Anti-arrythmics: for AV nodes
"Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil
Aortic regurgitation: causes
CREAM:
Congenital
Rheumatic damage
Endocarditis
Aortic dissection/ Aortic root dilatation
Marfan’s
Aortic stenosis characteristics
SAD:
Syncope
Angina
Dyspnoea
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
Apex beat: differential for impalpable apex beat
DOPES:
Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Sinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)
Atrial fibrillation: causes
A SHIT:
Alcohol
Stenosis (mitral valve)
Hypertension
Infarction/ Ischaemia
Thyrotoxicosis
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
Beck's triad (cardiac tamponade)
3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
Betablockers: cardioselective betablockers
"Betablockers Acting Exclusively At Myocardium"
_ Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
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
CHF: causes of exacerbation
A SMITH PEAR:
Anemia
Salt/ Stress/ Stopping meds
MI
Infection/ Ischemia
Thyroid (high/low)
HTN
Pericarditis
Endocarditis (valve disease)
Arrhythmia
Rx (beta blocker, etc)
Coronary artery bypass graft: indications
DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
Coronary artery bypass graft: indications
DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
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
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: T wave inversion causes
INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]
Exercise ramp ECG: contraindications
RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension
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
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 murmurs
"hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic
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
JVP: wave form
ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
MI: basic management
BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size
MI: signs and symptoms
PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating
MI: therapeutic treatment
ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine
MI: therapeutic treatment
"O BATMAN!":
Oxygen
Beta blocker
ASA
Thrombolytics (eg heparin)
Morphine
Ace prn
Nitroglycerin
MI: therapeutic treatment
MONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
MI: treatment of acute MI
COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate
Mitral regurgitation
When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".
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.
Murmur attributes
"IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
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
"Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil
Aortic regurgitation: causes
CREAM:
Congenital
Rheumatic damage
Endocarditis
Aortic dissection/ Aortic root dilatation
Marfan’s
Aortic stenosis characteristics
SAD:
Syncope
Angina
Dyspnoea
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
Apex beat: differential for impalpable apex beat
DOPES:
Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Sinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)
Atrial fibrillation: causes
A SHIT:
Alcohol
Stenosis (mitral valve)
Hypertension
Infarction/ Ischaemia
Thyrotoxicosis
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
Beck's triad (cardiac tamponade)
3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
Betablockers: cardioselective betablockers
"Betablockers Acting Exclusively At Myocardium"
_ Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
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
CHF: causes of exacerbation
A SMITH PEAR:
Anemia
Salt/ Stress/ Stopping meds
MI
Infection/ Ischemia
Thyroid (high/low)
HTN
Pericarditis
Endocarditis (valve disease)
Arrhythmia
Rx (beta blocker, etc)
Coronary artery bypass graft: indications
DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
Coronary artery bypass graft: indications
DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
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
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: T wave inversion causes
INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]
Exercise ramp ECG: contraindications
RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension
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
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 murmurs
"hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic
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
JVP: wave form
ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
MI: basic management
BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size
MI: signs and symptoms
PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating
MI: therapeutic treatment
ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine
MI: therapeutic treatment
"O BATMAN!":
Oxygen
Beta blocker
ASA
Thrombolytics (eg heparin)
Morphine
Ace prn
Nitroglycerin
MI: therapeutic treatment
MONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
MI: treatment of acute MI
COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate
Mitral regurgitation
When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".
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.
Murmur attributes
"IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
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
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