Cardiologу

PART 1

Anatomy of the heart

Cardiac arrest

Checking airway, breathing and circulation
1) Start CPR
30 compression: 2 breath
Minimize

PART 2

Electrically conductive disorders

Supraventricular tachycardia

Narrow QRS complex
HR >140bpm
Unusual P waves

Supraventricular tachycardia

Management:
For unstable patients: synchronized cardioversion
BP below 90/60 or

Atrial fibrillation

Absent P waves
V1,V2,V3, avF
Irregular rhythm

Atrial fibrillation

Management:
For unstable patients: synchronized cardioversion
For stable patients:
Beta blockers (Metoprolol)
Diltiazem
Verapamil
Digoxin

To

Atrial flutter

Management
For unstable patients: synchronized cardioversion
For stable: rate control + warfarin

Premature ventricular beat

Causes: post myocardial infarction, hypokalemia
Symptoms:
Dyspnea
Multiple/multifocal ectopic beats
Management
If no

Ventricular tachycardia

Tachycardia
Wide QRS
Regular rhythm
Management:
Unstable + Pulseless: unsynchronized cardioversion - defibrillator
Unstable +

Ventricular fibrillation

Zigzag pattern
Managment

Bradycardia

Causes:
Sinus node dysfunction
Conduction blocks
The rhythm with a rate of 50

Wolff Parkinson-white syndrome

Short PR interval <12 sec
Wide QRS
Delta wave
Management
Unstable patient: cardioversion
Stable:

Torsades De Pointes

Twisting of the QRS complex around the isoelectric line
No

Heart block

First degree: PR interval is more than 0.2 sec
No treatment

Heart block

Hyperkalemia

K+ nomal level 3.5-5.5
If there is ECG changes give IV calcium

Hypokalemia

LBBB

M shaped comlex usually in leads in V% and V6

LBBB

Right Bundle branch block

M shapes complex in leads usually in V1

Pericarditis

Caused by Viral coxsackie virus
Diffuse ST segment elevation
Treatment: NSAIDs

Symptoms of pericarditis
Chest

Hypertrophic obstructive cardiomyopathy

Clinical features Sudden loss of consciousness while on exertion,

PART 3

Abdominal aorta aneurysm

Clinical features:
A bulge or swelling in the aorta
Family history
May

Aortic dissection

Symptoms: severe, sudden, midline tearing or rippig sensation
Occlusion of the

Superior vena cava syndrome

Caused by: external compression or thrombosis
Malignant mediastinal tumour
Bronchogenic

Superior vena cava syndrome

Signs
Distended venous distention of the neck and chest

Superior vena cava syndrome

Hypertension

Causes:
Esential
Secondary
Kidney (glomerulonephritis, kidney artery stenosis)
Endocrine (primary aldosteronism, Cushing syndrome, pheochromocytoma)
Coarctation of

Hypertension

Diagnosis: ambulatory 24 hours monitoring

Management:
Diet, exercises, weight control
ACE inhibitors (-pril: Captopril,

Dilated Cardiomyopathy

Most common causes:
Alcohol, Coxsackie virus, drugs (doxorubicin, anthracycline)
Clinical features:
Pedal

PART 4

Mitral Stenosis

Clinical features:
murmur(mid-diastolic with presystolic accentuation)
loud S1
The character is

Mitral Regurgitation

The most common cause: mitral valve prolapse
Clinical features:
History of

Mitral valve prolapse

Clinical features:
Young females (with familial connection)
Atypical chest pain
Palpitations
Hyperventilation
Migranes

Aortic stenosis

Clinical features:
Chest pain
Syncope
SOB
Sudden death
Loss of consciousness
Microangiopathic hemolytic anemia
Small or weak

Aortic regurgitation

Causes by:
80% idiopatic
Marfan Syndrome
Rheumatic fever
Murmur:
Early diastolic decrescendo over left

Constrictive pericarditis

Causes: Tb, autoimmune disorders
Clinical features:
Systemic congestion
Paradoxical increase in JVP distention

Infective Endocarditis

Infection of the cardiac valves or endometrium
Clinical feature:
Fever of unknown

Infective Endocarditis

Symptoms:
Osler nodes
Janeway lesons
Splenomegaly
Petechiae
Roth spots
Cardiac Murmurs
Splinter hemorrhages
Clubbing

Infective Endocarditis

Diagnosis:
ERS increase, anemia and leucocytosis
In urine: proteinuria and hematuria
Blood

Myocardial infarction

Criteria of MI:
History of prolonged ischemic pain
Typical ECG appearance
Rise and

Myocardial infarction

Management:
Provide ABC (Airway, breathing, compression)
Aspirin
BB and ACE inhibitors
Coronary angioplasty
Nitrates
Anticoagulants (warfarin,

Rheumatic fever

Clinical features:
Young people 5-15
Acute onset fever, joint pain, malaise
Fitting arthralgia

Rheumatic fever erythema marginatum