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