•Poor prognostic indicators in glomerular disease:
•Male sex
•Hypertension
•Persistent and severe proteinuria
•Elevated creatinine at time of presentation
•Rapid rate of decline in renal function •Tubulo-interstitial fibrosis observed on renal biopsy.
#Renal
•Male sex
•Hypertension
•Persistent and severe proteinuria
•Elevated creatinine at time of presentation
•Rapid rate of decline in renal function •Tubulo-interstitial fibrosis observed on renal biopsy.
#Renal
What are the signs of severe AR?
1-Prolonged EDM
2-A2 absent
3-Presence of left ventricular 3rd heart sound
4-Presence of Austin Flint murmur
5-Signs of LVF
6-Signs of enlarging heart.
#Cardiology
1-Prolonged EDM
2-A2 absent
3-Presence of left ventricular 3rd heart sound
4-Presence of Austin Flint murmur
5-Signs of LVF
6-Signs of enlarging heart.
#Cardiology
•To diagnose AR, remember the formula of 3:
-3 pulse: Collapsing (water hammer), dancing carotid and capillary pulsation.
-3 BP: Rise of systolic, fall of diastolic and wide pulse pressure.
-3 murmur: Early diastolic murmur, Austin Flint murmur and ejection systolic murmur.
#Cardiology
-3 pulse: Collapsing (water hammer), dancing carotid and capillary pulsation.
-3 BP: Rise of systolic, fall of diastolic and wide pulse pressure.
-3 murmur: Early diastolic murmur, Austin Flint murmur and ejection systolic murmur.
#Cardiology
•What is collapsing pulse, causes?
-In collapsing pulse, there is rapid upstroke and descent of pulse, seen by raising the arm above the head.
-Causes are:
1-AR (the most common cause)
2-Hyperdynamic circulation due to any cause
3-PDA
4-Rupture of sinus of Valsalva
5-Large AV communication.
#Cardiology
-In collapsing pulse, there is rapid upstroke and descent of pulse, seen by raising the arm above the head.
-Causes are:
1-AR (the most common cause)
2-Hyperdynamic circulation due to any cause
3-PDA
4-Rupture of sinus of Valsalva
5-Large AV communication.
#Cardiology
•What are the causes of high volume pulse?
1-Aortic regurgitation
2-Hypertension
3-Hyperdynamic circulation due to any cause (severe anemia, thyrotoxicosis, AV fistula, fever, Beriberi, pregnancy, P. disease etc.)
4-PDA.
#Cardiology
1-Aortic regurgitation
2-Hypertension
3-Hyperdynamic circulation due to any cause (severe anemia, thyrotoxicosis, AV fistula, fever, Beriberi, pregnancy, P. disease etc.)
4-PDA.
#Cardiology
•Why this is called Water hammer pulse?
-The name originated from a Victorian toy, consisted of a sealed tube, half filled with water and half being vacuum.
-Inversion of the tube causes the fluid to fall rapidly without air resistance and strike the end like hammer blow.
#Cardiology
-The name originated from a Victorian toy, consisted of a sealed tube, half filled with water and half being vacuum.
-Inversion of the tube causes the fluid to fall rapidly without air resistance and strike the end like hammer blow.
#Cardiology
•Are “high volume pulse” and “collapsing pulse” synonymous?
-Collapsing pulse is always high volume, but all high volume pulse are not collapsing..!
#Cardiology
-Collapsing pulse is always high volume, but all high volume pulse are not collapsing..!
#Cardiology
Prognosis in AS:
-If aortic valve isn't replaced, the onset of angina, syncope and dyspnea has been shown to correlate with an average time to death of 5, 3 and 2 years.
-Dyspnea has the worst prognosis followed by syncope then angina.
#Cardiology
-If aortic valve isn't replaced, the onset of angina, syncope and dyspnea has been shown to correlate with an average time to death of 5, 3 and 2 years.
-Dyspnea has the worst prognosis followed by syncope then angina.
#Cardiology
•What are the signs of Pulmonary HTN?
-Palpable P2
-Prominent ‘a’ wave in JVP
-Left parasternal heave (indicates RVH)
-Epigastric pulsation (indicates RVH)
-Loud P2 on auscultation
-Early diastolic murmur (Graham steel murmur due to PR).
#Cardiology
-Palpable P2
-Prominent ‘a’ wave in JVP
-Left parasternal heave (indicates RVH)
-Epigastric pulsation (indicates RVH)
-Loud P2 on auscultation
-Early diastolic murmur (Graham steel murmur due to PR).
#Cardiology
•What are the causes of mid diastolic murmur (MDM)?
-Mitral stenosis
-ASD (due to increased flow through tricuspid valve)
-Tricuspid stenosis
-Left atrial myxoma
-Austin-Flint murmur in aortic regurgitation
-Carey Coomb’s murmur (a soft MDM due to mitral valvulitis in ARF).
#Cardiology
-Mitral stenosis
-ASD (due to increased flow through tricuspid valve)
-Tricuspid stenosis
-Left atrial myxoma
-Austin-Flint murmur in aortic regurgitation
-Carey Coomb’s murmur (a soft MDM due to mitral valvulitis in ARF).
#Cardiology
•What is Lutembacher’s syndrome?
-Combination of ASD with rheumatic MS (it occurs in 4% cases of ASD).
#Cardiology
-Combination of ASD with rheumatic MS (it occurs in 4% cases of ASD).
#Cardiology
•Signs of severe MS are:
-Pulse: Low volume
-S1: soft
-Opening snap: nearer to the S2
-MDM: Prolonged
-Evidence of pulmonary HTN and pulmonary congestion.severe it may be <1 cm2 (tight ms).
#Cardiology
-Pulse: Low volume
-S1: soft
-Opening snap: nearer to the S2
-MDM: Prolonged
-Evidence of pulmonary HTN and pulmonary congestion.severe it may be <1 cm2 (tight ms).
#Cardiology
•What is the significance of opening snap in MS?
-It indicates that the valve cusp is still mobile
-It is absent when the valve is calcified
-The gap between S2 and opening snap indicates the severity of MS. The diminishing gap indicates severe MS
-It is always due to organic MS.
#Cardiology
-It indicates that the valve cusp is still mobile
-It is absent when the valve is calcified
-The gap between S2 and opening snap indicates the severity of MS. The diminishing gap indicates severe MS
-It is always due to organic MS.
#Cardiology
•What is the feature of non-pliable mitral valve?
-Muffled first heart sound and no opening snap.
#Cardiology
-Muffled first heart sound and no opening snap.
#Cardiology
What are the causes of culture negative endocarditis?
-Prior antibiotic treatment (common cause).
-Fungal, yeast, anaerobic infection or Q fever (needs special culture).
Right sided endocarditis.
-Non-infective endocarditis: Libmann Sac (non-bacterial verrucous endocarditis in SLE, which is usually associated with antiphospholipid antibody syndrome), marantic endocarditis (non-bacterial thrombotic or verrucous endocarditis found in malignancy, such as bronchial carcinoma)
#Cardiology
-Prior antibiotic treatment (common cause).
-Fungal, yeast, anaerobic infection or Q fever (needs special culture).
Right sided endocarditis.
-Non-infective endocarditis: Libmann Sac (non-bacterial verrucous endocarditis in SLE, which is usually associated with antiphospholipid antibody syndrome), marantic endocarditis (non-bacterial thrombotic or verrucous endocarditis found in malignancy, such as bronchial carcinoma)
#Cardiology
What are the signs of activity in rheumatic fever?
-Persistent fever
-Tachycardia
-High ESR
-Leukocytosis
-Evidence of carditis.
#Cardiology
-Persistent fever
-Tachycardia
-High ESR
-Leukocytosis
-Evidence of carditis.
#Cardiology
Remember:
-Skin infection with streptococci is not associated with RF. It may be associated with acute post streptococcal glomerulonephritis.
#Cardiology
-Skin infection with streptococci is not associated with RF. It may be associated with acute post streptococcal glomerulonephritis.
#Cardiology
•What are the causes of migrating polyarthritis?
-Rheumatic fever
-Septicemia
-Gonococcal arthritis
-Syphilitic arthritis
-Lyme arthritis
-Hyperlipidemia (type 2)
-SLE.
#Cardiology
-Rheumatic fever
-Septicemia
-Gonococcal arthritis
-Syphilitic arthritis
-Lyme arthritis
-Hyperlipidemia (type 2)
-SLE.
#Cardiology
-Differential cyanosis (cyanosis in toes, not in the hand) occurs in PDA.
-Clubbing (differential clubbing clubbing in toes, not in the hand, occurs in PDA).What are the causes of mid diastolic murmur (MDM)?
-MS
-ASD (due to increased flow through tricuspid valve)
-Tricuspid stenosis
-Left atrial myxoma
-Austin-Flint murmur in aortic regurgitation
-Carey Coomb’s murmur (a soft MDM due to mitral valvulitis in acute rheumatic fever.
#Cardiology
-MS
-ASD (due to increased flow through tricuspid valve)
-Tricuspid stenosis
-Left atrial myxoma
-Austin-Flint murmur in aortic regurgitation
-Carey Coomb’s murmur (a soft MDM due to mitral valvulitis in acute rheumatic fever.
#Cardiology