nail plate
Vasodilator - decrease the peripheral resistance so backflow of the

blood to LV decrease hence ……………murmur of AR.
Mild AR murmur is called as - seagull murmur / Austin flint murmur

CARDIOLOGY:Aortic Regurgitation
Pulse - bounding
Pulse pressure -
💡
Rx -
EXTRA POINT
CLASSIFICATION — STANFORD A & B
Difference is blood pressure of upper limb and lower limb -
Bld supply to UL
It is associated with ……………syn.
Bld supply to UL -
CARDIOLOGY:Murmur
CHAPTER 12
MURMUR
TYPES OF MURMUR
A) CONTINOUS MURMUR
RA LA RA LA RA LA
TV MV TV MV TV MV
RV LV RV LV RV LV
CoA
Peripheral pul. Stenosis

………ductus arteriosus
B) SYSTOLIC MURMUR
RA LA
MV
RV LV
Aorta

CARDIOLOGY:Murmur
Ejection systolic
S1 SYSTOLE S2
Pansystolic
S1 SYSTOLE S2
*MR murmur radiates towards -

*pansystolic murmur with high JVP -
Late Systolic
Normal S1 SYSTOLE S2
⑳
LA
LA LA
LV
LV LV
Aorta
Displacement of MV leaflet
posteriorly in LA during systole
MVP is associated with Euler Danlos sys / marfan syn / straight back syn.
· Contact sports should be avoided in severe MVP .

CARDIOLOGY:Murmur
3) DIASTOLIC MURMUR
— Early —
— Mid-Diastolic —
— Pan-Diastolic —
Mid diastolic murmur with prominent “a” wave on JVP-
Triangle of auscultation-

💡
CARDIOLOGY:Murmur
EXTRA POINT
HOCM & Mitral valve prolapse murmur
________ on valsalva
NAMED MURMUR
Carvallo Murmur —
Carey Coomb Murmur —
Austin Flint Murmur (low pitch /soft)—
Graham Steel Murmur (high pitch) —
AS Murmur Radiates towards mitral area [apex]
— c/a — Phenomenon
Tumor Plop Sound —
NAMED PULSES
Anacrotic Pulse — AS
OR
P. Parvus et Tardus
Dicrotic Pulse — D CMP
P. BisFeriens — HOCM
P. Alternance — LVF
Corrigan / water hammer pulse — AR
THE CHAPTER YOU ARE LEARNING TODAY IS

GOING TO SAVE SOMEONE’S LIFE TOMORROW

THE FUTURE BELONGS TO
THOSE WHO BELIEVE IN THE
BEAUTY OF THEIR DREAMS.
ELEANOR ROOSEVELT
ARISE-Chennai ARISE-Delhi
+91-89779 41723, +91-89779 42723 +91-95600228-36 / 37 / 38
arisemedicalacademy.chennai@gmail.com arisemedicalacademy.delhi@gmail.com
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Estate, SIDCO Industrial Estate, Guindy, Saket, New Delhi.
Chennai, Tamil Nadu 600032
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Medicine

WHERE THE ART OF MEDICINE

DR. PRIYANSH JAIN

DR. PRIYANSH JAIN

I a Dr. Priyansh Jain I

• MBBS (Gold Medalist)

INDEX OF CARDIOLOGY WORKBOOK

CHAPTER 2: RVF & LVF………………………………….………….9

CHAPTER 3: HEART FAILURE……………………………………..12

CHAPTER 4: CORONARY ARTERY DISEASE……………….18

CHAPTER 5: JUGULAR VENOUS PRESSURE……………….35

CHAPTER 6: PERICARDIAL DISORDERS…………………….39

CHAPTER 8: RHEUMATIC FEVER………………………………..54

CHAPTER 9: INFECTIVE ENDOCARDITIS……………………59

CHAPTER 10: ECG ……………………………………………………..62

CHAPTER 10: MITRAL STENOSIS………………………………84

CHAPTER 11: AORTIC REGURGITATION……………………86

CHAPTER 12: MURMUR………………………………………………88

DR. PRIYANSH JAIN MEDICINE 1

- width - ……% of arm circumference

—length - ……% of arm circumference

So, ausculatatory gap can lead to

If only increase in systolic or

DR. PRIYANSH JAIN MEDICINE 3

TARGET ORGAN DAMAGE

4 DR. PRIYANSH JAIN MEDICINE

-So, preffered in:

-Angiotensin Receptor Blocker [ARB]

-So, preffered in:

DR. PRIYANSH JAIN MEDICINE 5

Ist visit IInd visit IIIrd visit IVth visit

-If BP not controlled despite_____ classes of

anti-HTN drug including _______________.

ORTHOSTATIC HYPOTENSION OR POSTURAL HYPOTENSION

BP on standing after ……. Min

6 DR. PRIYANSH JAIN MEDICINE

HYPERTENSIVE URGENCY vs HYPERTENSIVE EMERGENCY

Target organ damage

HYPERTENSIVE…………………. HYPERTENSIVE …………………….

Control the BP in next ……. Hrs

Control the BP in next …….Hr Control the BP

If BP more than ………………..

DR. PRIYANSH JAIN MEDICINE 7

SUMMARY FOR HYPERTENSION

Deflation rate = ______mm go Hg/sec. ( < 2 / <3 / <4 / <5 )

HTN pt. taking Allopurinol which anti-HTN should

be avoided __________. ( ACE# / ARB / Diuretic / B-blocker)

DM+HTN — _________. ( ACE# / ARB / Diuretic / B-blocker)

HTN+Protienuria( CKD) — _________. ( ACE# / ARB / Diuretic/ B-block

Post MI — HTN — Rx 1st line-

BP+Papilloedema — c/a — ______ ______.

Mean Arterial Pressure -

High pulse pressure -

Low pulse pressure -

DOC for scleroderma crisis - ( ACE# / ARB / Diuretic/ B-blocker)

If HTN is due to excessive sympathomimetic activity such as with the

if diuretic is given with ACE # can lead to first DOSE HYPOTENSION

8 DR. PRIYANSH JAIN MEDICINE

Cardiac output in RVF -

COR PULMONALE Chronic pulmonary pathology

So corpulmonale is ……… cardiac output failure. DR. PRIYANSH JAIN MEDICINE 9

LEFT VENTRICULAR FAILURE [LVF]

PAROXYSMAL NOCTURNAL DYSPNEA [PND]

10 DR. PRIYANSH JAIN MEDICINE

BP+Papilloedema — c/a — .