> Aspirin: Adverse effects ASPIRIN
Asthma, Salicylism, Peptic ulcer / Premature closure of PDA, Intestinal blood loss, Reye's syndrome, Idiosyncracy ,Noise (tinnitus)
> Aortic root dilatation: causes ADAMS
Aneurysm, Dissection, Ankylosing spondylitis, Marfan's syndrome, Syphilis
> Vitelline duct: Time of closure VItelline
The VItelline duct usually closes around week VI of intrauterine life.
> LVF, Management of FOAM
Frusemide 40mg iv, Oxygen, Atrovent (& Ventolin) nebs, Morphine 2.5 - 5 mg
> Mitral Stenosis, Complications PASTRI
Pulm ↑BP, A fib, Systemic embolism, Tricuspid regurg, Right heart failure, Infective
endocarditis
> Myocardial infarct, complications ABCDE x2
Arrhythmias / Aneurysm
Bradycardia / ↓BP
Cardiac failure / cardiac tamponade
Dresslers / Death!
Embolism / Extra (VSD, pap muscle rupture)
> Pericarditis DRUMSTICX
Dresslers, Rh fever / RA, Uraemia, MI, SLE, Trauma, Idiopathic, Coxsackie, X-ray
> Postural Hypotension HANDI
Hypovolaemia / hypopituitarism, Addisons, Neuropathy (autonomic), Drugs (vasodilators /
TCADs, diuretics, antipsychotics), Idiopathic
> Rheumatic fever:
Major criteria CASES
Carditis, Arthritis (migratory), Subcut nodules, Erythema marginatum, Syndenhams chorea
Minor criteria 4PA
Pyrexia, prolonged PR, past Hx, positive (ie ↑)ESR/CRP, Arthralgia
> Occlusive arterial disease 6Ps
Pain, pallor, pulseless, parasthesia, paralysis, perishing with cold
> Splinter haemorrhages TRIP SAM
Trauma, RA, Infective Endo, PAN
SLE / Sepsis, Anaemia (profound), Malignancy (haematological)
> ST elevation ELEVATION
Electrolytes, LBBB, Early Repolarization, Ventricular hypertrophy, Aneurysm, Treatment (eg
pericardiocentesis), Injury (AMI, contusion), Osborne waves (hypothermia), Non-occlusive
vasospasm (prinzmetal’s)
> SVT Causes SNAP
Sinus tachy, nodal tachy, a fib, paroxysmal atrial tachy
> Symptoms of aortic stenosis ASD
Angina 2 years }
Syncope 1 year } prognosis
Dyspnoea 6/12 }
> No apex beat DOPES
Dextrocardia (don’t say this first!), Obesity, Pleural/Pericardial effusion, Emphysema, Shock.
> 3rd Heart Sound FIPPY
Failure, Incompetence (mitral/tricuspid), Pregnancy/Pill/PE/Pericarditis, Youth
> 4th Heart Sound SHIT
Stenosis (aortic/pulmonary), Hypertension/Heart Block, Ischaemic HD, Tamponade
> Arrhythmias ARHYTHMIAL 4PC
Atrial Myxoma, Rh heart dis, HYpertension, THyrotoxicosis, Mitral valve dis, IHD,
ALcohol
Pneumonia / PE / Pericardial eff, cardiomyopathy
> Atrial Fibrillation ARITHMATIC
Alcohol, Rh fever, IHD, Thyrotoxicosis, Hypertension, Mitral stenosis / MI / Myxoma
(atrial)
ASD, Toxins, Idiopathic/Infective endocarditis Cardiomyopathy/Constrictive pericarditis
> Bradycardia, regular PAD HIM
Physiological (athlete, sleep) / paroxysmal, AV block (2°II, 3°), Drugs (β, dig, amiodarone) Hypothyroid / hypothermia, Icteric (severe), MI
> Dominant R wave in V1 WORD
WPW, Old MI, RBBB, Dextrocardia
> EMD Arrest 4Hs 4Ts
Hypothermia, Hypo & hyper-electrolytes, Hypovolaemia, Hypoxia
Toxic (including drugs), Trauma, Tamponade, Tension pneumothorax
> JVP MOP HAIR
Multiple wave form, Occludable, Postural changes
Hepatojugular reflex, Above (fills from), Impalpable, Respiratory changes
> Non-pitting lower limb oedema MI CHAM
Milroys, infection (filariasis), Congenital, Hypothyroid, Allergy, Malignancy
> Shock HEN SCAM
Hypovolaemia, Endocrine (adrenal, thyroid), Neuropathic (autonomic)
Spinal cord injury/ Sepsis, Cardiac, anapyhlaxis/ anaesthesia, anti HPT, Massive PE
> ABCDE
Treatment of Heart Failure:
ACE inhibitors; Beta-blockers; Calcium channel blockers; Diuretics; Endothelin-converting enzyme inhibitors
> All Prostitutes Take Money
The order of resuscitation for heart sounds from right to left:
Aortic, Pulmonary, Tricuspid, Mitra
> BOOMAR
Basic MI management – Bed rest, Oxygen, Opiate, Monitoring, Anticoagulation, Reduce clot size
> CHIPCHANGE
The many unwanted affects of amiodarone: Cutaneous photosensitivity, Hepatic dysfunction, Increases LDL,Pulmonary fibrosis, CNS effects, Hyper/hypothyroidism, Asymptomatic corneal deposits, peripheral Neuropathy, GI dysfunction, Enhances the effects of warfarin/digoxin
> DOLMA
Lines of treatment of pulmonary oedema:
Digoxin, Oxygen, Lasix, Morfine, Aminophylline. (Dolma is a very famous food in the middle east.)
> M.O.N.A
"MONA" treatment for acute MI.
Morphine, Oxygen, Nitrate, Aspirin
> Please Read His Text
Signs of cor pulmonale:
Peripheral oedema, Raised JVP, Hepatomegaly, Tricuspid incompetence
> Mitral regurgitation When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".
> Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).
> Supraventricular tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)
> Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker
> Rheumatic fever: Revised Jones criteria JONES PEACE:
· Major criteria:
Joints: migratory
O (heart shaped) Carditis: new onset murmur
Nodules, subcutaneous: extensor surfaces
Erythema marginatum
Sydenham's chorea
· Minor criteria:
PR interval, prolonged
ESR elevated
Arthralgias
CRP elevated
Elevated temperature (fever)
· Need 2 major or 1 major and 2 minor criteria, plus evidence of recent GAS infection (throat cx, rapid antigen test, or rising strep antibody titer).
> Pulseless electrical activity: causes PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs
> Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes
> Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leucocytosis
> JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
> Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
> Exercise ramp ECG: contraindications RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension
> ECG: T wave inversion causes INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]
> Rheumatic fever: Jones major criteria JONES:
Joints (migrating polyarthritis)
Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)
Nodes (subcutaneous nodules)
Erythema marginatum
Sydenham's chorea
> Myocardial infarctions: treatment INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners
> Atrial fibrillation: causes PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome
> Atrial fibrillation: management ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin
> Anti-arrythmics: for AV nodes "Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil
> Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis
> Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Sinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)
> Rheumatic fever: Jones 5 major criteria STREP:
Sydenhams chorea
Transient migratory arthritis
Rheumatic subcutaneous nodules
Erythema marginatum
Pancarditis (endocarditis, myocarditis, pericarditis)
· STREP, since Rheumatic fever is caused by group A strep.
> Sinus tachycardia TACH FEVER:
Tamponade/ Thyrotoxicosis
Anemia
CHF
Hypotension
Fever
Excrutiating pain
Volume depletion
Exercise
Rx (Theo, Dopa, Epi, etc)
> CHF: causes of exacerbation A SMITH PEAR:
Anemia
Salt/ Stress/ Stopping meds
MI
Infection/ Ischemia
Thyroid (high/low)
HTN
Pericarditis
Endocarditis (valve disease)
Arrhythmia
Rx (beta blocker, etc)
> Murmurs: louder with inspiration vs expiration LEft sided murmurs louder with Expiration
RIght sided murmurs louder with Inspiration.
> Murmurs: questions to ask SCRIPT:
Site
Character (eg harsh, soft, blowing)
Radiation
Intensity
Pitch
Timing
> Aortic regurgitation: causes CREAM:
Congenital
Rheumatic damage
Endocarditis
Aortic dissection/ Aortic root dilatation
Marfan's
> Heart failure: signs TAPED TORCH:
Tachycardia
Ascites
Pulsus alternans
Elevated jugular venous pressure
Displaced apex beat
Third heart sound
Oedema
Right ventricular heave
Crepitations or wheeze
Hepatomegaly (tender)
> Pericarditis: causes PR DIP, ST UP:
Post-pericardiectomy
Rheumatic fever
Drugs (eg isoniazid, hydralazine, procainalmide)
Infection (eg TB, coxsackie, strep)
PE
SLE/Scleroderma
Tumours/ Thyroid disease
Uraemia
Post MI (includes Dressler's)
> Aortic dissection: risk factors ABC:
Atherosclerosis/ Ageing/ Aortic aneurysm
Blood pressure high/ Baby (pregnancy)
Connective tissue disorders (eg Marfan's, Ehlers-Danlos)/ Cystic medial necrosis
> CHF: Left-sided systolic failure signs and symptoms "Left Systolic Failure Can Have Dialated Heart CauseOf Pulmpnary Backflow":
Loss of hair on legs
Skin cold and clammy
Fatigue
Crackles
High heart rate
Dyspnea
HTN
Cyanosis
Orthopnea
Pink Sputum
> Acute Coronary Syndrome: initial treatment ABCD:
Aspirin
Beta blocker
Coagulation (anticoagulation with heparin/LMW Heparin)
Double product control (decrease heart rate and blood pressure)
> Heart failure: causes HEART FAILED:
Hypertension
Endocrine
Anemia
Rheumatic heart disease
Toxins
Failure to take meds
Arrythmia
Infection
Lung (PE, pneumonia)
Electrolytes
Diet
> EKG: 12 lead EKG quick interpretation of V1-V6 SSAALL:
· Elevations matched with their classic location of MI:
V1 Septal
V2 Septal
V3 Anterior
V4 Anterior
V5 Lateral
V6 Lateral
> Aortic regurgitation: causes MARRIS:
Marfans
Ankylosing spondylitis
Rheumatic fever
Rheumatoid arthritis
Infective endocarditis
Syphilis
> Cardiomyopathy: categories Cardiomyopathy is HARD:
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Restrictive cardiomyopathy
Dilated cardiomyopathy
> Murmurs: innocent murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression
> Murmur attributes "IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
> Murmurs: locations and descriptions "MRS A$$":
MRS: Mitral Regurgitation--Systolic
A$$: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.
> Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
> Apex beat: abnormalities found on palpation, causes of impalpable HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia
> MI: treatment of acute MI COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate
> Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
> Peripheral vascular insufficiency: inspection criteria SICVD:
Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair
> Rheumatic fever: Revised Jones' criteria JONES crITERIA:
· Major criteria:
Joint (arthritis)
Obvious (Cardiac)
Nodule (Rheumatic)
Erythema marginatum
Sydenham chorea
· Minor criteria:
Inflammatory cells (leukocytosis)
Temperature (fever)
ESR/CRP elevated
Raised PR interval
Itself (previous Hx of Rheumatic fever)
Arthralgia
> Heart murmurs "hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic
> MI: therapeutic treatment ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine
> CHF: causes of exacerbation FAILURE:
Forgot medication
Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary
> Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.
> Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden.
> MI: therapeutic treatment "O BATMAN!":
Oxygen
Beta blocker
ASA
Thrombolytics (eg heparin)
Morphine
Ace prn
Nitroglycerin
> Mitral stenosis (MS) vs. 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.
> Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation.
> Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase
> MI: therapeutic treatment MONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
> Depressed ST-segment: causes DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine
> Aortic stenosis characteristics SAD:
Syncope
Angina
Dyspnoea
> MI: basic management BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size
> 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.
> Pericarditis: causes CARDIAC RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome
> Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].
> MI: signs and symptoms PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating
> Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
· In all 5, system is activated/factor is released
> Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.
> ST elevation causes in ECG ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm
> Beck's triad (cardiac tamponade) 3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
> Abdominal aortic aneurysm: genetic component AAA (3 A's) is sometimes due to a defect in the gene encoding for type III procollagen.
> Varicose veins: symptoms AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)
> White toe (arterial insufficiency toe) 5 P's:
Pale coloration
Pain (excruciating)
Paresthesia
Pulselessness
Warm compression and vasodilatory Patch to Proximal area
> Blue toe (microembolic toe) CAVEMAN:
Cholesterol embolizations
Atrial fib with electricity or digitoxin
Valvular problems
Endocarditis
Mural thrimbosis
Aneurysm/ AV fistula
Nothing
> Peripheral vascular diseases ABCDEF:
Atherosclerosis.
Buerger's disease (TAO)
Cyanosis/ Cold agglutinin/ Connective tissue disease (Raynaud's phenomenon)
Deep vein phlebothrombosis
Embolism
inFlammation of veins
> TIA: internal carotid vs. vertebrobasilar MD vs. DPM
· Internal carotid:
Monocular blindness (amaurox fugax)
Dominant hemisphere (apahsia)
· The weakness or numbness is still less in the legs.
· Vetebrobasilar:
Diplopia/ Double blindness
Paralysis (quadriplesia)
Motor weakness (ipsilateral)
· Ataxia is characteristic in veterbrobasilar lesions.
> PGI2 vs. TxA2 coagulation function TxA2 Aggregates platelets.
PGI2 Inhibits aggregation.
· Note: full name of PGI2 is prostaglandin I2 or prostacyclin, full name of TxA2 is thromboxane A2.
> Einthoven's Triangle: organization Corners are at RA (right arm), LA (left arm), LL (left leg).
Number of L's at a corner tell how many + signs are at that corner [eg LL is ++].
Sum of number of L's of any 2 corners tells the name of the lead [eg LL-LA is lead III].
For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.
> Heart: -tropic definitions Lusitropic: loose is relaxed. Definition: relax heart.
Inotropic: when heart wall contracts, moves inward. Definition: contract heart.
Chronotropic: 'chrono-' means 'time'. Defintion: heart rate (of SA node impulses).
Dromotropic: only one left, it must be conduction speed by default.
> Heart valves: sequence of flow TRIPS BIAS:
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar
Alternatively: "TRIPS, MI ASs!" (uses MItral instead of BIcuspid)
> Intrinsic vs. extrinsic pathway tests "PeT PiTTbull":
PeT: PT is for extrinsic pathway.
PiTTbull: PTT is for intrinsic pathway.
> Carotid sinus vs. carotid body function carotid SinuS: measures preSSure.
carotid bO2dy measures O2.
> Hemoglobin and myoglobin: binding strengths, sites "ABC" of glycosylated Hb (Hb1c):
· Glucose binds to Amino terminal of Beta Chain.
"HbF binds Forcefully":
· HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left.
Stored blood is SOS:
· Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG.
2,3 BPG binding site is BBC:
· BPG binds to Beta Chain of Hb.
Myoglobin binding strength is MOM:
· Myoglobin binds Oxygen More strongly than Hb.
> Hb-oxygen dissociation curve shifts: effect, location Left shift: causes Loading of O2 in Lungs.
Right shift: causes Release of O2 from Hb.
> Heart electrical conduction pathway "If patient's family are all having Heart attacks, you must SAVe HIS KIN!"
SA node --->
AV node --->
His (bundle of) -->
PurKINje fibers
> Heart valves: closure sequence "Many Things Are Possible":
Mitral, Tricuspid, Aortic, Pulmonic
> Fluid compartments: volumes 12345:
12 liters of interstitial fluid
3 liters plasma volume and 30 liters inside cells
45 liters total body water
> Heart valves: placement of valves on standard heart anterior view "Try before you Buy": When read across the page, the tricuspid valve comes before the bicuspid valve.
Also, the lunar valves are near the top (in the sky), like the moon.
> Propranolol and related '-olol' drugs: usage "olol" is just two backwards lower case b's.
Backward b's stand for "beta blocker".
· Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol.
> Warfarin: action, monitoring WePT:
Warfarin works on the extrinsic pathway and is monitored by PT.
> Beta-blockers: side effects "BBC Loses Viewers In Rochedale":
Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia
> Captopril (an ACE inhibitor): side effects CAPTOPRIL:
Cough
Angioedema/ Agranulocystosis
Proteinuria/ Potassium excess
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
Renal failure (and renal artery stenosis contraindication)/ Rash
Indomethacin inhibition
Leukopenia/ Liver toxicity
> Beta-blockers: main contraindications, cautions ABCDE:
Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)
> Ca++ channel blockers: uses CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes
> Warfarin: metabolism SLOW:
· Has a slow onset of action.
· A quicK Vitamin K antagonist, though.
Small lipid-soluble molecule
Liver: site of action
Oral route of administration.
Warfarin
> Amiodarone: action, side effects 6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism
> Patent ductus arteriosus: treatment "Come In and Close the door":
INdomethacin is used to Close PDA.
> Hypertension: treatment ABCD:
ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also)
Beta blockers
Calcium antagonists
Diuretics (sometimes vasoDilators also)
> Clopidogrel: use CLOPIdogrel is a drug that prevents
CLots, an Oral Platelet Inhibitor (OPI).
> Beta blockers with intrinsic sympathomimetic activity Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels.
Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some diabetics or asthmatics despite the fact that they are non-seletive beta blockers.
> Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factorXa.
Monitor Xa concentration, rather than APTT.
> Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem" (because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol
> Thrombolytic agents USA:
Urokinase
Streptokinase
Alteplase (tPA)
> Antiarrhythmics: classification I to IV MBA College
· In order of class I to IV:
Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers
> HMG-CoA reductase inhibitors (statins): side effects, contraindications, interactions HMG-CoA:
· Side effects:
Hepatotoxicity
Myositis [aka rhabdomyolysis]
· Contraindications:
Girl during pregnancy/ Growing children
· Interactions:
Coumarin/ Cyclosporine
> Antiarrhythmics: class III members BIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol
> Adrenoceptors: vasomotor function of alpha vs. beta ABCD:
Alpha = Constrict.
Beta = Dilate.
> Beta blockers: B1 selective vs. B1-B2 non-selective A through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol.
O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol.
> Beta blockers: members "The NEPAL Prime Minister":
Timolol
Nadolol
Esmolol
Pindolol
Atenolol
Labetalol
Propranolol
Metoprolol
> Thalidomide: effect on cancer cells "Thalidomide makes the blood vessels hide":
Use thalidomide to stop cancer cells from growing new blood vessels.
> Patent ductus arteriosus: which prostaglandin keeps it open kEEp opEn with prostaglandin E.
> Cyanotic heart diseases: 5 types · Use your five fingers:
1 finger up: Truncus Arteriosus (1 vessel)
2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed)
3 fingers up: Tricuspid Atresia (3=Tri)
4 fingers up: Tetralogy of Fallot (4=Tetra)
5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)
> Cyanotic congenital heart diseases 5 T's:
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return
> Hemolytic-Uremic Syndrome (HUS): components "Remember to decrease the RATE of IV fluids in these patients":
Renal failure
Anemia (microangiopathic, hemolytic)
Thrombocytopenia
Encephalopathy (TTP)
> Cyanotic heart diseases: 5 types · 5 T's:
Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
Tricuspid atresia, pulmonary aTresia
Total anomalous pulmonary venous drainage
> APGAR score components · Five B's:
Breathing (respiratory effort)
Beating (heart rate)
Buff (tone)
Bothered (response to stimulation)
Blue (cyanosis)
> Takayasu's disease is Pulseless disease "Can't Tak'a ya pulse" (Can't take your pulse):
Takayasu's disease known as Pulseless disease, since pulse is weakened in the upper extremities.
> Acute ischemia: signs [especially limbs] 6 P's:
Pain
Pallor
Pulselessness
Paralysis
Paraesthesia
Perishingly cold
> Hypertension: secondary hypertension causes CHAPS:
Cushing's syndrome
Hyperaldosteronism [aka Conn's syndrome]
Aorta coarctation
Phaeochromocytoma
Stenosis of renal arteries
· Note: only 5% of hypertension cases are secondary, rest are primary.
> MI: sequence of elevated enzymes after MI "C-AST-Le" (castle):
CK-MB first
AST second
LDH third
· Also: can use the last 'E' for ESR.
> Atherosclerosis risk factors "You're a SAD BET with these risk factors":
Sex: male
Age: middle-aged, elderly
Diabetes mellitus
BP high: hypertension
Elevated cholesterol
Tobacco
> Atherosclerosis risk factors SHIFT MAID:
Smoking
Hypertension
(N)IDDM
Family history
Triglycerdides & fats
Male
Age
Inactivity
Diet / Drink
> Thrombus: possible fates DOPE:
Dissolution
Organization & repair
Propagation
Embolization
> MI: sequence of elevated enzymes after MI "Time to CALL 911":
· From first to appear to last:
Troponin
CK-MB
AST
LDH1
> Blood disorders: commoner sex HE (male) gets:
HEmophilia (X-linked)
HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
HEmochromatosis (male predominance)
HEart attacks (male predominance)
HEnoch-Schonlein purpura (male predominance)
SHE (female) gets:
SHEehan's syndrome
> Deep venous thrombosis: genetic causes ALASCA:
Antithrombin III
Leiden (Factor V)
APC (Activated Protein C)
S-protein deficiency
C-protein deficiency
Antiphospholipid antibody
> Buerger's disease features "burger SCRAPS":
Segmenting thrombosing vasculitis
Claudication (intermittent)
Raynaud's phenomenon
Associated with smoking
Pain, even at rest
Superficial nodular phlebitis
· Alternatively, if hungry for more detail [sic], "CRISP PIG burgers":
Chronic ulceration
Raynaud's phenomenon
Intermittent claudication
Segmenting, thrombosing vasculitis
Pain, even at rest
Phlebitis (superficial nodular)
Idiopathic
Gangrene
> Deep venous thrombosis: diagnosis DVT:
Dilated superficial veins/ Discoloration/ Doppler ultrasound
Venography is gold standard
Tenderness of Thigh and calf
> Virchow's triad (venous thrombosis) "VIRchow":
Vascular trauma
Increased coagulability
Reduced blood flow (stasis)
> Kawasaki disease: features Disease name: a Kawasaki motorcycle.
Usually young children, epidemic in Japan: Japanese child rides the motorcycle.
Conjunctival, oral erythema: red eyes, mouth.
Fever: thermometer.
Erythema of palms, soles: red palms, soles.
Generalized rash: rash dots.
Cervical lymphadenitis: enlarged cervical nodes with inflammation arrows.
Vasculitis of arteries: inflammation arrows on arteries.
Cardiovascular sequelae [20%]: inflammation arrows on cardiac arteries.
Treat with aspirin: aspirin headlight.
· See diagram.
> Von Hippel-Lindau: signs and symptoms HIPPEL:
Hemanigoblastomas
Increased renal cancer
Pheochromocytoma
Port-wine stains
Eye dysfunction
Liver, pancreas, kidney cysts
· Bare bones version: Hippel-Lindau, with H and L as above.
> Heart failure causes "HEART MAy DIE":
Hypertension
Embolism
Anemia
Rheumatic heart disease
Thyrotoxicosis (incl. pregnancy)
Myocardial infarct
Arrythmia
Y
Diet & lifestyle
Infection
Endocarditis
> Anemia causes (simplified) ANEMIA:
Anemia of chronic disease
No folate or B12
Ethanol
Marrow failure & hemaglobinopathies
Iron deficient
Acute & chronic blood loss
> Pick's disease: location, action, epidemiology · See figure.
Pick axes are Picking away at the old woman's cerebral cortex, causing cortical atrophy.
2 pick axes on her brain: frontal lobe and anterior 1/3 of temporal.
An old woman, since epidemiology is elderly & more common in women.
> Pericarditis: findings PERICarditis:
Pulsus paradoxus
ECG changes
Rub
Increased JVP
Chest pain [worse on inspiration, better when lean forward]
> Fat embolism: findings "Fat, Bat, Fract":
Fat in urine, sputum
Bat-wing lung x-ray
Fracture history
· Also, fracture of FEMur causes Fat EMboli.
> Hemolytic anemia types SHEEP T!T:
Sickle cell
Heriditary splenocytosis
Enzyme deficiencies: [G6P, pyruvate kinase]
Erythroblastosis fetalis
Paroxysmal nocturnal hemoglobinuria
Trauma to RBCs
Immunohemolytics: [warm Ab, cold Ag]
Thalassemias: [alpha, beta]
> Disseminated Intravascular Cogulation: causes DIC:
Delivery TEAR (obstetric complications)
Infections (gram negative)/ Immunological
Cancer (prostate, pancreas, lung, stomach)
· Obstretrical complications are TEAR:
Toxemia of pregnancy
Emboli (amniotic)
Abrutio placentae
Retain fetus products
> Thrombotic thrombocytopenic purpura: signs FAT RN:
Fever
Anemia
Thrombocytopenia
Renal problems
Neurologic dysfunction
> Kawasaki disease: diagnostic criteria CHILD:
5 letters=5 days, >5 years old, 5 out 6 criteria for diagnosis:
Conjuctivitis (bilateral)
Hyperthermia (fever) >5 days
Idiopathic polymorphic rash
Lymphoadenopathy (cervical)
Dryness & redness of (i)lips & month (ii)palms & soles [2 separate criteria]
> Protein C, Protein S: function C and S are:
Clot
Stoppers
· These proteins inhibit coagulation.
> Aneurysm types MAD SCAB:
Mycotic
Atherosclerotic
Dissecting
Syphilitic
Capillary microaneurysm
Arteriovenous fistula
Berry
> Kawasaki's disease: features FEAR ME:
Fever
Eye: perilimbic sparing conjunctival injection
Adenopathy: usually cervical
Rash
Mouth: red lips
Extremities: red hands and feet
· Disease to be feared because of risk of coronary aneurysms.
> MI: complications "LEAP on the MAP":
LVF
Embolism (systemic)
Aneurysm (ventricular)
Progressive infarction
Myocardial rupture
Arrhythmia
Pericarditis
> Portal hypertension: features ABCDE:
Ascites
Bleeding (haematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen
> Anemia (normocytic): causes ABCD:
Acute blood loss
Bone marrow failure
Chronic disease
Destruction (hemolysis)
> TTP: clinical features Thrombosis and thrombocytopenia PARTNER together:
Platelet count low
Anemia (microangiopathic hemolytic)
Renal failure
Temperature rise
Neurological deficits
ER admission (as it is an emergency)
> Macrocytic anaemia: differential FAT RBC:
Fetus (pregnancy)
Alcohol
Thyroid disease(ie hypothyroidism)
Reticulocytosis
B12 and folate deficiency
Cirrhosis and chronic liver disease
> MI: post-MI complications ACT RAPID:
Arrhythmias (SVT, VT, VF)
Congestive cardiac failure
Tamponade/ Thromboembolic disorders
Rupture (ventricle, septum, papillary muscle)
Aneurysm (ventricle)
Pericarditis
Infaction (a second one)
Death/ Dressler's syndrome
> Cardiovascular risk factors FLASH BODIES:
Family history
Lipids
Age
Sex
Homocystinaemia
Blood pressure
Obesity
Diabetes mellitus
Inflammation (raised CRP)/ Increased thrombosis
Exercise
Smoking
> Cardiovascular risk factors (Framingham) FRAMINGHAM:
Family history
Running (exercise)
Adiposity (obesity)
Marlboros (tobacco)
Insulin resistance (diabetes)
Non-regulated lipids (dyslipidaemia)
Georgie Pie (high fat diet)
Hypertension
Age
Male
> Syncope (fainting) treatment If the face is red, raise the head.
If the face is pale, raise the tail.
> Preeclampsia: classic triad PREeclampsia:
Proteinuria
Rising blood pressure
Edema
> Stroke risk factors HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)
> Battle sign BattlE:
Behind Ear
> Stroke: young patient's likely causes 7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion
> Stroke: basic work up The 3 P's:
Pump
Pipes
Plasma
> Endocarditis: lab results suggesting it "High Tech Lab Results Point At Endocarditis":
Hematuria
Thrombocytopenia
Leukocytosis, -penia
Red blood cell casta
Proteinuria
Anemia
Elevated ESR
> Endocarditis: causes of culture negative endocarditis "With Negative Tests, Investigators Should FocusAttention Somewhere Meaningful":
Wrong diagnosis
Noninfectious endocarditis
Timing (cultures drawn at end of chronic course)
obligate Intracellular organisms
Slow growing fastidious organisms
Fungal infection
Antibiotic used previously
Subacute right-sided endocarditis
Mural endocarditis
> Endocarditis: indications for surgery PUS RIVER:
Prosthetic valve endocarditis (most cases)
Uncontrolled infection
Supporative local complications with conduction abnormalities
Resection of mycotic aneurysm
Ineffective antimicrobial therapy (eg Vs fungi)
Valvular damage (significant)
Embolization (repeated systemic)
Refractory congestive heart failure
> Heart valve auscultation sites "All Patients Take Meds":
· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.
· Alternatively: Always Pumps Too Much.
> Heart valve auscultation sites "All People Try Marijuana":
Aortic
Pulmonic
Tricuspid
Mitral
> Branham sign: definition BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.
> Heart ausculation sites: ribs Apt. M 225A:
Aortic valve
Pulmonary valve
Tricuspid valve
Mitral valve
· In order they correspond with the following landmarks:
2nd intercostal space (right)
2nd intercostal space (left)
5th intercostal space (left)
Apex (still the 5th intercostal space)
> Pancytopaenia differential "All Of My Blood Has Taken Some Poison":
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria
> Haematology: key numbers 3 and 4 are key in in haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.
> Sickle cell disease complications SICKLE:
Strokes/ Swelling of hands and feet/ Spleen problems
Infections/ Infarctions
Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
Kidney disease
Liver disease/ Lung problems
Erection (priapism)/ Eye problems (retinopathy)
> ADP: role in platelet aggregation ADP = Aggregation from the Dense bodies of Platelets.
> Anion gap metabolic acidosis: causes A MUDPILE CAT:
Alcohol
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Carbamazepine
Aspirin
Toluene
> HbA2: concentration in normal blood HbA2:
Concentration of HbA2 is 2% in normal adult blood.
> Metabolic acidosis: causes USED CAR:
Ureteroenterostomy
Saline hydration
Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
Diarrhea/ DKA/ Drugs
Carbonic anhydrase inhibitors
Ammonium chloride
Renal tubular acidosis
· Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic fistula.
> Non-gap acidosis: causes HARD UP:
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula
> Toxicity/ sepsis: signs 6 T's:
Tachycardia
Tachypnea
Tremors
Toxic look
Tiredness
Temperature (fever)
> Macrocytic anemia: causes ABCDEF:
Alcohol + liver disease
B12 deficiency
Compensatory reticulocytosis (blood loss and hemolysis)
Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
Endocrine (hypothyroidism)
Folate deficieny/ Fetus (pregnancy)
> Metabolic acidosis: causes KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis
> Raynaud's disease: causes BAD CT:
Blood disorders (eg polycythaemia)
Arterial (eg atherosclerosis, Buerger's)
Drugs (eg beta-blockers)
Connective tissue disorders (rheumatoid arthritis, SLE)
Traumatic (eg vibration injury)
> Ulcers: types VAN:
Venous/ Vasculitic
Arterial
Neuropathic
> Anemia: non-megaloblastic causes of macrocytic anemia HAND LAMP:
Hypothyroidism
Aplastic anaemia
Neonates
Drugs
Liver disease
Alcohol
Myelodyplasia
Pregnancy
> NSAIDs: contraindications NSAID:
Nursing and pregnancy
Serious bleeding
Allergy/ Asthma/ Angioedema
Impaired renal function
Drug (anticoagulant)
> ACEI: contraindictions PARK:
Pregnancy
Allergy
Renal artery stenosis
K increase (hyperkalemia)
> Haemoptysis: causes CAVITATES:
CHF
Airway disease, bronchiectasis
Vasculitis/ Vascular malformations
Infection (eg TB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach
> Anion gap metabolic acidosis: causes MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Infection
Lactic acidosis
Ethylene glycol
Salicylates
> Cyanosis: DDx COLD PALMS:
· Peripheral cyanosis:
Cold
Obstruction
LVF and shock
Decreased cardiac output
· Central cyanosis:
Polycythemia
Altitude
Lung dz
Met-, sulphaemoglobinaemia
Shunt
> Vascular endothelium: simplified cross-section LIMA:
Lumen
Intima
Media
Adventitia
> Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere":
Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy
> Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide
> Shock: signs and symptoms TV SPARC CUBE:
Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank
> Acute LVF management LMNOP:
Lasex (frusemide)
Morphine (diamorphine)
Nitrates
Oxygen (sit patient up)
Pulmonary ventilation (if doing badly)
> Subarachnoid hemorrhage (SAH) causes BATS:
Berry aneurysm
Arteriovenous malformation/ Adult polycystic kidney disease
Trauma (eg being struck with baseball bat)
Stroke
> Ventricular fibrillation: treatment "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock":
Shock= Defibrillate
Everybody= Epinephine
Little= Lidocaine
Big= Bretylium
Momma= MgSO4
Poppa= Pocainamide
> Chest pain treatment, for nurses "MOVE your patient!":
Monitor: put patient on cardiac monitor
Oxygen: put patient on O2
Venous: gain large bore venous access
EKG: 12 lead EKG
> Endotrachial tube deliverable drugs O NAVEL:
Oxygen
Naloxone
Atropine
Ventolin (albuterol)
Epinephrine
Lidocaine
· If you can't get IV access established, and have necessity to administer resuscitative meds, remember you have the airway and can give the above drugs.
· Drug delivery is enhanced if diluted with 10cc NS and rapid introduced for aeresolization.
· Alternatively, bare bone version is ALE, as above.
> Syncope causes, by system HEAD HEART VESSELS:
· CNS causes include HEAD:
Hypoxia/ Hypoglycemia
Epilepsy
Anxiety
Dysfunctional brain stem (basivertebral TIA)
· Cardiac causes are HEART:
Heart attack
Embolism (PE)
Aortic obstruction (IHSS, AS or myxoma)
Rhythm disturbance, ventricular
Tachycardia
· Vascular causes are VESSELS:
Vasovagal
Ectopic (reminds one of hypovolemia)
Situational
Subclavian steal
ENT (glossopharyngeal neuralgia)
Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)
Sensitive carotid sinus
> Atrial fibrillation: causes of new onset THE ATRIAL FIBS:
Thyroid
Hypothermia
Embolism (P.E.)
Alcohol
Trauma (cardiac contusion)
Recent surgery (post CABG)
Ischemia
Atrial enlargement
Lone or idiopathic
Fever, anemia, high-output states
Infarct
Bad valves (mitral stenosis)
Stimulants (cocaine, theo, amphet, caffeine)
> Malaria: complications of falciparum malaria CHAPLIN:
Cerebral malaria/ Coma
Hypoglycemia
Anaemia
Pulmonary edema
Lactic acidosis
Infections
Necrois of renal tubules (ATN)
> MI: immediate treatment DOGASH:
Diamorphine
Oxygen
GTN spray
Asprin 300mg
Streptokinase
Heparin
> Pain history checklist OLDER SAAB:
Onset
Location
Description (what does it feel like)
Exacerbating factors
Radiation
Severity
Associated symptoms
Alleviating factors
Before (ever experience this before)
> Pulseless Electrical Activity (PEA): checklist PEA:
Pulses check
Epinepherine
Atropine
> PEA/Asystole (ACLS): etiology ITCHPAD:
Infarction
Tension pneumothorax
Cardiac tamponade
Hypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/ Hypoxemia
Pulmonary embolism
Acidosis
Drug overdose
> V-fib/pulseless v-tach (new ACLS as of 2001) "EVAL My Pumper":
Epinephrine
Vasopressin
Amiodarone (class IIb--better for heart failure)
Lidocaine (indeterminate - better for young, healthy or persistent)
MgSO4 (IIb for hypomagnesemic state or torsades)
Procainamide (IIb for intermittent/recurrent VF/VT)
> Asystole: treatment "Have some asystole "TEA":
Transcutaneous pacing
Epi
Atropine
> JVP: raised JVP differential PQRST (EKG waves):
Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)
> JVP: raised JVP: extra-cardiac causes FAT PEA:
Fever
Anaemia
Thyrotoxicosis
Pregnancy
Exercise
A-V fistula
· These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).
> Shock: general features CHORD ITEM:
Cold, clammy skin
Hypotension
Oliguria
Rapid, shallow breathing
Drowsiness, confusion
Irritability
Tachycardia
Elevated or reduced central venous pressure
Multi-organ damage
> Myocardial infarction: some emergency treatment drugs ABCD:
Aspirin
Beta blockers
Clot busters (thromboytics)
Dynamite (nitrates)
> Branchial arch giving rise to aorta "Aor- from Four":
Aorta is from fourth arch.
> Tetrology of Fallot "Don't DROP the baby":
Defect (VSD)
Right ventricular hypertrophy
Overriding aorta
Pulmonary stenosis
> Tetrology of Fallot "IHOP-International House of Pancakes":
Interventricular septal defect
Hypotrophy of right ventricle
Overriding aorta
Pulmonary stenosis
> Tetrology of Fallot PROVe:
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
> Heart: primitive heart chambers in fetal heart "The Broken Vein Always Stenoses, But Veins Are Smooth":
· The order of the compartments is: runcus, bulbus
Primitive Ventricle
Primitive Atrium
Sinus venosus
·The connections are:
Bulbotruncal junctionVentriculobulbar foramen
Atrioventricular canal
Sinuatrial junction
> Tetrology of Fallot "Problems Of Small Hearts":
Pulmonary stenosis
Overriding aorta
Ventricular Septal defect
Hypertrophy of right ventricle
> Coagulation common pathway: factors in order 10 + 5 - 2 = 13
Coagulation common pathway:
Factor X to Factor V to Factor II to Factor XIII
> Vitamin K dependent cofactors "Several Tend To Nicely Stop Clots":
Factor Seven, Ten, Two, Nine.
Protein S, Protein C.
> Femoral triangle: arrangement of contents NAVEL:
· From lateral hip towards medial navel:
Nerve (directly behind sheath)
Artery (within sheath)
Vein (within sheath)
Empty space (between vein and lymph)
Lymphatics (with deep inguinal node)
· Nerve/Artery/Vein are all called Femoral.
> Femoral triangle: arrangement of nerve, artery, vein VAN:
· From medial to lateral:
Vein
Artery
Nerve
· Nerve/Artery/Vein are all called Femoral.
> Aortic arch: major branch order "Know your ABC'S":
Aortic arch gives rise to:
Brachiocephalic trunk
left Common Carotid
left Subclavian
· Beware though trick question of 'What is first branch of aorta?' Technically, it's the coronary arteries.
> Lung lobe numbers: right vs. left Tricuspid heart valve and tri-lobed lung both on the right side.
Bicuspid and bi-lobed lung both on the left side.
> Ulnar nerve to ulnar artery and radial nerve to radial artery relations Think "peripheral nerves":
The ulnar nerve is "ulnar" to the ulnar artery.
Radial nerve is "radial" to the radial artery.
> Superior thyroid artery branches "May I Softly Squeeze Charlie's Girl?":
Muscular
Infrahyoid
Superior laryngeal
Sternomastoid
Cricothyroid
Glandular
> Female pelvic organs' blood supply "3 organs, each get 2 blood supplies":
Uterus: uterine, vaginal.
Rectum: middle rectal, inferior rectal [inferior rectal is the end of pudendal].
Bladder: superior vesical, inferior vesical.
> Liver: side with ligamentum venosum/ caudate lobe vs. side with quadrate lobe/ ligamentum teres"VC goes with VC":
The Venosum and Caudate is on same side as Vena Cava [posterior]. Therefore, quadrate and teres must be on anterior by default.
> Saphenous veins: path of great vs. small at malleolus "MAGdelaine has varicose veins" [The saphenous veins are important for varicose veins]:
Medial maleolus, Anterior to maleolus, and Great saphenous go together.
Then the opposites of these go together: Small saphenous is posterior to the lateral maleolus.
> Thoracic cage: relations to the important venous structures Behind the sternoclavicular joints: the brachiocephalic veins begin.
Behind the 1st costal cartilage on the right the superior vena cava begins.
Behind the 2nd costal cartilage on the right the azygos vein ends.
Behind the 3rd costal cartilage on the right the superior vena cava ends.
> External carotid artery branches "Sister Lucy's Powdered Face Often Attracts Silly Medicos":
· Before entering the parotid gland:
Superior thyroid
Lingual
Posterior auricular
Facial
Occipital
Ascending pharyngeal
· Ends as:
Superficial temporal and
Maxillary bifurcating in the in the parotid gland
> External carotid artery branches "Some Angry Lady Figured Out PMS":
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superificial temporal
> Descending abdominal aorta: seven divisions "Sometimes Intestines Get Really Stretched Causing Leakage":
Suprarenals [paired]
Inferior mesenteric
Gonadal [paired]
Renals [paired]
Superior mesenteric
Celiac
Lumbar [paired]
> Internal jugular vein: tributaries "Medical Schools Let Confident People In":
· From inferior to superior:
Middle thyroid
Superior thyroid
Lingual
Common facial
Pharyngeal
Inferior petrosal sinus
> Portal-systemic anastomoses: main 2 places that retroperitoneals connect into systemicRetroPeritoneals hook up with Renal and Paravertebral veins.
> Brachial artery: recurrent and collateral branches "I Am Pretty Sexy"
Inferior ulnar collateral artery goes with Anterior ulnar recurrent artery.
Posterior ulnar recurrent artery goes with Superior ulnar collateral artery.
· Alternatively: "I Am Pretty Smart".
> Thoracoacromial artery branches "CAlifornia Police Department":
Clavicular
Acromial
Pectoral
Deltoid
> Axillary artery branches "Send The Lord to Say A Prayer":
· From proximal to distal:
Superior thoracic
Thoracacromial
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
> Carotid sheath contents "I See 10 CC's in the IV":
I See (I.C.) = Internal Carotid artery
10 = CN 10 (Vagus nerve)
CC = Common Carotid artery
IV = Internal Jugular Vein
> Internal iliac artery: posterior branch PILS:
Posterior branch
Iliolumbar
Lateral sacral
Superior gluteal
> External carotid artery branches StApLE OPIS:
Superior thyroid
Ascending pharyngeal
Lingual
External maxillary (facial)
Occipital
Posterior auricular
Internal maxillary
Superficial temporal
> Axillary artery branches "Suzy Thompkins Loves Sex, Alcohol, and Pot":
· From proximal to distal:
Superior thoracic
Thoracacromial
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
> Maxillary artery branches "DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone AlcoholicsAnonymous":
Deep auricular
Anterior tympanic
Middle meningeal
Inferior alveolar
Accessory meningeal
Masseteric
Pterygoid
Deep temporal
Buccal
Sphenopalatine
Descending palatine
Infraorbital
Posterior superior alveolar
Middle superior alveolar
Pharyngeal
Anterior superior alveolar
Artery of the pterygoid canal
> Femoral hernia: epidemiology FEMoral hernias are more common in FEMales.
> External carotid artery branches "So Long For Acting Old Parenting Means Stability":
Superior thyroid
Lingual
Facial
Ascending pharyngeal
Occiptal
Posterior auricular
Maxillary
Superficial temporal
> Inferior vena cava tributaries "I Like To Rise So High":
Illiacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein.
· Think of the IVC wanting to rise high up to the heart.
> Cavernous sinus contents O TOM CAT:
O TOM are lateral wall components, in order from superior to inferior.
CA are the components within the sinus, from medial to lateral. CA ends at the level of T from O TOM.
· See diagram.
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI)
T: When written, connects to the T of OTOM.
> Femoral triangle: contents NAVY:
· In order from lateral to medial:
Nerve
Artery
Vein
Y of the groin
· Alternatively: Y = Y-fronts [male underwear].
> Internal iliac artery: anterior branches What Bill admitted to Hilary: "I Milked Our Insatiable Intern's UddersUnder the Desk":
Inferior gluteal
Middle rectal
Obturator
Inferior vesical artery
Internal pudendal artery
Umbilical
U/D=Uterine artery (female)/ Deferential artery (male)
> Thoracoacromial artery branches ABCD:
Acromial
Breast (pectoral)
Clavicular
> Axillary artery branches "Screw The Lawyer Save A Patient":
Superior thoracic
Thoracoacromiol
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
Alternatively: "Some Times Life Seems A Pain".
> External carotid artery branches "Sally Ate Lots Of Fresh Produce March Through September":
Superior thyroid
Ascending laryngeal
Lingual
Occipital (O before F is an extremely common variation)
Facial
Posterior auricular
Maxillary
Transverse facial
Superficial temporal
> Atrioventricular valves "LAB RAT":
Left Atrium: Bicuspid
Right Atrium: Tricuspid
> External carotid artery branches "She Lay Flaccid As Olaf's Penis Slipped In":
· From caudal to cephalad:
Superior thyroid
Lingual
Facial
Ascending pharyngeal
Occipital
Posterior auricular
Superficial temporal
(Internal) maxillary
> Brachial artery is medial to biceps tendon "BAMBI":
Brachial Artery is Medial to Biceps In elbow.
> External carotid artery branches "Suzy Always Lays Flat On Pillows Making Sex Terrific":
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superificial Temporal
> Coelic trunk: branches Left Hand Side (LHS):
Left gastric artery
Hepatic artery
Splenic artery
> Heart valve sequence "Try Pulling My Aorta":
Tricuspid
Pulmonary
Mitral
Aorta
> Femoral artery deep branches "Put My Leg Down Please":
Profundus femoris (deep femoral artery)
Medial circumflex femoral artery
Lateral circumflex femoral artery
Descending genicular arteries
Perforating arteries
> Subclavian artery branches "Very Tired Individuals Sip Strong Coffee Served Daily":
Vertebral artery
Thyrocervical trunk
---Inferior thyroid
---Superficial cervical
---Suprascapular
Costocervical
---Superior intercostal
---Deep cervical
> Cardiac valves: order in circuit "TRI berore you BI":
Tricuspid valve is located in left heart and Bicuspid valve is located in right heart. Blood flows through the tricuspidbefore bicuspid.
> Heart valves: order in circuit "First learn a Tricycle, then learn a Bicycle":
Flow through Tricuspid first, then Bicuspid.
> External jugular vein: tributaries PAST:
Posterior external jugular vein
Anterior jugular vein
Suprascapular vein
Transverse cervical vein
> Branches of Internal Iliac Artery "I Love Going Places In My Very Own Underwear":
Ileolumbar
Lateral sacral
Gluteal (superior and inferior)
Pudendal (internal)
Inferior vesicle (uterine in females)
Middle rectal
Vaginal
Obturator
Umbilical
> Thoracoacromial trunk: branches "Cadavers Are Dead People":
Clavicular
Acromial
Deltoid
Pectoral
> Posterior mediastinum: contents DATES:
Descending aorta
Azygos and hemiazygous veins
Thoracic duct
Esophagus
Sympathetic trunk/ganglia
> Rheumatic fever: Jones 5 major criteria SPACE:
Subcutaneous nodules
Pancarditis
Arthritis
Chorea
Erythema Marginatum
>Mnemonic: Magic Number in Clinical Medicine (12±2):
Age of puberty
Anion gap
Osmolar gap
Alveolar-arterial oxygen gradient
Pulsus paradoxus
Pulse deficit (AF)
SBP between upper and lower limbs (Hill,s sign)
>ABCDEF: Secondary prevention in athersclerotic coronary artery disease
A: Antiplatelet agent
Angiotensin-converting enzyme inhibitor (for
those with left ventricular dysfunction)
Avoid tobacco
B: β-Blockers Blood pressure control C: Cholesterol-lowering drug therapy
D: Dietary control
Diabetes control
E: Exercise
F: Fish oil (omega-3 fatty acids)
>CAUSES OF VALVULAR HEART DISEASE
--------------------------------------------------
C- Congenital,Coronary artery disease,Connective tissue disorder,Congestive cardiomyopathy,Carcinoid disease
A- Acute Rheumatic fever,Aortic dissection,Ankylosing spondylitis
U- Gout
S- Syphilitic aortitis,Scheie's syndrome
E- Ehler's Danlos syndrome
S- Storage(glycogen)
O- Osteogenesis imperfecta
F- Radiation fibrosis
V- Chronic Rheumatic valvular disease,Aortic valvular calcification,Prosthatic valve calcification
A- Aortitis
L- Libman sachs endocarditis
V-
U-
L-
A-
R- Rheumatoid arthritis, Reiter' syndrome, Relapsing polychondritis
H- Hypertension, Hurler's syndrome, Hunter's syndrome, Hyper lipoproteinemia, Hypertrophic cardiomyopathy, Hyper eosinophilic syndrome
E- pseudoxanthoma Elasticum
A-
R-
T- Trauma, Tumor's
D- Bachet's Disease, Degeneration
I- Ischaemia,Infarction, Idiopathic changes, Infective endocarditis
S-
E-
A-
S-
E-
>FOR THE SYMPTOMS OR DISEASE
VITMINS DEV this almost fits to all cause ...
V= VASCULAR CAUSE
I= INFECTIVE CAUSE OR IDIOPATHIC,
T=TRAUMATIC
A =AGEING
M= METABOLIC ,
I= ISCHEMIC , inflammatory
N=NEOPLASM
S=STRUCTURAL CONGENITAL DEFORMILTY.
D= DRUGS
E=ENDOCRINE ,ELECTROLYTE
V=Valvular
Asthma, Salicylism, Peptic ulcer / Premature closure of PDA, Intestinal blood loss, Reye's syndrome, Idiosyncracy ,Noise (tinnitus)
> Aortic root dilatation: causes ADAMS
Aneurysm, Dissection, Ankylosing spondylitis, Marfan's syndrome, Syphilis
> Vitelline duct: Time of closure VItelline
The VItelline duct usually closes around week VI of intrauterine life.
> LVF, Management of FOAM
Frusemide 40mg iv, Oxygen, Atrovent (& Ventolin) nebs, Morphine 2.5 - 5 mg
> Mitral Stenosis, Complications PASTRI
Pulm ↑BP, A fib, Systemic embolism, Tricuspid regurg, Right heart failure, Infective
endocarditis
> Myocardial infarct, complications ABCDE x2
Arrhythmias / Aneurysm
Bradycardia / ↓BP
Cardiac failure / cardiac tamponade
Dresslers / Death!
Embolism / Extra (VSD, pap muscle rupture)
> Pericarditis DRUMSTICX
Dresslers, Rh fever / RA, Uraemia, MI, SLE, Trauma, Idiopathic, Coxsackie, X-ray
> Postural Hypotension HANDI
Hypovolaemia / hypopituitarism, Addisons, Neuropathy (autonomic), Drugs (vasodilators /
TCADs, diuretics, antipsychotics), Idiopathic
> Rheumatic fever:
Major criteria CASES
Carditis, Arthritis (migratory), Subcut nodules, Erythema marginatum, Syndenhams chorea
Minor criteria 4PA
Pyrexia, prolonged PR, past Hx, positive (ie ↑)ESR/CRP, Arthralgia
> Occlusive arterial disease 6Ps
Pain, pallor, pulseless, parasthesia, paralysis, perishing with cold
> Splinter haemorrhages TRIP SAM
Trauma, RA, Infective Endo, PAN
SLE / Sepsis, Anaemia (profound), Malignancy (haematological)
> ST elevation ELEVATION
Electrolytes, LBBB, Early Repolarization, Ventricular hypertrophy, Aneurysm, Treatment (eg
pericardiocentesis), Injury (AMI, contusion), Osborne waves (hypothermia), Non-occlusive
vasospasm (prinzmetal’s)
> SVT Causes SNAP
Sinus tachy, nodal tachy, a fib, paroxysmal atrial tachy
> Symptoms of aortic stenosis ASD
Angina 2 years }
Syncope 1 year } prognosis
Dyspnoea 6/12 }
> No apex beat DOPES
Dextrocardia (don’t say this first!), Obesity, Pleural/Pericardial effusion, Emphysema, Shock.
> 3rd Heart Sound FIPPY
Failure, Incompetence (mitral/tricuspid), Pregnancy/Pill/PE/Pericarditis, Youth
> 4th Heart Sound SHIT
Stenosis (aortic/pulmonary), Hypertension/Heart Block, Ischaemic HD, Tamponade
> Arrhythmias ARHYTHMIAL 4PC
Atrial Myxoma, Rh heart dis, HYpertension, THyrotoxicosis, Mitral valve dis, IHD,
ALcohol
Pneumonia / PE / Pericardial eff, cardiomyopathy
> Atrial Fibrillation ARITHMATIC
Alcohol, Rh fever, IHD, Thyrotoxicosis, Hypertension, Mitral stenosis / MI / Myxoma
(atrial)
ASD, Toxins, Idiopathic/Infective endocarditis Cardiomyopathy/Constrictive pericarditis
> Bradycardia, regular PAD HIM
Physiological (athlete, sleep) / paroxysmal, AV block (2°II, 3°), Drugs (β, dig, amiodarone) Hypothyroid / hypothermia, Icteric (severe), MI
> Dominant R wave in V1 WORD
WPW, Old MI, RBBB, Dextrocardia
> EMD Arrest 4Hs 4Ts
Hypothermia, Hypo & hyper-electrolytes, Hypovolaemia, Hypoxia
Toxic (including drugs), Trauma, Tamponade, Tension pneumothorax
> JVP MOP HAIR
Multiple wave form, Occludable, Postural changes
Hepatojugular reflex, Above (fills from), Impalpable, Respiratory changes
> Non-pitting lower limb oedema MI CHAM
Milroys, infection (filariasis), Congenital, Hypothyroid, Allergy, Malignancy
> Shock HEN SCAM
Hypovolaemia, Endocrine (adrenal, thyroid), Neuropathic (autonomic)
Spinal cord injury/ Sepsis, Cardiac, anapyhlaxis/ anaesthesia, anti HPT, Massive PE
> ABCDE
Treatment of Heart Failure:
ACE inhibitors; Beta-blockers; Calcium channel blockers; Diuretics; Endothelin-converting enzyme inhibitors
> All Prostitutes Take Money
The order of resuscitation for heart sounds from right to left:
Aortic, Pulmonary, Tricuspid, Mitra
> BOOMAR
Basic MI management – Bed rest, Oxygen, Opiate, Monitoring, Anticoagulation, Reduce clot size
> CHIPCHANGE
The many unwanted affects of amiodarone: Cutaneous photosensitivity, Hepatic dysfunction, Increases LDL,Pulmonary fibrosis, CNS effects, Hyper/hypothyroidism, Asymptomatic corneal deposits, peripheral Neuropathy, GI dysfunction, Enhances the effects of warfarin/digoxin
> DOLMA
Lines of treatment of pulmonary oedema:
Digoxin, Oxygen, Lasix, Morfine, Aminophylline. (Dolma is a very famous food in the middle east.)
> M.O.N.A
"MONA" treatment for acute MI.
Morphine, Oxygen, Nitrate, Aspirin
> Please Read His Text
Signs of cor pulmonale:
Peripheral oedema, Raised JVP, Hepatomegaly, Tricuspid incompetence
> Mitral regurgitation When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".
> Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).
> Supraventricular tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)
> Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker
> Rheumatic fever: Revised Jones criteria JONES PEACE:
· Major criteria:
Joints: migratory
O (heart shaped) Carditis: new onset murmur
Nodules, subcutaneous: extensor surfaces
Erythema marginatum
Sydenham's chorea
· Minor criteria:
PR interval, prolonged
ESR elevated
Arthralgias
CRP elevated
Elevated temperature (fever)
· Need 2 major or 1 major and 2 minor criteria, plus evidence of recent GAS infection (throat cx, rapid antigen test, or rising strep antibody titer).
> Pulseless electrical activity: causes PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs
> Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes
> Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leucocytosis
> JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
> Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
> Exercise ramp ECG: contraindications RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension
> ECG: T wave inversion causes INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]
> Rheumatic fever: Jones major criteria JONES:
Joints (migrating polyarthritis)
Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)
Nodes (subcutaneous nodules)
Erythema marginatum
Sydenham's chorea
> Myocardial infarctions: treatment INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners
> Atrial fibrillation: causes PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome
> Atrial fibrillation: management ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin
> Anti-arrythmics: for AV nodes "Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil
> Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis
> Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Sinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)
> Rheumatic fever: Jones 5 major criteria STREP:
Sydenhams chorea
Transient migratory arthritis
Rheumatic subcutaneous nodules
Erythema marginatum
Pancarditis (endocarditis, myocarditis, pericarditis)
· STREP, since Rheumatic fever is caused by group A strep.
> Sinus tachycardia TACH FEVER:
Tamponade/ Thyrotoxicosis
Anemia
CHF
Hypotension
Fever
Excrutiating pain
Volume depletion
Exercise
Rx (Theo, Dopa, Epi, etc)
> CHF: causes of exacerbation A SMITH PEAR:
Anemia
Salt/ Stress/ Stopping meds
MI
Infection/ Ischemia
Thyroid (high/low)
HTN
Pericarditis
Endocarditis (valve disease)
Arrhythmia
Rx (beta blocker, etc)
> Murmurs: louder with inspiration vs expiration LEft sided murmurs louder with Expiration
RIght sided murmurs louder with Inspiration.
> Murmurs: questions to ask SCRIPT:
Site
Character (eg harsh, soft, blowing)
Radiation
Intensity
Pitch
Timing
> Aortic regurgitation: causes CREAM:
Congenital
Rheumatic damage
Endocarditis
Aortic dissection/ Aortic root dilatation
Marfan's
> Heart failure: signs TAPED TORCH:
Tachycardia
Ascites
Pulsus alternans
Elevated jugular venous pressure
Displaced apex beat
Third heart sound
Oedema
Right ventricular heave
Crepitations or wheeze
Hepatomegaly (tender)
> Pericarditis: causes PR DIP, ST UP:
Post-pericardiectomy
Rheumatic fever
Drugs (eg isoniazid, hydralazine, procainalmide)
Infection (eg TB, coxsackie, strep)
PE
SLE/Scleroderma
Tumours/ Thyroid disease
Uraemia
Post MI (includes Dressler's)
> Aortic dissection: risk factors ABC:
Atherosclerosis/ Ageing/ Aortic aneurysm
Blood pressure high/ Baby (pregnancy)
Connective tissue disorders (eg Marfan's, Ehlers-Danlos)/ Cystic medial necrosis
> CHF: Left-sided systolic failure signs and symptoms "Left Systolic Failure Can Have Dialated Heart CauseOf Pulmpnary Backflow":
Loss of hair on legs
Skin cold and clammy
Fatigue
Crackles
High heart rate
Dyspnea
HTN
Cyanosis
Orthopnea
Pink Sputum
> Acute Coronary Syndrome: initial treatment ABCD:
Aspirin
Beta blocker
Coagulation (anticoagulation with heparin/LMW Heparin)
Double product control (decrease heart rate and blood pressure)
> Heart failure: causes HEART FAILED:
Hypertension
Endocrine
Anemia
Rheumatic heart disease
Toxins
Failure to take meds
Arrythmia
Infection
Lung (PE, pneumonia)
Electrolytes
Diet
> EKG: 12 lead EKG quick interpretation of V1-V6 SSAALL:
· Elevations matched with their classic location of MI:
V1 Septal
V2 Septal
V3 Anterior
V4 Anterior
V5 Lateral
V6 Lateral
> Aortic regurgitation: causes MARRIS:
Marfans
Ankylosing spondylitis
Rheumatic fever
Rheumatoid arthritis
Infective endocarditis
Syphilis
> Cardiomyopathy: categories Cardiomyopathy is HARD:
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Restrictive cardiomyopathy
Dilated cardiomyopathy
> Murmurs: innocent murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression
> Murmur attributes "IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
> Murmurs: locations and descriptions "MRS A$$":
MRS: Mitral Regurgitation--Systolic
A$$: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.
> Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
> Apex beat: abnormalities found on palpation, causes of impalpable HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia
> MI: treatment of acute MI COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate
> Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
> Peripheral vascular insufficiency: inspection criteria SICVD:
Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair
> Rheumatic fever: Revised Jones' criteria JONES crITERIA:
· Major criteria:
Joint (arthritis)
Obvious (Cardiac)
Nodule (Rheumatic)
Erythema marginatum
Sydenham chorea
· Minor criteria:
Inflammatory cells (leukocytosis)
Temperature (fever)
ESR/CRP elevated
Raised PR interval
Itself (previous Hx of Rheumatic fever)
Arthralgia
> Heart murmurs "hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic
> MI: therapeutic treatment ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine
> CHF: causes of exacerbation FAILURE:
Forgot medication
Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary
> Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.
> Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden.
> MI: therapeutic treatment "O BATMAN!":
Oxygen
Beta blocker
ASA
Thrombolytics (eg heparin)
Morphine
Ace prn
Nitroglycerin
> Mitral stenosis (MS) vs. 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.
> Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation.
> Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase
> MI: therapeutic treatment MONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
> Depressed ST-segment: causes DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine
> Aortic stenosis characteristics SAD:
Syncope
Angina
Dyspnoea
> MI: basic management BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size
> 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.
> Pericarditis: causes CARDIAC RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome
> Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].
> MI: signs and symptoms PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating
> Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
· In all 5, system is activated/factor is released
> Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.
> ST elevation causes in ECG ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm
> Beck's triad (cardiac tamponade) 3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
> Abdominal aortic aneurysm: genetic component AAA (3 A's) is sometimes due to a defect in the gene encoding for type III procollagen.
> Varicose veins: symptoms AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)
> White toe (arterial insufficiency toe) 5 P's:
Pale coloration
Pain (excruciating)
Paresthesia
Pulselessness
Warm compression and vasodilatory Patch to Proximal area
> Blue toe (microembolic toe) CAVEMAN:
Cholesterol embolizations
Atrial fib with electricity or digitoxin
Valvular problems
Endocarditis
Mural thrimbosis
Aneurysm/ AV fistula
Nothing
> Peripheral vascular diseases ABCDEF:
Atherosclerosis.
Buerger's disease (TAO)
Cyanosis/ Cold agglutinin/ Connective tissue disease (Raynaud's phenomenon)
Deep vein phlebothrombosis
Embolism
inFlammation of veins
> TIA: internal carotid vs. vertebrobasilar MD vs. DPM
· Internal carotid:
Monocular blindness (amaurox fugax)
Dominant hemisphere (apahsia)
· The weakness or numbness is still less in the legs.
· Vetebrobasilar:
Diplopia/ Double blindness
Paralysis (quadriplesia)
Motor weakness (ipsilateral)
· Ataxia is characteristic in veterbrobasilar lesions.
> PGI2 vs. TxA2 coagulation function TxA2 Aggregates platelets.
PGI2 Inhibits aggregation.
· Note: full name of PGI2 is prostaglandin I2 or prostacyclin, full name of TxA2 is thromboxane A2.
> Einthoven's Triangle: organization Corners are at RA (right arm), LA (left arm), LL (left leg).
Number of L's at a corner tell how many + signs are at that corner [eg LL is ++].
Sum of number of L's of any 2 corners tells the name of the lead [eg LL-LA is lead III].
For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.
> Heart: -tropic definitions Lusitropic: loose is relaxed. Definition: relax heart.
Inotropic: when heart wall contracts, moves inward. Definition: contract heart.
Chronotropic: 'chrono-' means 'time'. Defintion: heart rate (of SA node impulses).
Dromotropic: only one left, it must be conduction speed by default.
> Heart valves: sequence of flow TRIPS BIAS:
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar
Alternatively: "TRIPS, MI ASs!" (uses MItral instead of BIcuspid)
> Intrinsic vs. extrinsic pathway tests "PeT PiTTbull":
PeT: PT is for extrinsic pathway.
PiTTbull: PTT is for intrinsic pathway.
> Carotid sinus vs. carotid body function carotid SinuS: measures preSSure.
carotid bO2dy measures O2.
> Hemoglobin and myoglobin: binding strengths, sites "ABC" of glycosylated Hb (Hb1c):
· Glucose binds to Amino terminal of Beta Chain.
"HbF binds Forcefully":
· HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left.
Stored blood is SOS:
· Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG.
2,3 BPG binding site is BBC:
· BPG binds to Beta Chain of Hb.
Myoglobin binding strength is MOM:
· Myoglobin binds Oxygen More strongly than Hb.
> Hb-oxygen dissociation curve shifts: effect, location Left shift: causes Loading of O2 in Lungs.
Right shift: causes Release of O2 from Hb.
> Heart electrical conduction pathway "If patient's family are all having Heart attacks, you must SAVe HIS KIN!"
SA node --->
AV node --->
His (bundle of) -->
PurKINje fibers
> Heart valves: closure sequence "Many Things Are Possible":
Mitral, Tricuspid, Aortic, Pulmonic
> Fluid compartments: volumes 12345:
12 liters of interstitial fluid
3 liters plasma volume and 30 liters inside cells
45 liters total body water
> Heart valves: placement of valves on standard heart anterior view "Try before you Buy": When read across the page, the tricuspid valve comes before the bicuspid valve.
Also, the lunar valves are near the top (in the sky), like the moon.
> Propranolol and related '-olol' drugs: usage "olol" is just two backwards lower case b's.
Backward b's stand for "beta blocker".
· Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol.
> Warfarin: action, monitoring WePT:
Warfarin works on the extrinsic pathway and is monitored by PT.
> Beta-blockers: side effects "BBC Loses Viewers In Rochedale":
Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia
> Captopril (an ACE inhibitor): side effects CAPTOPRIL:
Cough
Angioedema/ Agranulocystosis
Proteinuria/ Potassium excess
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
Renal failure (and renal artery stenosis contraindication)/ Rash
Indomethacin inhibition
Leukopenia/ Liver toxicity
> Beta-blockers: main contraindications, cautions ABCDE:
Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)
> Ca++ channel blockers: uses CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes
> Warfarin: metabolism SLOW:
· Has a slow onset of action.
· A quicK Vitamin K antagonist, though.
Small lipid-soluble molecule
Liver: site of action
Oral route of administration.
Warfarin
> Amiodarone: action, side effects 6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism
> Patent ductus arteriosus: treatment "Come In and Close the door":
INdomethacin is used to Close PDA.
> Hypertension: treatment ABCD:
ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also)
Beta blockers
Calcium antagonists
Diuretics (sometimes vasoDilators also)
> Clopidogrel: use CLOPIdogrel is a drug that prevents
CLots, an Oral Platelet Inhibitor (OPI).
> Beta blockers with intrinsic sympathomimetic activity Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels.
Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some diabetics or asthmatics despite the fact that they are non-seletive beta blockers.
> Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factorXa.
Monitor Xa concentration, rather than APTT.
> Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem" (because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol
> Thrombolytic agents USA:
Urokinase
Streptokinase
Alteplase (tPA)
> Antiarrhythmics: classification I to IV MBA College
· In order of class I to IV:
Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers
> HMG-CoA reductase inhibitors (statins): side effects, contraindications, interactions HMG-CoA:
· Side effects:
Hepatotoxicity
Myositis [aka rhabdomyolysis]
· Contraindications:
Girl during pregnancy/ Growing children
· Interactions:
Coumarin/ Cyclosporine
> Antiarrhythmics: class III members BIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol
> Adrenoceptors: vasomotor function of alpha vs. beta ABCD:
Alpha = Constrict.
Beta = Dilate.
> Beta blockers: B1 selective vs. B1-B2 non-selective A through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol.
O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol.
> Beta blockers: members "The NEPAL Prime Minister":
Timolol
Nadolol
Esmolol
Pindolol
Atenolol
Labetalol
Propranolol
Metoprolol
> Thalidomide: effect on cancer cells "Thalidomide makes the blood vessels hide":
Use thalidomide to stop cancer cells from growing new blood vessels.
> Patent ductus arteriosus: which prostaglandin keeps it open kEEp opEn with prostaglandin E.
> Cyanotic heart diseases: 5 types · Use your five fingers:
1 finger up: Truncus Arteriosus (1 vessel)
2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed)
3 fingers up: Tricuspid Atresia (3=Tri)
4 fingers up: Tetralogy of Fallot (4=Tetra)
5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)
> Cyanotic congenital heart diseases 5 T's:
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return
> Hemolytic-Uremic Syndrome (HUS): components "Remember to decrease the RATE of IV fluids in these patients":
Renal failure
Anemia (microangiopathic, hemolytic)
Thrombocytopenia
Encephalopathy (TTP)
> Cyanotic heart diseases: 5 types · 5 T's:
Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
Tricuspid atresia, pulmonary aTresia
Total anomalous pulmonary venous drainage
> APGAR score components · Five B's:
Breathing (respiratory effort)
Beating (heart rate)
Buff (tone)
Bothered (response to stimulation)
Blue (cyanosis)
> Takayasu's disease is Pulseless disease "Can't Tak'a ya pulse" (Can't take your pulse):
Takayasu's disease known as Pulseless disease, since pulse is weakened in the upper extremities.
> Acute ischemia: signs [especially limbs] 6 P's:
Pain
Pallor
Pulselessness
Paralysis
Paraesthesia
Perishingly cold
> Hypertension: secondary hypertension causes CHAPS:
Cushing's syndrome
Hyperaldosteronism [aka Conn's syndrome]
Aorta coarctation
Phaeochromocytoma
Stenosis of renal arteries
· Note: only 5% of hypertension cases are secondary, rest are primary.
> MI: sequence of elevated enzymes after MI "C-AST-Le" (castle):
CK-MB first
AST second
LDH third
· Also: can use the last 'E' for ESR.
> Atherosclerosis risk factors "You're a SAD BET with these risk factors":
Sex: male
Age: middle-aged, elderly
Diabetes mellitus
BP high: hypertension
Elevated cholesterol
Tobacco
> Atherosclerosis risk factors SHIFT MAID:
Smoking
Hypertension
(N)IDDM
Family history
Triglycerdides & fats
Male
Age
Inactivity
Diet / Drink
> Thrombus: possible fates DOPE:
Dissolution
Organization & repair
Propagation
Embolization
> MI: sequence of elevated enzymes after MI "Time to CALL 911":
· From first to appear to last:
Troponin
CK-MB
AST
LDH1
> Blood disorders: commoner sex HE (male) gets:
HEmophilia (X-linked)
HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
HEmochromatosis (male predominance)
HEart attacks (male predominance)
HEnoch-Schonlein purpura (male predominance)
SHE (female) gets:
SHEehan's syndrome
> Deep venous thrombosis: genetic causes ALASCA:
Antithrombin III
Leiden (Factor V)
APC (Activated Protein C)
S-protein deficiency
C-protein deficiency
Antiphospholipid antibody
> Buerger's disease features "burger SCRAPS":
Segmenting thrombosing vasculitis
Claudication (intermittent)
Raynaud's phenomenon
Associated with smoking
Pain, even at rest
Superficial nodular phlebitis
· Alternatively, if hungry for more detail [sic], "CRISP PIG burgers":
Chronic ulceration
Raynaud's phenomenon
Intermittent claudication
Segmenting, thrombosing vasculitis
Pain, even at rest
Phlebitis (superficial nodular)
Idiopathic
Gangrene
> Deep venous thrombosis: diagnosis DVT:
Dilated superficial veins/ Discoloration/ Doppler ultrasound
Venography is gold standard
Tenderness of Thigh and calf
> Virchow's triad (venous thrombosis) "VIRchow":
Vascular trauma
Increased coagulability
Reduced blood flow (stasis)
> Kawasaki disease: features Disease name: a Kawasaki motorcycle.
Usually young children, epidemic in Japan: Japanese child rides the motorcycle.
Conjunctival, oral erythema: red eyes, mouth.
Fever: thermometer.
Erythema of palms, soles: red palms, soles.
Generalized rash: rash dots.
Cervical lymphadenitis: enlarged cervical nodes with inflammation arrows.
Vasculitis of arteries: inflammation arrows on arteries.
Cardiovascular sequelae [20%]: inflammation arrows on cardiac arteries.
Treat with aspirin: aspirin headlight.
· See diagram.
> Von Hippel-Lindau: signs and symptoms HIPPEL:
Hemanigoblastomas
Increased renal cancer
Pheochromocytoma
Port-wine stains
Eye dysfunction
Liver, pancreas, kidney cysts
· Bare bones version: Hippel-Lindau, with H and L as above.
> Heart failure causes "HEART MAy DIE":
Hypertension
Embolism
Anemia
Rheumatic heart disease
Thyrotoxicosis (incl. pregnancy)
Myocardial infarct
Arrythmia
Y
Diet & lifestyle
Infection
Endocarditis
> Anemia causes (simplified) ANEMIA:
Anemia of chronic disease
No folate or B12
Ethanol
Marrow failure & hemaglobinopathies
Iron deficient
Acute & chronic blood loss
> Pick's disease: location, action, epidemiology · See figure.
Pick axes are Picking away at the old woman's cerebral cortex, causing cortical atrophy.
2 pick axes on her brain: frontal lobe and anterior 1/3 of temporal.
An old woman, since epidemiology is elderly & more common in women.
> Pericarditis: findings PERICarditis:
Pulsus paradoxus
ECG changes
Rub
Increased JVP
Chest pain [worse on inspiration, better when lean forward]
> Fat embolism: findings "Fat, Bat, Fract":
Fat in urine, sputum
Bat-wing lung x-ray
Fracture history
· Also, fracture of FEMur causes Fat EMboli.
> Hemolytic anemia types SHEEP T!T:
Sickle cell
Heriditary splenocytosis
Enzyme deficiencies: [G6P, pyruvate kinase]
Erythroblastosis fetalis
Paroxysmal nocturnal hemoglobinuria
Trauma to RBCs
Immunohemolytics: [warm Ab, cold Ag]
Thalassemias: [alpha, beta]
> Disseminated Intravascular Cogulation: causes DIC:
Delivery TEAR (obstetric complications)
Infections (gram negative)/ Immunological
Cancer (prostate, pancreas, lung, stomach)
· Obstretrical complications are TEAR:
Toxemia of pregnancy
Emboli (amniotic)
Abrutio placentae
Retain fetus products
> Thrombotic thrombocytopenic purpura: signs FAT RN:
Fever
Anemia
Thrombocytopenia
Renal problems
Neurologic dysfunction
> Kawasaki disease: diagnostic criteria CHILD:
5 letters=5 days, >5 years old, 5 out 6 criteria for diagnosis:
Conjuctivitis (bilateral)
Hyperthermia (fever) >5 days
Idiopathic polymorphic rash
Lymphoadenopathy (cervical)
Dryness & redness of (i)lips & month (ii)palms & soles [2 separate criteria]
> Protein C, Protein S: function C and S are:
Clot
Stoppers
· These proteins inhibit coagulation.
> Aneurysm types MAD SCAB:
Mycotic
Atherosclerotic
Dissecting
Syphilitic
Capillary microaneurysm
Arteriovenous fistula
Berry
> Kawasaki's disease: features FEAR ME:
Fever
Eye: perilimbic sparing conjunctival injection
Adenopathy: usually cervical
Rash
Mouth: red lips
Extremities: red hands and feet
· Disease to be feared because of risk of coronary aneurysms.
> MI: complications "LEAP on the MAP":
LVF
Embolism (systemic)
Aneurysm (ventricular)
Progressive infarction
Myocardial rupture
Arrhythmia
Pericarditis
> Portal hypertension: features ABCDE:
Ascites
Bleeding (haematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen
> Anemia (normocytic): causes ABCD:
Acute blood loss
Bone marrow failure
Chronic disease
Destruction (hemolysis)
> TTP: clinical features Thrombosis and thrombocytopenia PARTNER together:
Platelet count low
Anemia (microangiopathic hemolytic)
Renal failure
Temperature rise
Neurological deficits
ER admission (as it is an emergency)
> Macrocytic anaemia: differential FAT RBC:
Fetus (pregnancy)
Alcohol
Thyroid disease(ie hypothyroidism)
Reticulocytosis
B12 and folate deficiency
Cirrhosis and chronic liver disease
> MI: post-MI complications ACT RAPID:
Arrhythmias (SVT, VT, VF)
Congestive cardiac failure
Tamponade/ Thromboembolic disorders
Rupture (ventricle, septum, papillary muscle)
Aneurysm (ventricle)
Pericarditis
Infaction (a second one)
Death/ Dressler's syndrome
> Cardiovascular risk factors FLASH BODIES:
Family history
Lipids
Age
Sex
Homocystinaemia
Blood pressure
Obesity
Diabetes mellitus
Inflammation (raised CRP)/ Increased thrombosis
Exercise
Smoking
> Cardiovascular risk factors (Framingham) FRAMINGHAM:
Family history
Running (exercise)
Adiposity (obesity)
Marlboros (tobacco)
Insulin resistance (diabetes)
Non-regulated lipids (dyslipidaemia)
Georgie Pie (high fat diet)
Hypertension
Age
Male
> Syncope (fainting) treatment If the face is red, raise the head.
If the face is pale, raise the tail.
> Preeclampsia: classic triad PREeclampsia:
Proteinuria
Rising blood pressure
Edema
> Stroke risk factors HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)
> Battle sign BattlE:
Behind Ear
> Stroke: young patient's likely causes 7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion
> Stroke: basic work up The 3 P's:
Pump
Pipes
Plasma
> Endocarditis: lab results suggesting it "High Tech Lab Results Point At Endocarditis":
Hematuria
Thrombocytopenia
Leukocytosis, -penia
Red blood cell casta
Proteinuria
Anemia
Elevated ESR
> Endocarditis: causes of culture negative endocarditis "With Negative Tests, Investigators Should FocusAttention Somewhere Meaningful":
Wrong diagnosis
Noninfectious endocarditis
Timing (cultures drawn at end of chronic course)
obligate Intracellular organisms
Slow growing fastidious organisms
Fungal infection
Antibiotic used previously
Subacute right-sided endocarditis
Mural endocarditis
> Endocarditis: indications for surgery PUS RIVER:
Prosthetic valve endocarditis (most cases)
Uncontrolled infection
Supporative local complications with conduction abnormalities
Resection of mycotic aneurysm
Ineffective antimicrobial therapy (eg Vs fungi)
Valvular damage (significant)
Embolization (repeated systemic)
Refractory congestive heart failure
> Heart valve auscultation sites "All Patients Take Meds":
· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.
· Alternatively: Always Pumps Too Much.
> Heart valve auscultation sites "All People Try Marijuana":
Aortic
Pulmonic
Tricuspid
Mitral
> Branham sign: definition BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.
> Heart ausculation sites: ribs Apt. M 225A:
Aortic valve
Pulmonary valve
Tricuspid valve
Mitral valve
· In order they correspond with the following landmarks:
2nd intercostal space (right)
2nd intercostal space (left)
5th intercostal space (left)
Apex (still the 5th intercostal space)
> Pancytopaenia differential "All Of My Blood Has Taken Some Poison":
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria
> Haematology: key numbers 3 and 4 are key in in haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.
> Sickle cell disease complications SICKLE:
Strokes/ Swelling of hands and feet/ Spleen problems
Infections/ Infarctions
Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
Kidney disease
Liver disease/ Lung problems
Erection (priapism)/ Eye problems (retinopathy)
> ADP: role in platelet aggregation ADP = Aggregation from the Dense bodies of Platelets.
> Anion gap metabolic acidosis: causes A MUDPILE CAT:
Alcohol
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Carbamazepine
Aspirin
Toluene
> HbA2: concentration in normal blood HbA2:
Concentration of HbA2 is 2% in normal adult blood.
> Metabolic acidosis: causes USED CAR:
Ureteroenterostomy
Saline hydration
Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
Diarrhea/ DKA/ Drugs
Carbonic anhydrase inhibitors
Ammonium chloride
Renal tubular acidosis
· Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic fistula.
> Non-gap acidosis: causes HARD UP:
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula
> Toxicity/ sepsis: signs 6 T's:
Tachycardia
Tachypnea
Tremors
Toxic look
Tiredness
Temperature (fever)
> Macrocytic anemia: causes ABCDEF:
Alcohol + liver disease
B12 deficiency
Compensatory reticulocytosis (blood loss and hemolysis)
Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
Endocrine (hypothyroidism)
Folate deficieny/ Fetus (pregnancy)
> Metabolic acidosis: causes KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis
> Raynaud's disease: causes BAD CT:
Blood disorders (eg polycythaemia)
Arterial (eg atherosclerosis, Buerger's)
Drugs (eg beta-blockers)
Connective tissue disorders (rheumatoid arthritis, SLE)
Traumatic (eg vibration injury)
> Ulcers: types VAN:
Venous/ Vasculitic
Arterial
Neuropathic
> Anemia: non-megaloblastic causes of macrocytic anemia HAND LAMP:
Hypothyroidism
Aplastic anaemia
Neonates
Drugs
Liver disease
Alcohol
Myelodyplasia
Pregnancy
> NSAIDs: contraindications NSAID:
Nursing and pregnancy
Serious bleeding
Allergy/ Asthma/ Angioedema
Impaired renal function
Drug (anticoagulant)
> ACEI: contraindictions PARK:
Pregnancy
Allergy
Renal artery stenosis
K increase (hyperkalemia)
> Haemoptysis: causes CAVITATES:
CHF
Airway disease, bronchiectasis
Vasculitis/ Vascular malformations
Infection (eg TB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach
> Anion gap metabolic acidosis: causes MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Infection
Lactic acidosis
Ethylene glycol
Salicylates
> Cyanosis: DDx COLD PALMS:
· Peripheral cyanosis:
Cold
Obstruction
LVF and shock
Decreased cardiac output
· Central cyanosis:
Polycythemia
Altitude
Lung dz
Met-, sulphaemoglobinaemia
Shunt
> Vascular endothelium: simplified cross-section LIMA:
Lumen
Intima
Media
Adventitia
> Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere":
Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy
> Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide
> Shock: signs and symptoms TV SPARC CUBE:
Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank
> Acute LVF management LMNOP:
Lasex (frusemide)
Morphine (diamorphine)
Nitrates
Oxygen (sit patient up)
Pulmonary ventilation (if doing badly)
> Subarachnoid hemorrhage (SAH) causes BATS:
Berry aneurysm
Arteriovenous malformation/ Adult polycystic kidney disease
Trauma (eg being struck with baseball bat)
Stroke
> Ventricular fibrillation: treatment "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock":
Shock= Defibrillate
Everybody= Epinephine
Little= Lidocaine
Big= Bretylium
Momma= MgSO4
Poppa= Pocainamide
> Chest pain treatment, for nurses "MOVE your patient!":
Monitor: put patient on cardiac monitor
Oxygen: put patient on O2
Venous: gain large bore venous access
EKG: 12 lead EKG
> Endotrachial tube deliverable drugs O NAVEL:
Oxygen
Naloxone
Atropine
Ventolin (albuterol)
Epinephrine
Lidocaine
· If you can't get IV access established, and have necessity to administer resuscitative meds, remember you have the airway and can give the above drugs.
· Drug delivery is enhanced if diluted with 10cc NS and rapid introduced for aeresolization.
· Alternatively, bare bone version is ALE, as above.
> Syncope causes, by system HEAD HEART VESSELS:
· CNS causes include HEAD:
Hypoxia/ Hypoglycemia
Epilepsy
Anxiety
Dysfunctional brain stem (basivertebral TIA)
· Cardiac causes are HEART:
Heart attack
Embolism (PE)
Aortic obstruction (IHSS, AS or myxoma)
Rhythm disturbance, ventricular
Tachycardia
· Vascular causes are VESSELS:
Vasovagal
Ectopic (reminds one of hypovolemia)
Situational
Subclavian steal
ENT (glossopharyngeal neuralgia)
Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)
Sensitive carotid sinus
> Atrial fibrillation: causes of new onset THE ATRIAL FIBS:
Thyroid
Hypothermia
Embolism (P.E.)
Alcohol
Trauma (cardiac contusion)
Recent surgery (post CABG)
Ischemia
Atrial enlargement
Lone or idiopathic
Fever, anemia, high-output states
Infarct
Bad valves (mitral stenosis)
Stimulants (cocaine, theo, amphet, caffeine)
> Malaria: complications of falciparum malaria CHAPLIN:
Cerebral malaria/ Coma
Hypoglycemia
Anaemia
Pulmonary edema
Lactic acidosis
Infections
Necrois of renal tubules (ATN)
> MI: immediate treatment DOGASH:
Diamorphine
Oxygen
GTN spray
Asprin 300mg
Streptokinase
Heparin
> Pain history checklist OLDER SAAB:
Onset
Location
Description (what does it feel like)
Exacerbating factors
Radiation
Severity
Associated symptoms
Alleviating factors
Before (ever experience this before)
> Pulseless Electrical Activity (PEA): checklist PEA:
Pulses check
Epinepherine
Atropine
> PEA/Asystole (ACLS): etiology ITCHPAD:
Infarction
Tension pneumothorax
Cardiac tamponade
Hypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/ Hypoxemia
Pulmonary embolism
Acidosis
Drug overdose
> V-fib/pulseless v-tach (new ACLS as of 2001) "EVAL My Pumper":
Epinephrine
Vasopressin
Amiodarone (class IIb--better for heart failure)
Lidocaine (indeterminate - better for young, healthy or persistent)
MgSO4 (IIb for hypomagnesemic state or torsades)
Procainamide (IIb for intermittent/recurrent VF/VT)
> Asystole: treatment "Have some asystole "TEA":
Transcutaneous pacing
Epi
Atropine
> JVP: raised JVP differential PQRST (EKG waves):
Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)
> JVP: raised JVP: extra-cardiac causes FAT PEA:
Fever
Anaemia
Thyrotoxicosis
Pregnancy
Exercise
A-V fistula
· These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).
> Shock: general features CHORD ITEM:
Cold, clammy skin
Hypotension
Oliguria
Rapid, shallow breathing
Drowsiness, confusion
Irritability
Tachycardia
Elevated or reduced central venous pressure
Multi-organ damage
> Myocardial infarction: some emergency treatment drugs ABCD:
Aspirin
Beta blockers
Clot busters (thromboytics)
Dynamite (nitrates)
> Branchial arch giving rise to aorta "Aor- from Four":
Aorta is from fourth arch.
> Tetrology of Fallot "Don't DROP the baby":
Defect (VSD)
Right ventricular hypertrophy
Overriding aorta
Pulmonary stenosis
> Tetrology of Fallot "IHOP-International House of Pancakes":
Interventricular septal defect
Hypotrophy of right ventricle
Overriding aorta
Pulmonary stenosis
> Tetrology of Fallot PROVe:
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
> Heart: primitive heart chambers in fetal heart "The Broken Vein Always Stenoses, But Veins Are Smooth":
· The order of the compartments is: runcus, bulbus
Primitive Ventricle
Primitive Atrium
Sinus venosus
·The connections are:
Bulbotruncal junctionVentriculobulbar foramen
Atrioventricular canal
Sinuatrial junction
> Tetrology of Fallot "Problems Of Small Hearts":
Pulmonary stenosis
Overriding aorta
Ventricular Septal defect
Hypertrophy of right ventricle
> Coagulation common pathway: factors in order 10 + 5 - 2 = 13
Coagulation common pathway:
Factor X to Factor V to Factor II to Factor XIII
> Vitamin K dependent cofactors "Several Tend To Nicely Stop Clots":
Factor Seven, Ten, Two, Nine.
Protein S, Protein C.
> Femoral triangle: arrangement of contents NAVEL:
· From lateral hip towards medial navel:
Nerve (directly behind sheath)
Artery (within sheath)
Vein (within sheath)
Empty space (between vein and lymph)
Lymphatics (with deep inguinal node)
· Nerve/Artery/Vein are all called Femoral.
> Femoral triangle: arrangement of nerve, artery, vein VAN:
· From medial to lateral:
Vein
Artery
Nerve
· Nerve/Artery/Vein are all called Femoral.
> Aortic arch: major branch order "Know your ABC'S":
Aortic arch gives rise to:
Brachiocephalic trunk
left Common Carotid
left Subclavian
· Beware though trick question of 'What is first branch of aorta?' Technically, it's the coronary arteries.
> Lung lobe numbers: right vs. left Tricuspid heart valve and tri-lobed lung both on the right side.
Bicuspid and bi-lobed lung both on the left side.
> Ulnar nerve to ulnar artery and radial nerve to radial artery relations Think "peripheral nerves":
The ulnar nerve is "ulnar" to the ulnar artery.
Radial nerve is "radial" to the radial artery.
> Superior thyroid artery branches "May I Softly Squeeze Charlie's Girl?":
Muscular
Infrahyoid
Superior laryngeal
Sternomastoid
Cricothyroid
Glandular
> Female pelvic organs' blood supply "3 organs, each get 2 blood supplies":
Uterus: uterine, vaginal.
Rectum: middle rectal, inferior rectal [inferior rectal is the end of pudendal].
Bladder: superior vesical, inferior vesical.
> Liver: side with ligamentum venosum/ caudate lobe vs. side with quadrate lobe/ ligamentum teres"VC goes with VC":
The Venosum and Caudate is on same side as Vena Cava [posterior]. Therefore, quadrate and teres must be on anterior by default.
> Saphenous veins: path of great vs. small at malleolus "MAGdelaine has varicose veins" [The saphenous veins are important for varicose veins]:
Medial maleolus, Anterior to maleolus, and Great saphenous go together.
Then the opposites of these go together: Small saphenous is posterior to the lateral maleolus.
> Thoracic cage: relations to the important venous structures Behind the sternoclavicular joints: the brachiocephalic veins begin.
Behind the 1st costal cartilage on the right the superior vena cava begins.
Behind the 2nd costal cartilage on the right the azygos vein ends.
Behind the 3rd costal cartilage on the right the superior vena cava ends.
> External carotid artery branches "Sister Lucy's Powdered Face Often Attracts Silly Medicos":
· Before entering the parotid gland:
Superior thyroid
Lingual
Posterior auricular
Facial
Occipital
Ascending pharyngeal
· Ends as:
Superficial temporal and
Maxillary bifurcating in the in the parotid gland
> External carotid artery branches "Some Angry Lady Figured Out PMS":
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superificial temporal
> Descending abdominal aorta: seven divisions "Sometimes Intestines Get Really Stretched Causing Leakage":
Suprarenals [paired]
Inferior mesenteric
Gonadal [paired]
Renals [paired]
Superior mesenteric
Celiac
Lumbar [paired]
> Internal jugular vein: tributaries "Medical Schools Let Confident People In":
· From inferior to superior:
Middle thyroid
Superior thyroid
Lingual
Common facial
Pharyngeal
Inferior petrosal sinus
> Portal-systemic anastomoses: main 2 places that retroperitoneals connect into systemicRetroPeritoneals hook up with Renal and Paravertebral veins.
> Brachial artery: recurrent and collateral branches "I Am Pretty Sexy"
Inferior ulnar collateral artery goes with Anterior ulnar recurrent artery.
Posterior ulnar recurrent artery goes with Superior ulnar collateral artery.
· Alternatively: "I Am Pretty Smart".
> Thoracoacromial artery branches "CAlifornia Police Department":
Clavicular
Acromial
Pectoral
Deltoid
> Axillary artery branches "Send The Lord to Say A Prayer":
· From proximal to distal:
Superior thoracic
Thoracacromial
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
> Carotid sheath contents "I See 10 CC's in the IV":
I See (I.C.) = Internal Carotid artery
10 = CN 10 (Vagus nerve)
CC = Common Carotid artery
IV = Internal Jugular Vein
> Internal iliac artery: posterior branch PILS:
Posterior branch
Iliolumbar
Lateral sacral
Superior gluteal
> External carotid artery branches StApLE OPIS:
Superior thyroid
Ascending pharyngeal
Lingual
External maxillary (facial)
Occipital
Posterior auricular
Internal maxillary
Superficial temporal
> Axillary artery branches "Suzy Thompkins Loves Sex, Alcohol, and Pot":
· From proximal to distal:
Superior thoracic
Thoracacromial
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
> Maxillary artery branches "DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone AlcoholicsAnonymous":
Deep auricular
Anterior tympanic
Middle meningeal
Inferior alveolar
Accessory meningeal
Masseteric
Pterygoid
Deep temporal
Buccal
Sphenopalatine
Descending palatine
Infraorbital
Posterior superior alveolar
Middle superior alveolar
Pharyngeal
Anterior superior alveolar
Artery of the pterygoid canal
> Femoral hernia: epidemiology FEMoral hernias are more common in FEMales.
> External carotid artery branches "So Long For Acting Old Parenting Means Stability":
Superior thyroid
Lingual
Facial
Ascending pharyngeal
Occiptal
Posterior auricular
Maxillary
Superficial temporal
> Inferior vena cava tributaries "I Like To Rise So High":
Illiacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein.
· Think of the IVC wanting to rise high up to the heart.
> Cavernous sinus contents O TOM CAT:
O TOM are lateral wall components, in order from superior to inferior.
CA are the components within the sinus, from medial to lateral. CA ends at the level of T from O TOM.
· See diagram.
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI)
T: When written, connects to the T of OTOM.
> Femoral triangle: contents NAVY:
· In order from lateral to medial:
Nerve
Artery
Vein
Y of the groin
· Alternatively: Y = Y-fronts [male underwear].
> Internal iliac artery: anterior branches What Bill admitted to Hilary: "I Milked Our Insatiable Intern's UddersUnder the Desk":
Inferior gluteal
Middle rectal
Obturator
Inferior vesical artery
Internal pudendal artery
Umbilical
U/D=Uterine artery (female)/ Deferential artery (male)
> Thoracoacromial artery branches ABCD:
Acromial
Breast (pectoral)
Clavicular
> Axillary artery branches "Screw The Lawyer Save A Patient":
Superior thoracic
Thoracoacromiol
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
Alternatively: "Some Times Life Seems A Pain".
> External carotid artery branches "Sally Ate Lots Of Fresh Produce March Through September":
Superior thyroid
Ascending laryngeal
Lingual
Occipital (O before F is an extremely common variation)
Facial
Posterior auricular
Maxillary
Transverse facial
Superficial temporal
> Atrioventricular valves "LAB RAT":
Left Atrium: Bicuspid
Right Atrium: Tricuspid
> External carotid artery branches "She Lay Flaccid As Olaf's Penis Slipped In":
· From caudal to cephalad:
Superior thyroid
Lingual
Facial
Ascending pharyngeal
Occipital
Posterior auricular
Superficial temporal
(Internal) maxillary
> Brachial artery is medial to biceps tendon "BAMBI":
Brachial Artery is Medial to Biceps In elbow.
> External carotid artery branches "Suzy Always Lays Flat On Pillows Making Sex Terrific":
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superificial Temporal
> Coelic trunk: branches Left Hand Side (LHS):
Left gastric artery
Hepatic artery
Splenic artery
> Heart valve sequence "Try Pulling My Aorta":
Tricuspid
Pulmonary
Mitral
Aorta
> Femoral artery deep branches "Put My Leg Down Please":
Profundus femoris (deep femoral artery)
Medial circumflex femoral artery
Lateral circumflex femoral artery
Descending genicular arteries
Perforating arteries
> Subclavian artery branches "Very Tired Individuals Sip Strong Coffee Served Daily":
Vertebral artery
Thyrocervical trunk
---Inferior thyroid
---Superficial cervical
---Suprascapular
Costocervical
---Superior intercostal
---Deep cervical
> Cardiac valves: order in circuit "TRI berore you BI":
Tricuspid valve is located in left heart and Bicuspid valve is located in right heart. Blood flows through the tricuspidbefore bicuspid.
> Heart valves: order in circuit "First learn a Tricycle, then learn a Bicycle":
Flow through Tricuspid first, then Bicuspid.
> External jugular vein: tributaries PAST:
Posterior external jugular vein
Anterior jugular vein
Suprascapular vein
Transverse cervical vein
> Branches of Internal Iliac Artery "I Love Going Places In My Very Own Underwear":
Ileolumbar
Lateral sacral
Gluteal (superior and inferior)
Pudendal (internal)
Inferior vesicle (uterine in females)
Middle rectal
Vaginal
Obturator
Umbilical
> Thoracoacromial trunk: branches "Cadavers Are Dead People":
Clavicular
Acromial
Deltoid
Pectoral
> Posterior mediastinum: contents DATES:
Descending aorta
Azygos and hemiazygous veins
Thoracic duct
Esophagus
Sympathetic trunk/ganglia
> Rheumatic fever: Jones 5 major criteria SPACE:
Subcutaneous nodules
Pancarditis
Arthritis
Chorea
Erythema Marginatum
>Mnemonic: Magic Number in Clinical Medicine (12±2):
Age of puberty
Anion gap
Osmolar gap
Alveolar-arterial oxygen gradient
Pulsus paradoxus
Pulse deficit (AF)
SBP between upper and lower limbs (Hill,s sign)
>ABCDEF: Secondary prevention in athersclerotic coronary artery disease
A: Antiplatelet agent
Angiotensin-converting enzyme inhibitor (for
those with left ventricular dysfunction)
Avoid tobacco
B: β-Blockers Blood pressure control C: Cholesterol-lowering drug therapy
D: Dietary control
Diabetes control
E: Exercise
F: Fish oil (omega-3 fatty acids)
>CAUSES OF VALVULAR HEART DISEASE
--------------------------------------------------
C- Congenital,Coronary artery disease,Connective tissue disorder,Congestive cardiomyopathy,Carcinoid disease
A- Acute Rheumatic fever,Aortic dissection,Ankylosing spondylitis
U- Gout
S- Syphilitic aortitis,Scheie's syndrome
E- Ehler's Danlos syndrome
S- Storage(glycogen)
O- Osteogenesis imperfecta
F- Radiation fibrosis
V- Chronic Rheumatic valvular disease,Aortic valvular calcification,Prosthatic valve calcification
A- Aortitis
L- Libman sachs endocarditis
V-
U-
L-
A-
R- Rheumatoid arthritis, Reiter' syndrome, Relapsing polychondritis
H- Hypertension, Hurler's syndrome, Hunter's syndrome, Hyper lipoproteinemia, Hypertrophic cardiomyopathy, Hyper eosinophilic syndrome
E- pseudoxanthoma Elasticum
A-
R-
T- Trauma, Tumor's
D- Bachet's Disease, Degeneration
I- Ischaemia,Infarction, Idiopathic changes, Infective endocarditis
S-
E-
A-
S-
E-
>FOR THE SYMPTOMS OR DISEASE
VITMINS DEV this almost fits to all cause ...
V= VASCULAR CAUSE
I= INFECTIVE CAUSE OR IDIOPATHIC,
T=TRAUMATIC
A =AGEING
M= METABOLIC ,
I= ISCHEMIC , inflammatory
N=NEOPLASM
S=STRUCTURAL CONGENITAL DEFORMILTY.
D= DRUGS
E=ENDOCRINE ,ELECTROLYTE
V=Valvular
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