Aortic
stenosis characteristics
SAD:
Syncope
Angina
Dyspnoea
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 RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome
Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary
stenosis.
· Similarly, it's common sense that if it is
aortic and pulmonary stenosis it could also be
mitral and tricusp regurgitation].
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.
· If get confused about which is which, remember LIRE=liar which will
be inherently false.
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
11
MI: therapeutic
treatment ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine
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
Murmurs: systolic vs. diastolic PASS: Pulmonic
& Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.
Murmurs: systolic vs. diastolic Systolic murmurs: MR AS:
"MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Ed
Asner and Ms. Jane Arden.
Mitral stenosis (MS) vs. 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.
Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation.
Jugular venous pressure (JVP) elevation: causes HOLT:
Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase
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
22
Murmurs: innocent
murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression
Murmur attributes "IL PQRST" (person has ill PQRST
heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
Murmurs: locations and descriptions "MRS butt":
MRS: Mitral Regurgitation--Systolic
butt: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and
Aortic regurgitation, are obviously diastolic.
Betablockers: cardioselective betablockers "Betablockers
Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
Apex beat: abnormalities found on palpation, causes of impalpable
HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia
MI: treatment of acute MI COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate
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
Heart murmurs "hARD
ASS MRS. MSD":
hARD: Aortic Regurg
= Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic
33
Mitral
regurgitation When you hear
holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".
Sino-atrial node: innervation Sympathetic acts on
Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).
Supraventricular
tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)
Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker
Pulseless electrical activity: causes PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/
Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs
Sinus bradycardia: aetiology "SINUS
BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes
Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leucocytosis
JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of
tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
· See diagram.
Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
41
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]
Rheumatic fever: Jones major criteria JONES:
Joints (migrating polyarthritis)
Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis
or valvulits)
Nodes (subcutaneous nodules)
Erythema marginatum
Sydenham's chorea
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
Anti-arrythmics: for AV nodes "Do
Block AV":
Digoxin
B-blockers
Adenosine
Verapamil
Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis
Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis or pericardial tamponade
Emphysema
Sinus inversus/ Student incompetence
CARDIOLOGY