AV blocks (Wenkebach , Mobitz ) - First Second Complete Heart Block

EKG Findings - Axis in Degrees

Pulmonary Embolism - EKG Findings

Torsade de pointes

Drugs list Torsade de pointes :

• Class 1 Anti-Arrhythmia : Quinidine , Procainamide , Disopyramide
• Class 3 Anti-Arrhythmia : Sotalol , Ibutilide , dofetilide

• Combination of Class 1 and Class 3 : Amiadrone

• Antipsychotic : Haloperidol
• Antidepressants : TCA 

Abnormal Pulses and Possible Etiologies

Abnormal Pulses 

Pulsus alternans: sign of left ventricular systolic dysfunction

Pulsus bigeminus: sign of hypertrophic obstructive cardiomyopathy
(HOCM)

Pulsus bisferiens: in aortic regurgitation

Pulsus tardus et parvus: aortic stenosis

Pulsus paradoxus: cardiac tamponade and tension pneumothorax

Irregularly irregular: atrial fibrillation

Features of constrictive pericarditis

Features of constrictive pericarditis

Etiology 

• Idiopathic or viral pericarditis
• Cardiac surgery or radiation therapy
• Tuberculous pericarditis (in endemic areas)

Clinical presentation

• Fatigue and dyspnea on exertion
• Peripheral edema and ascites
• Increased JVP
• Pericardial knock may be heard
• Pulsus paradoxus
• Kussmaul's sign

Diagnostic findings

• ECG may be nonspecific or show atrial fibrillation or low voltage QRS complex
• Imaging shows pericardial thickening and calcification
• Jugular venous pulse tracing shows prominent x and y decents.

Findings of Cor pulmonale

Characteristic findings of Cor pulmonale

Common etiologies :

• COPD
• Interstitial lung disease
• Pulmonary vascular disease (eg, thromboembolic)
• Obstructive sleep apnea

Symptoms :

• Dyspnea on exertion, fatigue, lethargy
• Exertional syncope (due to decreased CO)
• Exertional angina (due to increased myocardial demand)

Examination : 

1. Peripheral edema
2. Increased Jugular venous pressure with prominent a wave
3. Loud S2
4. Right sided heave
5. Pulsatile liver from congestion
6. Tricuspid regurgitation murmur

Imaging :

• EKG : partial or complete RBBB , right axis deviation, right ventricular hypertrophy right ventricular enlargement

• Echocardiogram : Pulmonary hypertension, dilated right ventricle, tricuspid regurgitation

Right heart catheterization: Gold standard for Dx showing right ventricular dysfunction, pulmonary HTN and no left heart disease.

PDA (patent ductus arteriosus) dependent Congenital Heart Diseases

• COA (coarctation of aorta)

• D-TGA (d-transposition of the great arteries)

• Hypoplastic left heart syndrome

• TAPVR (total anomalous pulmonary venous return)

• Tricuspid atresia

Heart murmur maneuvers (Easy way to Understand)

Carotid Echocardiogram (right carotid artery plaque)

Patient is having a plaque in his right carotid artery 

Vascular and immunologic manifestations of infective endocarditis

Vascular & immunologic manifestations of infective endocarditis:

Duke Criteria

Vascular phenomena:

• Systemic arterial emboli (focal neurologic deficits, renal or splenic infarcts)
• Septic pulmonary infarcts
• Mycotic aneurysm
• Conjunctival hemorrhages
• Janeway lesions- Macular, erythematous, non-tender lesions on the palms and soles.

Immunologic phenomena:

• Osler's nodes- Painful, violaceous nodules seen on the fingertips & toes.
• Roth spots- Edematous and hemorrhagic lesions of the retina.
• Glomerulonephritis
• Arthritis or positive rheumatoid factor.

Submaximal Exercise Testing

Cardiovascular Angiography