Aorta vs. vena cava: right vs. left

- (When looking at the patient from the anterior side.) Aorta and right each have 5 letters, so aorta is on the right. Vena and cava and left each have 4 letters, so vena cava is on the left

Aortic regurgitation: causes

Congenital Rheumatic damage Endocarditis Aortic dissection/ Aortic root dilatation Marfan’s

Aortic stenosis characteristics

Syncope Angina Dyspnoea SAD

Aortic to left Subclavian path

Aortic arch gives rise to: Brachiocephalic trunk left Common Carotid left Subclavian ABC'S

Apex beat: abnormalities found on palpation, causes of impalpable

Heaving Impalpable Laterally displaced Thrusting/ Tapping If it's impalpable, causes are COPD COPD

Atrial Fibrillation causes

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

Atrial fibrillation management

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

Beck's triad (cardiac tamponade)

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

Betablockers: cardioselective betablockers

Betaxolol Acebutelol Esmolol Atenolol Metoprolol

CHF Treatment

Lasix Morphine Nitrites Oxygen VassoPressors

CHF: causes of exacerbation

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

Complications of Myocardial Infarction

Death Arrythmia Rupture(free ventricular wall/ ventricular septum/ papillary muscles) Tamponade Heart failure (acute or chronic) Valve disease

Coronary artery bypass graft: indications

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

ECG: left vs. right bundle block

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. WiLLiaM MaRRoW

Exercise ramp ECG: contraindications

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

Heart blocks

Longer, longer, longer, drop! Then you have a Wenkebach. if some P's don't get through, then you have Mobitz II. If P's and Q's don't agree, then you have a Third Degree. If the R is far from P, then you have a First Degree.

Heart valve sequence

Tricuspid Pulmonary Mitral (bicuspid) Aorta Try Puling My Aorta

Heart valves (right to left)

Tricuspid valve Pulmonary semilunar valve Mitral (bicuspid) valve Aortic semilunar valve Toilet Paper My Ass (or They Pay Me Alcohol)

Infarctions

IV access Narcotic analgesics (e.g. morphine, pethidine) Facilities for defibrillation (DF) Aspirin/ Anticoagulant (heparin) Rest Converting enzyme inhibitor

JVP: wave form

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

MI: basic management

Bed rest Oxygen Opiate Monitor Anticoagulate Reduce clot size

MI: signs and symptoms

Persistent chest pains Upset stomach Lightheadedness Shortness of breath Excessive sweating

MI: therapeutic treatment

Oxygen Beta blocker ASA Thrombolytics (e.g. heparin) Morphine Ace prn

MI: treatment of acute MI

Cyclomorph Oxygen Aspirin Glycerol trinitrate COAG

Murmur attributes

Intensity Location Pitch Quality Radiation Shape

Murmurs: innocent murmur features

Soft Systolic Short Sounds (S1 & S2) normal Symptomless Special tests normal (X-ray, EKG)

Murmurs: louder with inspiration vs expiration

RIght sided murmurs louder with Inspiration. LEft sided murmurs louder with Expiration

Murmurs: questions to ask

Site Character (e.g. harsh, soft, blowing) Radiation Intensity Pitch Timing

Murmurs: systolic vs. diastolic

- MS. PAID Mitral Stenosis Pulmonic or Aortic Insufficiency -> Diastolic.

Pericarditis: EKG

PR depression in precordial leads. ST elevation. PericarditiS

Pericarditis: causes

Collagen vascular disease Aortic aneurysm Radiation Drugs (such as hydralazine) Infections Acute renal failure

Peripheral vascular insufficiency: inspection criteria

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

Pulseless electrical activity: causes

Pulmonary embolus Acidosis Tension pneumothorax Cardiac tamponade Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia Myocardial infarction

ST elevation causes in ECG

Electrolytes LBBB Early repolarization Ventricular hypertrophy Aneurysm Treatment (e.g. pericardiocentesis)

Supraventricular tachycardia: treatment

Adenosine Beta-blocker Calcium channel antagonist Digoxin Excitation (vagal stimulation)

Ventricular tachycardia: treatment

Lidocaine Amiodarone Mexiltene/ Magnesium Beta-blocker LAMB: