cardiology made easy

Which thrombolytic agent can be given in a single bolus injection? What are its advantages?

2011-07-28T10:53:00.000-07:00

TENECTEPLASE

Advantages
Single IV bolus dose
Fibrin specific
Weight-adjusted dosing
Less bleeding chances
Long half-life
PAI-resistant
Best suited for pre-hospital use

How sensitive is ECG for diagnosis of MI?

2010-12-02T00:16:00.000-08:00

Single 12 lead ECG is 50-70% sensitive.
Serial ECGs >80% sensitive.

Characteristics of normal sinus rhythm?

2010-11-16T06:18:00.000-08:00

P wave of sinus origin
Constant PR interval
Rate between 60-100/min
Constant P wave configuration
Constant PP or RR INTERVAL

What are the common sites of cardiac calcification?

2010-06-03T19:43:00.001-07:00

a LV apex

b LV aneurysm

c Aortic valve

d Mitral valve

e PDA calcification

f Pericardium

g Coronaries

i Conduction system

Name the disease in which grotesque facial features are seen? Enumerate the cardiac conditions associtaed

2010-03-29T10:54:00.000-07:00

HURLER'S SYNDROME
Grotesque facial features - prominent supraorbital ridge, depressed nasal bridge, thick lips, corneal clouding, peg shaped teeth
CARDIAC CONDITIONS ASSOCIATED ARE

CAD
AR
HOCM
Mitral annulus calcification (MR)

What are Brushfield's spots?

2010-03-27T19:35:00.000-07:00

Grayish white spots at the periphery of the iris
It is more clearly seen in dark pigmented iris
Seen in DOWN'S SYNDROME

What are the causes of thrombosis in situ in coronary artery?

2010-03-26T19:28:00.000-07:00

TTP
Polycythemia vera
Sickle cell anemia
Primary thrombocytosis

What are the causes of Precordial tenderness?

2010-03-25T18:03:00.000-07:00

Tietze syndrome
Acute pericarditis
Acute myocarditis

Why is Internal Jugular Vein (IJV) preferred over External Jugular Vein (EJV)?

2010-03-24T17:30:00.000-07:00

IJV is in direct continuation of right atrium
Right atrial pulsation is not transmitted well as there are prominent valves at the proximal EJV
Adjoining structures of neck and upper thorax can cause extrinsic compression of EJV
Increased sympathetic activity can cause vasoconstriction of EJV thus making its pulsation invisible

Why Right internal jugular vein is preferred to left internal jugular vein?

2010-03-23T10:14:00.000-07:00

Right jugular vein and innominate vein extends in a straight line from superior vena cava and right atrium
Left innominate vein into which left internal jugular vein drains does not extend in a straight line from superior vena cava and right atrium
Left innominate vein may be kinked or compressed by dilated aorta or aneurysm or other surrounding structures

When does bruit suggest?

2010-03-12T06:20:00.000-08:00

Bruit suggests partial obstruction of an artery or transmission of a cardiac murmur
Bruit is heard if the obstruction in an artery is equal to or more than 50%
If the obstruction is equal to 80%, a continuous bruit is heard
If obstruction is more than 80%, no bruit heard

How should we record the Blood pressure if the patient has Atrial Fibrillation?

2010-03-10T13:47:00.000-08:00

3-5 recordings are done. It is the mean of 3-5 recordings.
Systolic BP is recorded as the maximum audible sound at a particular level.If the difference between the two recording is less than or equal to 5mm, average of the two recordings are taken.
Beat to beat variation can lead to underestimation of the blood pressure.
Blood pressure recorded after a long cycle can be falsely high.

What is Clindactyly?

2010-03-09T13:15:00.000-08:00

Clindactyly means incurved fingers
Claw like appearance of the hand
Seen in Down's syndrome
Ellis van Creveld syndrome
Hurler's syndrome

What are the techniques to record Blood pressure?

2010-03-08T09:29:00.000-08:00

Palpatory method
Auscultatory method
Flush method
Ultrasound Doppler method
Arterial tonometry/ Oscillometric method
Ambulatory BP monitor(ABPM)

Differential Diagnosis - Upper limb and Lower limb Blood pressure difference

2010-03-07T17:10:00.000-08:00

Coarctation of aorta
Aortic dissection
Aortic arch syndrome
Subclavian steal syndrome
Severe chronic aortic regurgitation
Inaapropriate cuff size for thigh

Difference of more than 20 mmHg Blood pressure is considered significant.

Differential Diagnosis - Upper limb Blood pressure difference

2010-03-06T18:51:00.000-08:00

Aortic Arch Syndrome/ Coarctation of Aorta
Supravalvular aortic stenosis
Subclavian steal syndrome
Scalenus anticus syndrome/ Cervical rib syndrome
Aneurysm of subclavian or innominate artery
Thrombosis of innominate or subclavian artery

A Blood Pressure difference of more than 10 mmHg between the two arms is considered significant.

What is Mean Blood Pressure?

2010-03-04T07:09:00.000-08:00

It is the average blood pressure during a single cardiac cycle.
It can be determined from the formula MAP = (CO X SVR) + CVP where CO is cardiac output, SVR is systemic vascular resistance and CVP is central venous pressure.
At nomal heart rate, it can be estimated as MBP = DBP+ 1/3 PP

(Mean blood pressure = Diastolic blood pressure + 1/3 Pulse pressure,
PP = SBP- DBP)

At higher heart rate, MAP is the arithmetic mean of systolic and diastolic blood pressure
The regional blood flow or the organ perfusion depends on MBP
Normal ranges between 95-100 mmHg.
MAP greater than 60 mmHg is enough to sustain the perfusion of organs

What are Korotkoff sounds? What are its five phases?

2010-03-03T09:37:00.000-08:00

Korotkoff sound represents arterial oscillation resulting from distension of the arterial wall with each cardiac impulse due to partial occlusion of artery by the cuff.
Low pitch sound
Five phases are
PHASE 1 - CLEAR TAPPING SOUND (SBP)
PHASE II - ONSET OF SWISHING SOUND OR SOFT MURMUR
PHASE III- LOUD SLAPPING SOUND
PHASE IV - SUDDEN MUFFLING OF SOUND
PHASE V - DISAPPEARANCE OF SOUND / PHASE OF SILENCE (DBP)
"Tap - Murmur - Slap - Muffle - Silence"
It was described by Nikolai Korotkoff, a Russian surgeon in 1905

What is the average Blood Pressure in children?

2010-03-02T08:51:00.000-08:00

At 1 yr of age , average Systolic Blood Pressure(SBP) is 90mmHg
Every 3 yr , increases by 5 mmHg
At 12 yrs , reaches adult level
Diastolic Blood pressure remains average 60mmHg
Formula to calculate SBP in children

SBP = 90+(AGE X 5)/3

What is Murmur? How does it differ from Heart Sounds?

2010-03-01T10:40:00.000-08:00

Murmur is a latin word
It is defined as a prolonged series of audible signals/ vibrations of varying intensity, frequency, configuration and duration.
Heart sounds results from sudden deceleration of blood.
Murmurs are produced by turbulent blood flow.

What is the meaning of the word " STETHOSCOPE"?

2010-02-28T10:43:00.000-08:00

Stethoscope is derived from greek word stethos meaning " chest" and scope meaning " to view"
It was invented by a French physician Rene' The'ophile Hyacinthe Laennec in 1816

What is Pulse pressure(PP)? What is Proportional pulse pressure(PPP)?

2010-02-26T17:10:00.000-08:00

Pulse pressure = Systolic blood pressure - Diastolic blood pressure( PP= SBP-DBP)
It indicates pulse volume
Average PP is 30- 40 mmhg
Proportional Pulse Pressure = Pulse pressure / Systolic blood pressure(PPP= PP/SBP)
It is an indicator of LV function
If PPP < = 25% , indicates LVF and Cardiac index <= 2.2 l/min/m2

What are Pacemaker sounds?

2010-02-25T08:32:00.000-08:00

High frequency, clicking, pre-systolic sound
Produced by transvenous pacemakers
Due to stimulation of intercostal muscles by the endocardial leads
Timing correlates with pacemaker spike in ECG
Associated with twitching of chest wall muscle - contraction of chest wall muscle following spread of electrical impulse from pacemaker
Diaphragmatic stimulation can also occur
Very loud sound may suggest myocardial perforation

Perception of pulse is by which receptors?

2010-02-24T10:00:00.000-08:00

Tactile receptors - Meissener's corpuscles, Pacinian corpuscles and Merkel's discs
mediate tactile sensation on the finger tips.

Character of pulse depends on what factors?

2010-02-24T09:47:00.000-08:00

Stroke volume
Ejection velocity
Vascular compliance
Systemic vascular resistance

What are the indications of Ambulatory Blood Pressure Monitoring? (ABPM)

2010-02-23T06:40:00.000-08:00

Suspected White coat hypertension
Drug resistant hypertension
Drug induced hypertension
Episodic/Paroxysmal hypertension
Autonomic dysfunction

During sleep BP falls by 10-20%. If it doesnot fall by 10-20% during night, it suggests an increased risk of cardiovascular events

If 24 hrs BP exceeds 135/85 mmHg, the risk of CV events is twice as compared to those with 24hr BP < 135/85

What is Arachnodactyly? What is Metacarpal Index?

2010-02-22T09:42:00.000-08:00

Arachnodactyly ("Spider fingers") means abnormally long and thin fingers compared to the size of the palm
Derived from the Greek word " Arachne" - Spider, "Daktylos" - Finger
Arachne word is derived from Greek mythology where a maiden named Arachne was cursed and turned to a spider by the Greek Goddess Athena, when Arachne a skilled weaver challenged her to a weaving contest
Seen in Marfan's Syndrome, Homocysteinuria
Arachnodactyly is assessed by-

Ratio of Middle finger length to total hand length
METACARPAL INDEX -

FINGER INDEX LENGTH/ WIDTH + MIDDLE L/W + RING L/W + LITTLE L/W DIVIDED BY 4
METACARPAL INDEX > 8.4 SUGGESTS ARACHNODACTYLY

Differential Diagnosis - Hypertelorism?

2010-02-19T11:13:00.000-08:00

Hypertelorism -Wide set eyes ie when distance between two eyes more than the size of one eye

Hurler's Syndrome
Klippel- Feil Syndrome
LEOPARD
Noonan's Syndrome
Turner's Syndrome
William's Syndrome

Cafe eu' lait is seen in?

2010-02-19T10:46:00.000-08:00

Carney complex (LAMB and NAME Syndrome)

LAMB - Lentigines, Atrial Myxoma, Mucocutaneous Myxoma, Blue Naevi
NAME - Naevi, Atrial Myxoma, Myxoid Neurofibroma, Ephelides

LEOPARD - Lentigines, Electrocardiographic Abnormailties, Ocular hypertelorism, Pulmonary stenosis,Abnormal genitalia, Retarded growth, Deafness
Neurofibromatosis

cafe eu lait pics http://www.dermis.net/dermisroot/en/37575/diagnose.htm

Differential Diagnosis - Micrognathia (llar to Hypognathia)

2010-02-19T10:19:00.000-08:00

Pierre Robin Syndrome
Cri Du Chat Syndrome
Fetal Alcohol Syndrome
Rubenstein Tayabi Syndrome
Trisomy 13-18
Treacher Collins Syndrome
Pyknodystosis

Differential Diagnosis - Cardio-Facial Syndrome ?

2010-02-18T07:57:00.000-08:00

CATCH-22
CHARGE
Down's Syndrome
Goldenhar Syndrome(Oculo-auriculo-vertebral dysplasia)
Noonan's Syndrome
Pierre Robin Syndrome
Shprintzen Syndrome
William's Syndrome

Differential Diagnosis - Hypognathia

2010-02-17T11:07:00.000-08:00

Pierre Robin Syndrome
Cri-du chat Syndrome
Fetal Alcohol Syndrome
Rubenstein Taybi Syndrome
Trisomy 13,18
Treacher Collins Syndrome
Pyknodystosis

What is Trepopnea? Why do CCF pt prefer Rt lateral decubitus?

2010-02-16T09:11:00.000-08:00

Trepopnea is dyspnoea in lateral decubitus/position
CCF pts prefer Rt Lateral decubitus -

To avoid unfavourable autonomic modulation during sleep. In Rt lat decubitus, sympathetic nervous modulation is attenuated and parasympathetic is accentuated which helps to improve cardiac output.
Rt sided pleural effusion more common in CCF pts

What are the Shroeder's criteria of successful reperfusion?

2010-02-16T08:49:00.000-08:00

Early T inversion
Reperfusion arrhythmias
Early Q wave
ST resolution >70%

What is Mycotic Aneurysm? Is it caused by Fungal or Bacterial Infection?

2010-02-14T15:26:00.000-08:00

Mycotic Aneurysm is a localized irreversible arterial dilatation due to destruction of vessel wall by infection
Osler coined the term ( to denote appearance like "fresh fungal vegetation" )
Can be Fungal or Bacterial , majority Bacterial
Can be seen in Cerebral or Systemic circulation
Due to occlusion of vasa vasorum by tiny septic emboli

Name Important Cardiac drugs which can cause Hepatitis?

2010-02-12T07:25:00.000-08:00

A2L(all) MY QUeST VaRy

Acebutolol
Amiodarone
Labetolol
MethYldopa
Quinidine
Statins
Verapamil

Granuloma- Clofibrate

Mixed - Captopril

What is Marriot's lead in ECG and what is its importance?

2010-02-11T16:18:00.000-08:00

MCL1 is also known as Marriot's lead

It is the most important lead at the time of uncertainty
Best to assess Atrial activity
Helps in analysis of QRS
Best for analysis of PAT with Block

Refer : Practical Electrocardiography

What is BIX RULE?

2010-02-11T16:11:00.000-08:00

Described by Harold Bix, a Viennese Cardiologist from Baltimore

If 'P' wave is halfway between ventricular complex , additional 'P' wave is most probably hiding 'within' the QRS complex

Seen in PAT with block
refer http://download.journals.elsevierhealth.com/pdfs/journals/0147-9563/PIIS0147956307002166.pdf

Why is Right Ventricle less prone to infarction?

2010-02-10T16:01:00.000-08:00

Lower coronary vascular resistance- high coronary/ RV end diastolic gradient
Contribution from LAD
Collaterals from LMCA more common
Direct perfusion of RV cavity

Mnemonic to remember causes of ACUTE PERICARDITIS

2010-02-10T15:42:00.000-08:00

"TUMOR"
T - Trauma
U- Uremia
M- Myocardial Infarction, Medication
O - Other infections (bacterial, fungal)
R - Rheumatoid Arthritis, Radiation

what is CHADS2 Score? Importance of the score.

2010-02-09T21:02:00.000-08:00

CHADS2 score helps in assessment of risk of STROKE IN AF

Mnemonic stands for
C- CHF (1*)
H- HTN(1*)
A- Age > 35yrs(1*)
D- DM(1*)
S2- H/O Stroke or TIA(2*)

Score >2 (CVA risk >5%) Rx Warfarin
Score >1 (CVA risk >4%) Rx Warfarin or Aspirin
Score 0 Rx Aspirin
* point

Differential Diagnosis of Low pressure TR

2010-02-09T17:58:00.000-08:00

Infective Endocarditis
Ebstein's anomaly
Right venrticular MI
Carcinoid
Tricuspid valve prolapse
Pacemaker
RV Endomyocardial fibrois
Loffler's
RA Myxoma
Trauma

what does ischemia mean?

2010-02-09T13:00:00.000-08:00

Ischemia is derived from ISCHO meaning "to hold back"
HAIMA means "blood"
first used by Rudolf Virchow in 1858