Heart Sound
Wide splitting: Pulmonary stenosis and RBBB
Fixed Splitting: ASD
Paradoxical Splitting: Aortic Stenosis and LBBB
S3: Dilated ventricles (normal in children and pregnancy, just after S3)
S4: Hypertrophic Cardiomyopathy (always pathological)
Murmurs:
Mitral Regurgitation and VSD: Harsh Holosystolic murmur (radiates to axilla)
Aortic Stenosis: Crescendo-Decresendo systolic murmur that radiates to carotid
Mitral Valve Prolapse: Late Systolic cresendo murmur with midsystolic click
Aortic Regurgitation: High pitched blowing early diastolic murmur (best hear leaning forward)
Mitral Stenosis: Opening Snap Diastolic murmur
PDA: continuous machine like murmur
ECG tracing:
Atrial fibrilation: Irregular irregular or choatic baseline, no P wave
Atrial flutter: too many p waves
Ventricular fibrillation: a completely erratic rhythm with no identifiable wave
ST segment depression: Subendocardial infarct
ST segment elevation: Transmural infarct
Congential heart disease:
Heart shaped boat: Tetralogy of fallot
VSD: most common
ASD: most common in Down syndrome
Patent Ductus Arterious: Differential cyanosis (only in lower extremities)
Coarctation of aorta: notching of ribs, radiofemoral delay
Diabetic mother: Transposition of great vessel
Hypertension related:
Hyaline: Essential HTN or in diabetics
Onion Skinning: severe hypertension
Abdominal aortic aneurysm: in in hypertensive person
Thoracic aortic aneurysm: in syphilitic
Aneurysm great than 5 cm: surgically remove
Aortic dissection: unequal bp in right and left arm and chest pain radiating to back
MI:
Most common artery in MI: LAD
Death within one hour of MI: arrhythmia
Gold standard within 6 hours: ECG
Gold Standard enzyme: Troponin I
For reinfarction: CK-MB
Friction rub within 3 days: Fibrinious pericarditis
Friction rub after 3 week: Dressler syndrome
Cardiomyopathies:
Dilated: most common (most common idiopathic, exam purpose remember chagas)
Hypertrophic: sudden death in athlete
Restrictive: Sacroidosis, amyloidosis
Chronic Heart failure
Systolic failure: Ejection fraction decreases
Diastolic failure: Ejection fraction normal
Infections:
Fever + NEW murmur: Infection endocarditis (IV drug: S. aureus, most common valve: mitral)
Aschoff bodies, Anitschkow cells: Rheumatic fever (JONES criteria, J for joints as in polyarthritis, O make it look like heart {most common cause of death in Rheumatic fever}, N for nodules E for erythmea nodosa, S for syndem chorea)
Cardiac tumor:
Myxoma: most common tumor in adult
Rhabdomyoma: most common tumor in children
REMEMBER THE MOST COMMON TUMOR IN HEART IS METASTATIC
Vasculitis:
Old woman plus pain in jaw plus increase ESR: Temporal arteritis
Pulseless disease (typically they will give 35 year old asian): Takayasu
Polyarteritis nodosa: Infect every vessel other than pulmonary, transmural fibroinoid necrosis
Kawaski: asian kid with rash on palm sole and strawberry tongue
Beuger: Smoking
Wegener: URI, nasal septum perforation plus hematuria, C-ANCA
Microscopic polyangiitis: involves lung and kidney but not upper respiratory tract like Wegener, p-ANCA
Churg-Strauss: Asthma + vasculitis
Henoch Schonlein purpura: most common vasculitidis in children, often follow URI, palpable purpura in buttock, IgA
Treatment of Vasculitis:
Temporal, Takayasua: Corticosteroid
PAN, Wegener, Microscopic polyangitis: Corticosteroid and cyclophosphamide
Kawasaki: Aspirin and IVIG
Buerger: stop smoking
Wide splitting: Pulmonary stenosis and RBBB
Fixed Splitting: ASD
Paradoxical Splitting: Aortic Stenosis and LBBB
S3: Dilated ventricles (normal in children and pregnancy, just after S3)
S4: Hypertrophic Cardiomyopathy (always pathological)
Murmurs:
Mitral Regurgitation and VSD: Harsh Holosystolic murmur (radiates to axilla)
Aortic Stenosis: Crescendo-Decresendo systolic murmur that radiates to carotid
Mitral Valve Prolapse: Late Systolic cresendo murmur with midsystolic click
Aortic Regurgitation: High pitched blowing early diastolic murmur (best hear leaning forward)
Mitral Stenosis: Opening Snap Diastolic murmur
PDA: continuous machine like murmur
ECG tracing:
Atrial fibrilation: Irregular irregular or choatic baseline, no P wave
Atrial flutter: too many p waves
Ventricular fibrillation: a completely erratic rhythm with no identifiable wave
ST segment depression: Subendocardial infarct
ST segment elevation: Transmural infarct
Congential heart disease:
Heart shaped boat: Tetralogy of fallot
VSD: most common
ASD: most common in Down syndrome
Patent Ductus Arterious: Differential cyanosis (only in lower extremities)
Coarctation of aorta: notching of ribs, radiofemoral delay
Diabetic mother: Transposition of great vessel
Hypertension related:
Hyaline: Essential HTN or in diabetics
Onion Skinning: severe hypertension
Abdominal aortic aneurysm: in in hypertensive person
Thoracic aortic aneurysm: in syphilitic
Aneurysm great than 5 cm: surgically remove
Aortic dissection: unequal bp in right and left arm and chest pain radiating to back
MI:
Most common artery in MI: LAD
Death within one hour of MI: arrhythmia
Gold standard within 6 hours: ECG
Gold Standard enzyme: Troponin I
For reinfarction: CK-MB
Friction rub within 3 days: Fibrinious pericarditis
Friction rub after 3 week: Dressler syndrome
Cardiomyopathies:
Dilated: most common (most common idiopathic, exam purpose remember chagas)
Hypertrophic: sudden death in athlete
Restrictive: Sacroidosis, amyloidosis
Chronic Heart failure
Systolic failure: Ejection fraction decreases
Diastolic failure: Ejection fraction normal
Infections:
Fever + NEW murmur: Infection endocarditis (IV drug: S. aureus, most common valve: mitral)
Aschoff bodies, Anitschkow cells: Rheumatic fever (JONES criteria, J for joints as in polyarthritis, O make it look like heart {most common cause of death in Rheumatic fever}, N for nodules E for erythmea nodosa, S for syndem chorea)
Cardiac tumor:
Myxoma: most common tumor in adult
Rhabdomyoma: most common tumor in children
REMEMBER THE MOST COMMON TUMOR IN HEART IS METASTATIC
Vasculitis:
Old woman plus pain in jaw plus increase ESR: Temporal arteritis
Pulseless disease (typically they will give 35 year old asian): Takayasu
Polyarteritis nodosa: Infect every vessel other than pulmonary, transmural fibroinoid necrosis
Kawaski: asian kid with rash on palm sole and strawberry tongue
Beuger: Smoking
Wegener: URI, nasal septum perforation plus hematuria, C-ANCA
Microscopic polyangiitis: involves lung and kidney but not upper respiratory tract like Wegener, p-ANCA
Churg-Strauss: Asthma + vasculitis
Henoch Schonlein purpura: most common vasculitidis in children, often follow URI, palpable purpura in buttock, IgA
Treatment of Vasculitis:
Temporal, Takayasua: Corticosteroid
PAN, Wegener, Microscopic polyangitis: Corticosteroid and cyclophosphamide
Kawasaki: Aspirin and IVIG
Buerger: stop smoking
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