Right heart failure
Restrictive cardiomyopathy
Heart Sound | Synonym | Mechanism | Diseases |
---|---|---|---|
S2 | Opening snap | MV & TV opening | MS & TS |
S3 | Ventricular gallop | Ventricular filling Volume overload | HF & DCMP & MR & TR |
S4 | Atrial gallop | Atrial contraction Diastolic dysfunction | HF & HCMP |
Type | Etiology |
---|---|
Wide | Pulmonary stenosis RBBB |
Paradoxical | Aortic stenosis LBBB |
Fixed | ASD |
Disease | Phase | ↑ Preload | ↑ Afterload |
---|---|---|---|
VSD | Systolic | ↑ | ↑ |
AS | Systolic | ↑ | ↓ |
AR | Diastolic | ↑ | ↑ |
MS | Diastolic | ↑ | - |
MR | Systolic | ↑ | ↑ |
MVP | Systolic | ↓ | ↓ |
HCMP | Systolic | ↓ | ↓ |
Grade | Thrill | Stethoscope |
---|---|---|
1 | - | Against |
2 | - | Against |
3 | - | Against |
4 | + | Against |
5 | + | Partially off |
6 | + | Completely off |
Finding | Conditions |
---|---|
Diffuse ST elevation | Acute pericarditis |
Electrical alternans | Pericardial effusion |
Low voltage | Pericardial effusion |
Widened QRS | Ventricular rhythm Hyperkalemia TCA toxicity |
Bidirectional VT | Digitalis toxicity |
S1Q3T3 | Pulmonary embolism |
Delta waves | Wolff-Parkinson-White (WPW) syndrome |
U waves | Hypokalemia |
Sine waves | Hyperkalemia |
Osborn waves | Hypothermia |
Mechanism | Medication |
---|---|
Na-K pump blockers | Digitalis |
β1 agonists | Norepinephrine Epinephrine Isoproterenol Dobutamine Dopamine |
PDE inhibitors | Inamrinone Milrinone |
Inotrope | Mechanism | CO | SVR | MAP | IE |
---|---|---|---|---|---|
Norepinephrine | α1 > β1 | - | ↑ (1°) | ↑ | 100 |
Epinephrine | β1 > β2 > α1 | ↑ (1°) | ↓ | ↑ | 100 |
Isoproterenol | β1 = β2 | ↑ (1°) | ↓ (1°) | - | 100 |
Dobutamine | β1 > β2 | ↑ (1°) | ↓ | ↑ | 1 |
Dopamine | D > β1 > α1 | ↑ | ↓ (1°) | ↓ | 1 |
Inamrinone Milrinone | - | ↑ (1°) | - | ↑ | 15 |
Parameter | Σ(E × R) |
---|---|
E | Equivalent |
R | Rate (µg/kg/min) |
Type | Prevalence |
---|---|
Secundum | 70% |
Primum | 20% |
Sinus venosus | 10% |
Coronary sinus | < 1% |
Defect | Obligatory Shunt | Cyanosis |
---|---|---|
Truncus arteriosus | - | Non-differential |
Transposition of great artery (TGA) | (ASD / VSD) & PDA | Reverse differential |
Tricuspid atresia | ASD & (VSD / PDA) | Non-differential |
Tetralogy of Fallot (TOF) | VSD & PDA | Non-differential |
Total anomalous pulmonary venous return (TAPVR) | ASD / VSD / PDA | Non-differential |
Hypoplastic left heart syndrome (HLHS) | ASD & PDA | Non-differential |
Eisenmenger syndrome of ASD | - | Non-differential |
Eisenmenger syndrome of VSD | - | Non-differential |
Eisenmenger syndrome of PDA | - | Differential |
Defect | Conditions |
---|---|
Endocardial cushion defects | Down syndrome |
Atrial septal defect (ASD) | Down syndrome Fetal alcohol syndrome |
Ventricular septal defect (VSD) | Down syndrome Fetal alcohol syndrome VACTERL association Apert syndrome |
Patent ductus arteriosus (PDA) | Congenital rubella |
Tetralogy of Fallot (TOF) | DiGeorge syndrome Velocardiofacial syndrome |
Mitral valve prolapse (MVP) | Ehlers-Danlos syndrome (EDS) Marfan syndrome Fragile X syndrome Rheumatic fever ADPKD |
Supravalvular aortic stenosis | Williams syndrome |
Bicuspid aortic value Coarctation of the aorta (CoA) | Turner syndrome |
Ebstein anomaly | Lithium |
Libman-Sacks endocarditis | Systemic lupus erythematosus (SLE) |
Coronary artery aneurysms | Kawasaki disease |
Aortic dissection | Ehlers-Danlos syndrome (EDS) Marfan syndrome Tertiary syphilis |
HFrEF | HFpEF | |
---|---|---|
LVEDV | ↑ | ↓ |
LVESV | ↑ | ↓ |
SV | ↓ | ↓ |
LVEF | ↓ | - |
Dysfunction | Systolic | Diastolic |
Etiology | ACS & DCMP | HCMP & RCMP |
Class | Mechanism | Medication |
---|---|---|
1 | Na channel blockers | Class 1A: Quinidine Procainamide Disopyramide |
Class 1B: Lidocaine Mexiletine | ||
Class 1C: Flecainide Propafenone | ||
2 | β antagonists | - |
3 | K channel blockers | Amiodarone Ibutilide Dofetilide Sotalol |
4 | Ca channel blockers | Verapamil Diltiazem |
- | - | Adenosine Digitalis Magnesium |
ECG | Heart | Phase | Ion Channel | Antiarrhythmics |
---|---|---|---|---|
Heart rate | SA node | 4 | Na & K | Class 2 |
PR interval | AV node | 0 | Ca | Class 2 & 4 |
QRS complex | Ventricle | 0 | Na | Class 1 |
QT interval | Ventricle | 2 & 3 | K | Class 1 & 3 |
Condition | Energy (J) |
---|---|
VF | 120 ~ 200 |
Pulseless VT | 120 ~ 200 |
Unstable polymorphic VT | 120 ~ 200 |
Condition | Energy (J) |
---|---|
Unstable narrow-QRS tachycardia | 50 ~ 100 |
Unstable atrial flutter | 50 ~ 100 |
Unstable atrial fibrillation | 120 ~ 200 |
Unstable monomorphic VT | > 100 |
Type | Pathogenesis | T Wave | ST Segment | Q Wave | Triggers | Cardiac Enzymes |
---|---|---|---|---|---|---|
Variant [Prinzmetal] angina | Coronary artery spasm | HTW | STE | - | Drugs | - |
Stable angina | Coronary artery thrombosis | - | STD | - | Exertion | - |
Unstable angina | Coronary artery thrombosis | TWI | STD | - | Anytime | - |
NSTEMI | Subendocardial infarction | TWI | STD | - | Anytime | ↑ |
STEMI | Transmural infarction | HTW | STE | PQW | Anytime | ↑ |
Score | Risk | Management |
---|---|---|
< 3 | Low | Cardiac stress test |
≥ 3 | High | Coronary angiography |
Time (days) | Histology | Complications |
---|---|---|
< 1 | Coagulative necrosis Contraction bank Wavy fiber | Cardiogenic shock Arrhythmia Heaert failure |
1 ~ 3 | - | Fibrinous pericarditis |
3 ~ 14 | Granulation tissue | Pseudo-aneurysm Free wall rupture Papillary muscle rupture |
> 14 | Contracted scar | Aneurysm Mural thrombus Dressler syndrome |
Endpoint | Outcome |
---|---|
Mortality | Biosprosthetic > Mechanical |
Durability | Biosprosthetic < Mechanical |
Bleeding | Biosprosthetic < Mechanical |
Thromboembolism | Biosprosthetic < Mechanical |
Etiology | Management |
---|---|
Bacterial | Antibiotics |
Viral | NSAIDs Colchicine |
Fibrinous | Aspirin |
Uremic | Corticosteroids |