•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
-When Eisenmenger’s syndrome develops, there is cyanosis, clubbing and evidence of pulmonary hypertension.
-Pansystolic murmur may disappear, because of equalization of pressure in right and left ventricle.
#Cardiology
-Pansystolic murmur may disappear, because of equalization of pressure in right and left ventricle.
#Cardiology
•What is Eisenmenger’s syndrome?
-Pulmonary hypertension with reversal of shunt is called Eisenmenger’s syndrome.
-Causes are:
VSD
ASD
PDA
-In VSD, this occurs in early life, in PDA a little later than VSD, in ASD this occurs in adult life.
#Cardiology
-Pulmonary hypertension with reversal of shunt is called Eisenmenger’s syndrome.
-Causes are:
VSD
ASD
PDA
-In VSD, this occurs in early life, in PDA a little later than VSD, in ASD this occurs in adult life.
#Cardiology
-Asthma with IHD:
-Antianginal nitrates, calcium channel blocker (diltiazem and verapamil) are drug of choice.
-Clopidogrel is preferred than aspirin (as it may trigger or aggravate asthma).
-Sometimes, cardioselective b-blocker (like metoprolol) may be given.
-Asthma should be well controlled.
#Respiratory
-Antianginal nitrates, calcium channel blocker (diltiazem and verapamil) are drug of choice.
-Clopidogrel is preferred than aspirin (as it may trigger or aggravate asthma).
-Sometimes, cardioselective b-blocker (like metoprolol) may be given.
-Asthma should be well controlled.
#Respiratory
Asthma with heart Failure:
-Diuretic is the drug of choice.
-ACE inhibitors should be continued, if tolerated.
-Digoxin may be given.
-Carvedilol may be used in low doses.
#Respiratory
-Diuretic is the drug of choice.
-ACE inhibitors should be continued, if tolerated.
-Digoxin may be given.
-Carvedilol may be used in low doses.
#Respiratory
Asthma with Pain:
-Paracetamol and tramadol are preferred for pain management.
COX 2 inhibitor can be used.
-NSAIDs like aspirin, diclofenac, etc. should be avoided.
-Steroid may be given, if needed.
-DMARDs are safe.
#Respiratory
-Paracetamol and tramadol are preferred for pain management.
COX 2 inhibitor can be used.
-NSAIDs like aspirin, diclofenac, etc. should be avoided.
-Steroid may be given, if needed.
-DMARDs are safe.
#Respiratory
-Asthma with Arrhythmia:
-Digoxin and amiodarone may be used.
-Aminophylline or theophylline should be avoided.
#Respiratory
-Digoxin and amiodarone may be used.
-Aminophylline or theophylline should be avoided.
#Respiratory
Drug of choice—calcium channel blocker or ARB (losartan, valsartan). ACE inhibitor is avoided as it may induce cough in Asthma.
#Respiratory
#Respiratory
Remember:
-Metformin should be avoided in uncontrolled asthma and contraindicated in acute severe asthma.
#Respiratory
-Metformin should be avoided in uncontrolled asthma and contraindicated in acute severe asthma.
#Respiratory
Cardiac asthma:
-It means left ventricular failure in which the patient usually presents with sudden severe dyspnea and cough with profuse mucoid expectoration.
-On examination, there are bilateral basal crepitations and no rhonchi or wheeze.
#Respiratory
-It means left ventricular failure in which the patient usually presents with sudden severe dyspnea and cough with profuse mucoid expectoration.
-On examination, there are bilateral basal crepitations and no rhonchi or wheeze.
#Respiratory
Gordon’s sign:
-Elicited by pinching the calcaneus tendon.
-If present, there is extensor plantar response.
#Neurology
-Elicited by pinching the calcaneus tendon.
-If present, there is extensor plantar response.
#Neurology
Oppenheim’s sign:
-Elicited by squeezing the calf or pressing heavily along the inner border of the tibia.
-If present, there is extensor plantar response.
#Neurology
-Elicited by squeezing the calf or pressing heavily along the inner border of the tibia.
-If present, there is extensor plantar response.
#Neurology