Normal

Arterial Pulse
Anacrotic
Dicrotic
Bisferiens
Paradoxus
Alternans
AP deficit
Delays- RR or RF
 Blood Pressure
Diagnosis
JNC VII
White coat HTN
Masked HTN
Hypertensive crisis
Differential BP
ABI
Hill’s sign
 JVP
Significance
Waveforms
Abnormal JVP
HJR
Kussmaul’s sign
 Heart Sounds
• S1
• S2
• S3
• S4
• OS
• Pericardial knock
• Murmurs- PSM, Early systolic murmurs, Mid
systolic murmurs, EDM, Continuous murmurs
• Dynamic Auscultation
-Respiration – Caravallo’s sign
-Valsalva
-Standing
-Squatting
-Isometric handgrip
• Specific signs- gallavardin phenomenon
 ECG
• Chamber enlargement
• Axis
• Heart blocks- I,II,III,LAHB,LPHB, BBB
Alternating,Bifasicular,Trifasicular
• Localisation of Myocardial infarction
• Electrical alternans
• Repolarisation alternans
• Digitalis effect & toxicity
• Juvenile Pattern and CVA-T pattern
 ECG
ST segment elevation is seen in all
except?
1) Hypercalcemia
2) Hypothermia
3) Hyperkalemia
4) Hypokalemia
 ECG
All are the ECG patterns seen in CRF
except?
1) Tall peaked P waves
2) Short QT interval
3) LVH
4) ST segment depression
 Echocardiography
• Ultrasonic waves
• Doppler Shift
• Bernoulli’s equation
• Role of TEE
• Contrast Echo
• 3 D Echo
• Dobutamine Stress test
• CT Coronary Angiogram
• Coronary angiogram
• PET scan
• SPECT scan
• MRI
• Head Up tilt test
 Ischemic Heart Disease
• Risk factors
• CSA
• ACS- NSTEMI/UA
- MI
• Complications of MI
• Revascularistaion
• Concept of stunning and hibernation
All but one of the following regarding CAD in
women is not true
1)DM & HTN are more common than in men
2)Women are approx 10 yrs older than men when
symptoms develop
3)Post menopausal HRT may increase ischemic
events
4)Aspirin fails to reduce MI risk in women with CAD
5)Sudden death is less common in women than men
The vulnerability of a 50-95% diameter narrowing
coronary stenosis to rupture is least likely to be
affected by which of the following factors?
1) Plaque cap thickness
2) Plaque foam cell & T lymphocyte count
3) Angiographic stenosis severity
4) Plaque eccentricity
5) Angiographic stenosis ‘complexity’
Which statement regarding revascularisation in in CS is
untrue?
1)The mortality benefit for adjunctive IABP support is
proven
2)The window for benefit with revascularisation extends
beyond the traditional reperfusion time window
3)The benefit for revascularisation is seen for both with
direct and transfer in patients
4)Observed mortality with CS appears to have declined
overtime
Which statement regarding revascularisation in in CS
is untrue?
1)The benefits of revascularisation in CS are similar
to benefits of CABG for left main disease at 1 yr
2)Most survivors of CS are in NYHA I/II at 1 yr
3)Although short term mortality benefit is proven,
there is no long term mortality benefit
4)Revascularisation in the setting of CS is a Class I
indication
Which of the following set of findings are
most consistent with a patient in
predominant LVCS?
1) CI 3.2; PCWP 18, SVR 1400,LVEF 58%
2) CI 2; PCWP 25, SVR 1350,LVEF 33%
3) CI 1.6; PCWP 12, SVR 1600,LVEF 58%
4) CI 2; PCWP 27, SVR 2000,LVEF 25%
Which of the following statements about PMR are
true?
1)Anterolateral PM is more vulnerable because it is
involved in anterior myocardial infarcts
2)Posteromedial PM is more vulnerable
3)The vulnerability of the PM is determined by the
dominance of the coronary circulation
4) The vulnerability of the PM to rupture is
determined by its anatomy
 SVT
• Afib
• Aflutter
• AT
• AVRT
• AV NRT
• SNRT
 WCT- 120 msec with Rate >100/min
• Tachycardia originating in a ventricle- VT
• Tachycardia originating above the ventricle with abnormal
ventricular activation (BBB/AP)
-BBB, AP, IVCD, dyselectrolytemia
• Ventricular paced rhythm
• Recording artifact
• FBI
• Torsades
• Bidirectional VT
 ECG criteria
• Tachycardia rate
• Regularity
• QRS duration
• QRS axis
• Capture beats and fusion beats
• AV dissociation
• QRS precordial concordance
• Absence of precordial RS pattern
• QRS morphology criteria
 Cycle lengths Vs rates
• CL (msec) = 60000/rate (bpm)
• 60 bpm = 1000 msec
• 100 bpm = 600 msec
• 120 bpm = 500 msec
• 150 bpm = 400 msec
• 200 bpm = 300 msec
55/m h/o CAD with LVEF of 50% presents with
recurrent episodes of symptomatic afib. A rate
control strategy is pursued but the patient remains
symptomatic. Which rhythm control strategy would
you opt for?
1) Amiodarone
2) Sotalol
3) Flecanide
4) Quinidine
5) Disopiramide
45 yr/f with recent IWMI and LVEF of 45%. Presents with
recurrent intermittent palpitations. Holter shows 200
VPCs over 24 hrs but no VT. Rx on beta blocker and ACE.
She is nervous about VPCs and is aware about the
increased risk of sudden death in patients with frequent
VPCs who are post MI. What is your mgmt?
1)Amiodarone
2)EP study & implant an ICD if she has inducible VT
3)Flecanide
4)Consider adding aspirin and statin
 Catheter ablation
• DC energy- 1st used by Scheinman in 1980
• RF energy- 300-3000 kHz, 55 degrees, 40 sec
• Cryoenergy
• Microwaves- 915 to 2450 MHz

• Current day indication

 Heart failure
• Left or Right or both
• Systolic and Diastolic -> Dyspnoea
• LV remodeling
• BNP and NT pro BNP
• Stages AHA/ACC
• Acute HF- Profile A/L/B/C
A- warm and dry B- warm and wet
L- cold and dry C- cold and wet
 Heart Failure
• Treatment-
ACEi, ARB, BB, Ald antagonists,
Isosorbide + Hydralazine, Digoxin,
CRT, Nesiritide, Vaptans.
• IABP
• LVAD
• Cardiac transplant
• What is SCD? SCD
• Magnitude of SCD
• Etiology < 35 & > 35
• Substrates- electrical/anatomical
• Markers- HRV, SAECG, QTV, TWA
• Long QT syndromes
• Short QT syndrome
• Brugada Syndrome
• WPW syndrome (with Afib)
• Commotio cordis
Which medicine is least associated
with acquired long QT?
1) Lignocaine
2) Quinidine
3) Sotalol
4) Dofetilide
 CHD
• Acyanotic- ASD, VSD, PDA, AP window
• Cyanotic - Decreased Pulmonary blood flow
• Cyanotic - Increased Pulmonary blood flow
• Cyanotic - Normal Pulmonary blood flow
• Others - LVOTO- valvular, sub & supra valvular
- Coronary cameral fistula, ALCAPPA
- COA, PS
- HCM
 Valvular Heart disease
• Rheumatic – most common
• MVP
• Prosthetic valves - Mechanical
- Bioprosthetic
 Cardiomyopathy
• DCM- Idiopathic
- Ischemic
- Toxins & Drugs
- Misc (Takotsubo, Peripartum, Reversible)
• HCM
• ARVD
• LVNC
• RCM including EMF, Carcinoid
• Beriberi, selenium deficiency
 Myocarditis
• Viral
• Parasitic
• Bacterial
Pericardium
• Acute, sub acute
• Chronic CP
• Effusive constrictive
• Pericardial effusion and tamponade
• Screening
Dyslipidemia
• Metabolic syndrome
Risk Category Goal Initiate TLC Consider Rx
High <100 >100 >130
(CHD/CHD eq)
>130
2+ risk factors <130 >130
>160
0-1 risk
<160 >160 >190
factors