Cardiology for PLAB-1: A Comprehensive Review PDF

Cardiology for PLAB-1: A Comprehensive Review Introduction to Cardiac Tamponade Definition: Fluid accumulation in the pericardial space causing obstruction to blood inflow into ventricles Causes: Acute pericarditis, aortic dissection, trauma Beck's triad: Hypotension,...

Cardiology for PLAB-1: A Comprehensive Review Introduction to Cardiac Tamponade Definition: Fluid accumulation in the pericardial space causing obstruction to blood inflow into ventricles Causes: Acute pericarditis, aortic dissection, trauma Beck's triad: Hypotension, Muffled heart sounds, Raised JVP (prominent x descent, absent y This Photo by Unknown Author descent) is licensed under CC BY-SA  Cardiac Tamponade: Paradoxical Pulse Definition: Mechanism: >10 mmHg inspiratory drop of systolic BP During inspiration, increased blood flow to right ventricle causes: Interventricular septum bulges towards left ventricle Decreased left ventricular volume Reduced cardiac output Cardiac Tamponade: Diagnosis and Treatment ECG Treatment Diagnosis: findings: options: Echocardiography Reduced amplitude (investigation of QRS complexes, Pericardiocentesis choice) electrical alternans IV fluids (if patient is in shock) Thi s Photo by Unknown Author i s l icensed under CC BY-SA-NC Acute Pericarditis: Overview Definition: Inflammation of the pericardium Presentation: Symptoms: Sharp pleuritic pain, increases during inspiration, relieved by leaning forward Auscultation: Friction rub ECG: Widespread saddle-shaped ST elevation This Photo by Unknown Author is licensed under CC BY-NC Acute Pericarditis: Causes and Treatment Causes: Viral infection (e.g., coxsackievirus B) Post-MI (fibrinous pericarditis) and Dressler syndrome Autoimmune (SLE, RA) Uraemia Radiation therapy Treatment: NSAIDs Colchicine Corticosteroids This Photo by Unknown Author is licensed under CC BY-NC-ND Cardiac Murmurs: Mitral Valve Disorders Mitral Stenosis: Mid-diastolic murmur at cardiac apex Associated with opening snap Mitral Regurgitation: Pansystolic murmur at apex radiating to axilla  Cardiac Murmurs: Aortic Valve Disorders Aortic Stenosis: Aortic Regurgitation: Crescendo/decrescendo systolic murmur Diastolic decrescendo murmur Bounding pulse Wide pulse pressure  Ventricular Septal Defect (VSD): Pansystolic murmur Chronic VSD: Possible shunt reversal Cardiac (Eisenmenger syndrome) Murmurs: Tricuspid Regurgitation: Pansystolic murmur at left lower Other Defects sternal border Patent Ductus Arteriosus: Continuous machinery murmur Best heard in left infraclavicular area  Cardiac Murmurs: Hypertrophic Obstructive Cardiomyopathy Crescendo/decrescendo Murmur increases with: systolic murmur Valsalva maneuver Standing up (decreased preload)  Cardiomyopathy: Types and Features Dilated Hypertrophic Restrictive Cardiomyopathy: Cardiomyopathy: Cardiomyopathy: Causes: Alcohol, Cause: Autosomal Causes: viral myocarditis, dominant Amyloidosis, doxorubicin mutation sarcoidosis, post- Features: Systolic Features: Diastolic radiation fibrosis dysfunction, heart dysfunction, Features: Diastolic failure, S3 heart syncope during dysfunction, right- sound exercise sided symptoms (edema, ascites) Cardiomyopathy: Treatment Approaches Dilated Cardiomyopathy: ACE inhibitors Beta-blockers Diuretics Hypertrophic Cardiomyopathy: Beta-blockers or calcium channel blockers ICD (for arrhythmia) Restrictive Cardiomyopathy: Beta-blockers Diuretics Digoxin  Thi s Photo by Unknown Author i s l icensed under CC BY-SA-NC Characteristics: AV Conduction Prolonged PR interval (>200ms) Block: First- All P waves conducted Treatment: Degree No treatment required  Thi s Photo by Unknown Author i s l icensed under CC BY-SA Characteristics: AV Conduction PR interval lengthens progressively until a beat is missed Block: Second- Variable RR interval Treatment: Degree Mobitz Type If hypotension or bradycardia present, treat with Atropine I AV Conduction Block: Second-Degree Mobitz Type II Characteristics: Dropped beats (QRS complex) Fixed PR interval Treatment: Pacemaker Thi s Photo by Unknown Author i s l icensed under CC BY-SA AV Conduction Block: Third-Degree (Complete) Atria and ventricles contract independently Characteristics: No association between P wave and QRS complex Myocardial infarction, Lyme Causes: disease Thi s Photo by Unknown Author i s l icensed under CC BY-SA-NC Immediate: Atropine 500 mcg IV, followed by transcutaneous Treatment: pacing Definitive: Pacemaker Anti-arrhythmic Medications: Class I and II Class I (Sodium channel blockers): Drugs: Quinidine, lidocaine Uses: Atrial and ventricular arrhythmias Side effects: Cinchonism (headache, tinnitus) Class II (Beta-blockers): Drug: Metoprolol Uses: SVT, rate control for AF and atrial flutter Side effects: COPD/asthma exacerbation, AV block  Class III (Potassium channel blockers): Anti- Drug: Amiodarone arrhythmic Uses: Ventricular tachycardia Medications: Side effects: Pulmonary fibrosis, hepatotoxicity, thyroid dysfunction, Class III and corneal deposits IV Class IV (Calcium channel blockers): Drug: Verapamil Uses: Rate control in AF Side effects: Edema, constipation, AV block  Anti-anginal Medications: Nitrates and CCBs Drugs: Nitroglycerin, Isosorbide dinitrate Nitrates: Mechanism: Reduces preload, decreases myocardial oxygen requirements Side effects: Headache, tolerance, interaction with sildenafil Calcium Drugs: Verapamil, Diltiazem Channel Mechanism: Decreases cardiac contractility, vasodilation, reduces afterload Blockers: Side effects: Bradycardia, transient asystole  Anti-anginal Medications: Beta-blockers and Ivabradine Drugs: Atenolol, Bisoprolol, Metoprolol Beta- Mechanism: Decreases myocardial oxygen requirements by reducing heart rate blockers: Side effects: Bradycardia, AV block Mechanism: Reduces heart rate Ivabradine: Side effect: Phosphenes (visual disturbances) Cardiology for PLAB-1: Advanced Topics Amiodarone: Pre- treatment Tests Essential tests before starting amiodarone: Thyroid function tests Liver function tests Serum electrolyte and urea measurement (crucial) Chest radiography Electrocardiography Cyanotic Congenital Heart Diseases Thi s Photo by Unknown Author i s l icensed under CC BY Cyanotic Congenital Heart Diseases (Part 1) Tricuspid Absent tricuspid valve Atresia: Associated with ASD and VSD Transposition Pulmonary artery exits from left of Great ventricle Arteries: Aorta leaves from right ventricle Cyanotic Tetralogy of Fallot: Four key features: Congenital Pulmonary stenosis Right ventricular hypertrophy Heart Overriding of aorta Diseases VSD X-ray: Boot-shaped heart (Part 2) Clinical: Squatting spells Cyanotic Congenital Heart Diseases (Part 3) Persistent Truncus Arteriosus: Failure of truncus arteriosus to form pulmonary trunk and aorta Ebstein Anomaly: Atrialization of the right ventricle Associated with lithium use during pregnancy Total Anomalous Pulmonary Venous Connection: Pulmonary vein drains into the right heart Acyanotic Congenital Heart Diseases (Part 1) Ventricular Septal Atrial Septal Patent Ductus Defect (VSD): Defect (ASD): Arteriosus (PDA): Most common Fixed split S2 Continuous congenital heart machinery defect murmur in left Pansystolic infrascapular murmur region Acyanotic Congenital Heart Diseases (Part 2) Coarctation of Aorta: Associated with Turner syndrome Hypertension in upper limb with brachiofemoral delay Increased risk of Berry aneurysms and cerebral hemorrhage Eisenmenger Syndrome: Long-standing left-to-right shunts (VSD, ASD, PDA) Progression: Pulmonary hypertension → Shunt reversal → Late cyanosis and clubbing Hypertension: Definition and Medications Clinic BP ≥ 140/90 mmHg Definition: Ambulatory BP measurement ≥ 135/85 mmHg ACE Inhibitors: Medications Side effects: Cough, angioedema, hyperkalemia Calcium Channel Blockers: and Side Side effects: Peripheral edema, dizziness, flushing Effects: Thiazide Diuretics: Side effects: Hypokalemia, hyperuricemia, postural hypotension, increased serum lithium levels Postural Hypotension Definition: Drop in blood pressure upon standing Key Patients on multiple antihypertensive medications consideration: Always consider postural hypotension in hypertensive Clinical pearl: patients with recurrent falls Infective Endocarditis: Risk Factors and Signs Risk Factors: Valvular heart disease Valve replacement Previous episode of IE (highest risk) Intravenous drug use Signs: Murmur and fever Roth spots: White spots on retina surrounded by hemorrhage Osler nodes: Raised and tender lesions on fingers Janeway lesions: Painless, erythematous lesions on palm or sole Splinter hemorrhages on nail beds Thi s Photo by Unknown Author i s l icensed under CC BY-NC-ND Infective Endocarditis: Signs Thi s Photo by Unknown Author i s l icensed under CC BY-NC-ND Infective Endocarditis: Etiology and Diagnosis Common Causes: Streptococci and Staphylococcus aureus Mitral valve commonly affected In injection drug users: Tricuspid valve involvement, often S. aureus Diagnostic Approach: New murmur + Fever → Consider IE Initial steps: Blood culture → Echocardiography Modified Duke Criteria: Two major criteria, or One major criterion and three minor criteria, or Five minor criteria Infective Endocarditis: Management Native Amoxicillin + Gentamicin Valve: For MRSA: Vancomycin + Gentamicin Prosthetic Vancomycin + Gentamicin + Rifampin Valve:  Characteristics: Irregular RR interval Atrial No discrete P waves Irregularly irregular pulse rate Fibrillation: Treatment: Unstable vitals: Electrical cardioversion Characteristics Stable vitals: Rate control: Beta-blockers and Treatment Rhythm control: Amiodarone, flecainide Anticoagulation: Warfarin or NOAC Note: CHA2DS2-VASc score determines need for anticoagulation Thi s Photo by Unknown Author i s l icensed under CC BY-NC  Identical and rapid back-to-back P Characteristics: waves Sawtooth appearance on ECG Atrial Flutter Treatment: Similar to atrial fibrillation Thi s Photo by Unknown Author i s l icensed under CC BY-SA-NC  Torsades de Pointes Definition: Type of polymorphic ventricular tachycardia QRS complexes appear to twist around the baseline on ECG Associated with QT prolongation Causes: Long QT syndrome Electrolyte abnormalities (hypomagnesemia, hypokalemia, hypocalcemia) Medications (antipsychotics, erythromycin) Treatment: IV magnesium sulphate Correction of electrolyte abnormalities Removal of causative drug Defibrillation if progresses to VF Thi s Photo by Unknown Author i s l icensed under CC BY-SA-NC Ventricular Tachycardia Features: Wide QRS complex (broad complex tachycardia) Can progress to ventricular fibrillation Management: Unstable vitals: With pulse: Cardioversion Thi s Photo by Unknown Author i s l icensed under CC BY-NC Without pulse: Defibrillation Stable vitals: Beta-blockers Non-dihydropyridine CCB Sodium channel blockers  Thi s Photo by Unknown Author i s l icensed under CC BY-SA Characteristics: Completely disordered ventricular electrical activity No identifiable QRS complexes Ventricular Always pulseless Treatment: Immediate defibrillation to restore sinus rhythm Fibrillation Clinical Pearl: In broad complex tachycardia with hemodynamic instability: If pulse present → Cardiovert If no pulse → Defibrillate (unsynchronized cardioversion)  Characteristics: Wolff- Pre-excitation on ECG Delta waves Parkinson- Prolonged QRS complex Clinical Presentation: Sudden onset of symptoms (pallor, palpitations, difficulty breathing) White Often presents in children or young adults Symptoms may resolve spontaneously Syndrome Thi s Photo by Unknown Author i s l icensed under CC BY-SA  Definition: Characteristics: Common Types: Rapid heart Narrow QRS AV Nodal Supraventricular rhythm originating above the complex (unless aberrant Reentrant Tachycardia Tachycardia (SVT) ventricles conduction) Regular rhythm (AVNRT) AV Reentrant Sudden onset and Tachycardia (AVRT) termination Atrial Tachycardia Thi s Photo by Unknown Author i s l icensed under CC BY-SA Congenital Heart Ventricular Septal Defect (VSD): Characterized by a pansystolic murmur Diseases: Key Points In chronic cases, can lead to Eisenmenger syndrome (shunt reversal) Patent Ductus Arteriosus (PDA): Presents with a continuous machinery murmur Best heard in the left infraclavicular area Atrial Septal Defect (ASD): Not specifically mentioned in the original content, but is a common congenital heart defect Often presents with a fixed splitting of S2 heart sound Tetralogy of Fallot: Not mentioned in the original content, but is an important congenital heart defect Consists of four defects: VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta Coarctation of the Aorta: Another important congenital heart defect not mentioned in the original content Presents with upper body hypertension and weak femoral pulses General considerations: Congenital heart diseases can present with various murmurs May lead to complications like cyanosis, heart failure, or pulmonary hypertension Early detection and intervention are crucial for better outcomes  Common Treatments for Cardiac Conditions Cardiac Tamponade: Acute Pericarditis: Cardiomyopathies: Pericardiocentesis NSAIDs Dilated: ACE inhibitors, beta-blockers, diuretics IV fluids (if patient is in shock) Colchicine Hypertrophic: Beta-blockers or calcium channel Corticosteroids blockers, ICD (for arrhythmia) Restrictive: Beta-blockers, diuretics, digoxin AV Conduction Blocks: Arrhythmias: Angina: First-degree: No treatment required Class I antiarrhythmics (e.g., quinidine, lidocaine) Nitrates (e.g., nitroglycerin, isosorbide dinitrate) Second-degree Mobitz I: Atropine (if Class II antiarrhythmics (beta-blockers, e.g., Calcium channel blockers (e.g., verapamil, symptomatic) metoprolol) diltiazem) Second-degree Mobitz II: Pacemaker Class III antiarrhythmics (e.g., amiodarone) Beta-blockers (e.g., atenolol, bisoprolol, Third-degree: Immediate - Atropine and Class IV antiarrhythmics (calcium channel metoprolol) transcutaneous pacing; Definitive - Pacemaker blockers, e.g., verapamil) Ivabradine Side Effects of Cardiac Treatments Side Effects Antiarrhy thmic Medicat ions: Class I (e.g., Q uinidine): Cinchonism: Headache, tinnitus Class II (Bet a-blockers): of Cardiac Exacerbati on of CO PD and asthma AV block Class III (e.g., Amiodarone): Pulmonary fibrosis Hepatotoxicity Hypo or hyperthyroidism Treatments Corneal deposi ts Sotalol and ibut ilide: Torsades de pointes Class IV (Calcium Channel Blockers): Edema Const ipation AV block Other Antiarrhythmi cs: Adenosi ne: Hypotension Flushing Bronchospasm Anti-anginal Medications: Nitrates: Headache Tol erance Interaction with sildenafil Cal cium Channel Block ers: Bradycardia Transient asystole Beta-blockers: Bradycardia AV block Iv abradine: Phosphenes (visual di sturbances) Pacemakers and ICDs: Infection Bleedi ng Lead displacement Dev ice mal function  Remember the modified Duke criteria for infective endocarditis Differentiate between cyanotic and acyanotic congenital heart diseases Know the management of atrial fibrillation based on stability Understand the differences between VT and VF, especially in terms of management Be familiar with pre-treatment tests for amiodarone Recognize the importance of electrolyte imbalances in arrhythmias Understand the basics of ECG interpretation for common arrhythmias Key Points for PLAB-1 Cardiology Electrolyte Imbalances and Cardiac Conditions for PLAB-1  Hypokalaemia (K+