"Do Block AV" D igoxin B -blockers A denosine V erapamil Aortic regurgitation: causes CREAM C ongenital R heumatic damage E ndocarditis A ortic dissection/A ortic root dilation M arfan's Aortic stenosis characteristics SAD S yncope A ngina D yspnoea Apex beat: abnormalities found on palpation HILT H eaving I mpalpable L aterally displaced T hrusting/T apping Apex beat: causes of impalpable apex beat COPD C OPD O besity P leural, P ericardial effusion D extrocardia Apex beat: differential diagnosis for impalpable apex beat DOPES
Anti-arrythmics: for AV nodes
D extrocardia (dont say this first!) O besity P ericarditis/P ericardial tamponade/P neumothorax E mphysema S hock/S inus inversus/S coliosis/S keletal abnormalities (e.g. pectus excavatum) Arrhythmias ARHYTHMIAL 3PC A trial Myxoma R h heart dis HY pertension TH yrotoxicosis M itral valve dis I HD AL cohol P neumonia /PE / Pericardial eff C ardiomyopathy Atrial fibrillation: causes PIRATES P ulmonary: PE, COPD I atrogenic R heumatic heart: mirtral regurgitation A therosclerotic: MI, CAD T hyroid: hyperthyroid E ndocarditis S ick sinus syndrome Atrial fibrillation: causes A SHIT A lcohol S tenosis H ypertension I nfarction/I schemia T hyrotoxicosis Atrial fibrillation: causes
Anti-arrythmics: for AV nodes
ARITHMATIC A lcohol R h fever I HD T hyrotoxicosis H ypertension M itral stenosis/M I /M yxoma (atrial) A SD T oxins I diopathic/I nfective endocarditis C ardiomyopathy/Constrictive pericarditis Atrial fibrillation: management ABCD A nti-coagulate B eta-blocker to control rate C ardiovert D igoxin Atropine use: tachycardia or bradycardia "A goes with B" Atropine is used clinically to treat Bradycardia Beck's triad (cardiac tamponade) 3Ds D istant heart sounds D istended jugular veins D ecreased arterial pressure Beta-blockers: cardioselective beta-blockers "Beta-blockers Acting Exclusively At Myocardium" B etaxolol A cebutelol E smolol A tenolol M etoprolol Beta receptor activity "1 heart, 2 lungs"
Anti-arrythmics: for AV nodes
Beta-1 receptors are primarily on the heart, and the airway is Beta-2 receptors Bradycardia: regular PAD HIM P hysiological (athlete, sleep) /p aroxysmal A V block (2II, 3) D rugs (beta, dig, amiodarone) H ypothyroid /h ypothermia I cteric (severe) MI Congestive heart failure: causes of exacerbation FAILURE F orgot medication A rrhythmia/A naemia I schemia/I nfarction/I nfection L ifestyle: taking too much salt U pregulation of CO: pregnancy, hyperthyroidism R enal failure E mbolism: pulmonary Coronary artery bypass graft: indications DUST D epressed ventricular function U nstable angina S tenosis of the left main stem T riple vessel disease Coronary artery disease: risk factors HOPEFULSSS H TN O besity P VD E levated LDL F MH U p glucose - DM L ow HDL
Anti-arrythmics: for AV nodes
S moking S ex - male S edentary life style Cyanotic heart diseases 1-2-3-4-5-T's Truncus Arteriosus (1 vessel) Transposition of the 2 great vessels Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return (has 5 words) ECG: causes of ST-segment depression DEPRESSED ST D rooping valve (MVP) E nlargement of LV with strain P otassium loss (hypokalemia) R eciprocal ST-depression (in I/W AMI) E mbolism in lungs (pulmonary embolism) S ubendocardial ischemia S ubendocardial infarct E ncephalon haemorrhage (intracranial haemorrhage) D ilated cardiomyopathy S hock T oxicity 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 I schemia N ormality [esp. young, black] V entricular hypertrophy
Anti-arrythmics: for AV nodes
E ctopic foci [eg calcified plaques] R BBB, LBBB T reatments [digoxin] ECG: dominant R wave in V1 WORD W PW O ld MI R BBB D extrocardia ECG: ST elevation ELEVATION E lectrolytes L BBB (Left Bundle Branch Block) E arly Repolarization V entricular hypertrophy A neurysm T reatment (eg pacemaker, pericardiocentesis) I njury (AMI, contusion) O sborne waves (hypothermia) N on-occlusive vasospasm (prinzmetals) ECG: pulseless electrical activity causes PATCH MED P ulmonary embolus A cidosis T ension pneumothorax C ardiac tamponade H ypokalemia/H yperkalemia/H ypoxia/H ypothermia/H ypovolemia M yocardial infarction E lectrolyte derangements D rugs ECG: exercise ramp contraindications RAMP R ecent MI
Anti-arrythmics: for AV nodes
A ortic stenosis M I in the last 7 days P ulmonary hypertension EMD arrest 4Hs 4Ts H ypothermia H ypo & hyper-electrolytes H ypovolaemia H ypoxia T oxic (including drugs) T rauma T amponade T ension pneumothorax Heart compensatory mechanisms that "save" organ blood flow during shock "Heart SAVER" S ymphatoadrenal system A trial natriuretic factor V asopressin E ndogenous digitalis-like factor R enin-angiotensin-aldosterone system Heart sounds: 3rd heart sound FIPPY F ailure I ncompetence (mitral/tricuspid) P regnancy/Pill P E/Pericarditis Y outh Heart sounds: 4th heart sound SHIT S tenosis (aortic/pulmonary) H ypertension/Heart Block I schaemic HD T amponade
Anti-arrythmics: for AV nodes
Heart valves LAB RAT Left Atrium: Bicuspid Right Atrium:Tricuspid In case of high LDL STArT with STATins JVP: wave form ASK ME A trial contraction S ystole (ventricular contraction) K losure (closure) of tricusps, so atrial filling M aximal atrial filling E mptying of atrium JVP: characteristics of MOP HAIR M ultiple wave form O ccludable P ostural changes H epatojugular reflex A bove (fills from) I mpalpable R espiratory changes LVF: management FOAM F rusemide 40mg iv O xygen A trovent (& Ventolin) nebs M orphine 2.5 5 mg Mitral stenosis: complications PASTRI P ulm BP up A fib S ystemic embolism T ricuspid regurg
Anti-arrythmics: for AV nodes
R ight heart failure I nfective endocarditis Mitral stenosis (MS) vs. mitral 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") I ntensity L ocation P itch Q uality R adiation S hape T iming Murmurs: questions to ask SCRIPT S ite C haracter (e.g. harsh, soft, blowing) R adiation I ntensity P itch T iming Myocardial infarction: complications ABCDE x2 A rrhythmias/A neurysm B radycardia/BP lower C ardiac failure/C ardiac tamponade D resslers /D eath E mbolism /E xtra (VSD, pap muscle rupture) Myocardial infarction: treatment INFARCTIONS I V access N arcotic analgesics (e.g. morphine, pethidine)
Anti-arrythmics: for AV nodes
F acilities for defibrillation (DF) A spirin/A nticoagulant (heparin) R est C onverting enzyme inhibitor T hrombolysis I V beta-blocker O xygen 60% N itrates S tool softeners Myocardial infarction: basic management BOOMAR B ed rest O xygen O piate M onitor A nticoagulate R educe clot size Myocardial infarction: symptoms PULSE P ersistant chest pain U pset stomach L ightheadedness S hortness of breath E xcessive sweating Myocardial infarction: treatment of acute MI COAG C yclomorph O xygen A spirin G lycerol trinitrate Myocardial infarction: therapeutic treatment ROAMBAL R eassure
Anti-arrythmics: for AV nodes
O xygen A spirin M orphine (diamorphine) B eta blocker A rthroplasty L ignocaine Occlusive arterial disease 6Ps P ain P allor P ulseless P arasthesia P aralysis P erishing with cold Pericarditis DRUMSTICX D resslers R h fever /R A U raemia MI S LE T rauma I diopathic C oxsackie X ray Postural hypotension HANDI H ypovolaemia / hypopituitarism A ddisons N europathy (autonomic) D rugs (vasodilators / TCADs, diuretics, antipsychotics) I diopathic Rheumatic fever: Jones major criteria
Anti-arrythmics: for AV nodes
CASES C arditis A rthritis (migratory) S ubcut nodules E rythema marginatum S yndenhams chorea Rheumatic fever: Jones major criteria JONES J oints (migrating polyarthritis) O bvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits) N odes (subcutaneous nodules) E rythema marginatum S ydenham's chorea Rheumatic fever: Jones minor criteria 4PA P yrexia P rolonged PR P ast Hx P ositive (ie ?)ESR/CRP A rthralgia Rheumatic fever: Jones minor criteria CAFE PAL C RP increased A rthralgia F ever E levated ESR P rolonged PR interval A namnesis of rheumatism L eucocytosis Splinter haemorrhages TRIP SAM T rauma RA
Anti-arrythmics: for AV nodes
I nfective Endo P AN S LE / Sepsis A naemia (profound) M alignancy (haematological) Supraventricular tachycardia: causes SNAP S inus tachy N odal tachy A fib P aroxysmal atrial tachy Supraventricular tachycardia: treatment ABCDE A denosine B eta-blocker C alcium channel antagonist D igoxin E xcitation (vagal stimulation) Ventricular tachycardia: treatment LAMB L idocaine A miodarone M exiltene/ Magnesium B eta-blocker Secondary Causes of Hypertension (courtesy of Brian Dalton) TRACKPADS T hyroid disease (hyper-) R enovascular disease (renal artery stenosis) A orta, coarctation of C ushing syndrome K idney disease, chronic P heochromocytoma A ldosteronism (hyper-)
Anti-arrythmics: for AV nodes
D rugs (e.g. oral contraceptives, decongestants, NSAIDS) S leep apnea