How sensitive is ECG for diagnosis of MI?

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

Characteristics of normal sinus rhythm?

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

What are the common sites of cardiac calcification?

 a LV apex

b LV aneurysm

c Aortic valve

d Mitral valve

e PDA calcification

f Pericardium

g Coronaries

i Conduction system

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

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

• CAD
• AR
• HOCM
• Mitral annulus calcification (MR)

What are Brushfield's spots?

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

 

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

• TTP
• Polycythemia vera
• Sickle cell anemia
• Primary thrombocytosis

What are the causes of Precordial tenderness?

• Tietze syndrome
• Acute pericarditis
• Acute myocarditis

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

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

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

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

When does bruit suggest?

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

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

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

What is Clindactyly?

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

What are the techniques to record Blood pressure?

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

Differential Diagnosis - Upper limb and Lower limb Blood pressure difference

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

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

 

Differential Diagnosis - Upper limb Blood pressure difference

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

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

What is Mean Blood Pressure?

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

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

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

What are Korotkoff sounds? What are its five phases?

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

 

What is the average Blood Pressure in children?

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

SBP = 90+(AGE X 5)/3

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

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

What is the meaning of the word " STETHOSCOPE"?

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

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

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

What are Pacemaker sounds?

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

Perception of pulse is by which receptors?

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

Character of pulse depends on what factors?

• Stroke volume
• Ejection velocity
• Vascular compliance
• Systemic vascular resistance

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

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

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

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

What is Arachnodactyly? What is Metacarpal Index?

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

1. Ratio of Middle finger length to total hand length
2. METACARPAL INDEX - 

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

Differential Diagnosis - Hypertelorism?

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

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

Cafe eu' lait is seen in?

• Carney complex (LAMB and NAME Syndrome)

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

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

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

Differential Diagnosis - Micrognathia (llar to Hypognathia)

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

Differential Diagnosis - Cardio-Facial Syndrome ?

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

Differential Diagnosis - Hypognathia

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

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

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

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

What are the Shroeder's criteria of successful reperfusion?

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

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

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

Name Important Cardiac drugs which can cause Hepatitis?

A2L(all)  MY QUeST VaRy

1. Acebutolol
2. Amiodarone
3. Labetolol
4. MethYldopa
5. Quinidine
6. Statins
7. Verapamil

• Granuloma- Clofibrate

• Mixed - Captopril

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

• MCL1 is also known as Marriot's lead

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

Refer : Practical Electrocardiography

What is BIX RULE?

Described by Harold Bix, a Viennese Cardiologist from Baltimore

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

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

Why is Right Ventricle less prone to infarction?

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

Mnemonic to remember causes of ACUTE PERICARDITIS

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

what is CHADS2 Score? Importance of the score.

CHADS2 score helps in assessment of risk of STROKE IN  AF

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

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

Differential Diagnosis of Low pressure TR

1. Infective Endocarditis
2. Ebstein's anomaly
3. Right venrticular MI
4. Carcinoid
5. Tricuspid valve prolapse
6. Pacemaker
7. RV Endomyocardial fibrois
8. Loffler's
9. RA Myxoma
10. Trauma

what does ischemia mean?

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