Cardio Flashcards
Clinical features of infective endocarditis
. Sub conjunctival hemorrhage
. Roths spots
. Petechial hemorrhage in mucous membranes
. Murmurs,cardiac failure
. Splenomegaly
. Systemic emboli
. Splinter hemorrhage
. Clubbing
. Oslers nodes
. Haematuria
. Loss of pulses
Dukes criteria
Definite endocarditis: 2 major/1 major and 3 minor/5 minor
Possible endocarditis:1 major and 1 minor/3 minor
Major criteria
Positive blood culture
. Typical organism from two cultures
. Persistent positive blood cultures taken >12 hrs apart
. Three or more positive cultures taken over one HR
Endocardial involvement
. Positive echocardiographic findings of vegetations
. New valvular regurgitation
Minor criteria
. Predisposing valvular or cardiac abnormality
. Intravenous drug misuse
. Pyrexia>=38 C
. Embolic phenomenon
. Vasculitic phenomenon
. Blood culture suggestive
. Suggestive echo findings
Types of pulse felt
. Bounding pulse with high amplitude- aortic regurg,anemia,sepsis(large stroke volume)
. Slow rising,weak delayed oulse- aortic stenosis
. Irregularities -arrythmia,atrial fibrillation
JVP elevated and reduced where
Elevated in right heart failure
Reduced in hypovolemia
Apex beat diff feels
Displaced and thrusting-voline overload like mitral and aortic regurg
. Discrete and heaving- pressure overload like aortic stenosis
. Palpable S1- tapping Apex beat,mitral stenosis)
. Palpable p2- severe pulm hypertension
. Left parasternla heave - right ventricular hypertrophy
. Palpable thrill-aortic stenosis
Blood supply of heart and innervation
. Left main coronary artery,dividing into left anterior descending artery and left circumflex artery.
LAD supplys anterior part of septum,the anterior,lateral and apical part of LV.
CX supplys lateral,posterior and inferior part of LV
. Right coronary artery,supplys,RA,RV and iferoposterior aspects of LV
. Posterior descending,small branch of RCA(right Dom PPL) or CX(left Dom PPL)
Conduction system of heart
SA node at junction of RA and superior vena cava
Av node at right side of interatrial septum
Bundle of his
Left and right his bundles
Purkinje fibres
Basic unit of myocardial contraction
Sarcomere
Cardiac peptides
ANP -atrial myocytes,reduces blood pressure,diuretic,increases excretion of water and sodium from kidneys,vasodilator
BNP-ventricular myocytes
Neprilysin,enzyme from kidneys,breaks down anp and bnp and is vasoconstrictor
Windkessel effect
When blood is ejected from heart,the compliant aorta expands to accomodate the volume of blood,it prevents excessive rise in systolic BP while maintaining diastolic bp,thereby reducing afterload and maintaining coronary perfusion. These benefits r lost with progressive arterial stiffening with old age or advanced renal disease
Vaso active substances
Vasocontrictors - noradrenaline,angiotensin 2, endothelin 1
Vasodilator - adenosin,bradykinin, prostaglandin,nitric oxide
Short pr interval seen in
Wolff Parkinson white syndrome
Indications of exercise ecg
. To confirm diagnosis of angina
. To evaluate stable angina
. To assess prognosis after MI
. To assess outcome after coronary revascularization
. To diagnose and evaluate treatment of exercise induced arrythmias
Pressure gradient across a valve
Bernoulli equation
Pressure gradient = 4× peak velocity
NYHA classification of chest pain
Class 1: no limitation during ordinary activity
2: slight limitation during ordinary activity
3: marked limitation during normal activity,but goes at rest
4: at rest
