CARDIAC PHYSIOLOGYMNEMONICS

1. CARDIAC PHYSIOLOGYMNEMONICS

Heart compensatory mechanisms that 'save' organ blood flow during shock

"Heart SAVER":

Sympathoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system

Heart: tropic definitions

Lusitropic: loose is relaxed. Definition: relax heart.
Inotropic: when heart wall contracts, moves inward. Definition: contract heart.
Chronotropic: 'chrono-' means 'time'. Defintion: heart rate (of SA node impulses).
Dromotropic: only one left, it must be conduction speed by default.

Heart valves: closure sequence

"Many Things Are Possible":

Mitral, Tricuspid, Aortic, Pulmonic

Heart valves: sequence of flow

TRIPS BIAS:

TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar

JVP: wave form

ASK ME:

Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium

Sino-atrial node: innervation

Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).

2. CARDIAC PATHOLOGYMNEMONICS

Aneurysm: types

MAD SCAB:

Mycotic
Atherosclerotic
Dissecting
Syphilitic
Capillary microaneurysm
Arteriovenous fistula
Berry

Aortic regurgitation: causes

CREAM:

Congenital
Rheumatic damage
Endocarditis
Aortic dissection/ Aortic root dilatation
Marfan Syndrome

Aortic stenosis: characteristics

SAD:

Syncope
Angina
Dyspnea

Apex beat: abnormalities found on palpation, causes of impalpable

HILT:

Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping

*If it is impalpable, causes are COPD:

COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia

Apex beat: differential for impalpable apex beat

DOPES:

Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Situs inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg. pectus excavatum)

Atherosclerosis: risk factors

"You're a SAD BET with these risk factors":

Sex: male
Age: middle-aged, elderly
Diabetes mellitus
BP high: hypertension
Elevated cholesterol
Tobacco

Beck's triad (cardiac tamponade)

3 D's:

Distant heart sounds
Distended jugular veins
Decreased arterial pressure

Cardiovascular: risk factors

FLASH BODIES:

Family history
Lipids
Age
Sex
Homocystinemia
Blood pressure
Obesity
Diabetes mellitus
Inflammation (raised CRP)/ Increased thrombosis
Exercise
Smoking

CHF: causes of exacerbation

FAILURE:

Forgot medication
Arrhythmia/ Anemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Up regulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary

CHF: causes of exacerbation

A SMITH PEAR:

Anemia
Salt/ Stress/ Stopping meds
MI
Infection/ Ischemia
Thyroid (high/low)
HTN
Pericarditis
Endocarditis (valve disease)
Arrhythmia
Rx (beta blocker, etc)

Coronary artery bypass graft: indications

DUST:

Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

Deep venous thrombosis: genetic causes

ALASCA:

Anti thrombin III
Leiden (Factor V)
APC (Activated Protein C)
S-protein deficiency
C-protein deficiency
Anti phospholipid antibody

Deep venous thrombosis: diagnosis

DVT:

Dilated superficial veins/ Discoloration/ Doppler ultrasound
Venography is gold standard
Tenderness of Thigh and calf

Heart failure: causes

"HEART MAy DIE":

Hypertension
Embolism
Anemia
Rheumatic heart disease
Thyrotoxicosis (incl. pregnancy)
Myocardial infarct
Arrythmia
Y
Diet & lifestyle
Infection
Endocarditis

Heart failure: signs

TAPED TORCH:

Tachycardia
Ascites
Pulsus alternans
Elevated jugular venous pressure
Displaced apex beat
Third heart sound
Oedema
Right ventricular heave
Crepitations or wheeze
Hepatomegaly (tender)

Heart murmurs

"hARD ASS MRS. MSD":

hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic

Hypertension: secondary hypertension causes

CHAPS:

Cushing's syndrome
Hyperaldosteronism [aka Conn's syndrome]
Aorta coarctation
Phaeochromocytoma
Stenosis of renal arteries

*Note: only 5% of hypertension cases are secondary, rest are primary.

Jugular venous pressure (JVP) elevation: causes

HOLT: Grab Harold Holt around the neck and throw him in the ocean:

Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase

JVP: raised JVP differential

PQRST (EKG waves):

Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)

JVP: raised JVP: extra-cardiac causes

FAT PEA:

Fever
Anaemia
Thyrotoxicosis
Pregnancy
Exercise
A-V fistula

*These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).

MI: complications

HAS CRAPPED:

Heart failure/ Hypertension
Arrhythmia
Shock
Cardiac Rupture
Aneurysm
Pericarditis
Pulmonary Emboli
DVT

MI: complications

LEAP on the MAP

LVF
Embolism (systemic)
Aneurysm (ventricular)
Progressive infarction
Myocardial rupture
Arrhythmia
Pericarditis

MI: post-MI complications

ACT RAPID:

Arrhythmias (SVT, VT, VF)
Congestive cardiac failure
Tamponade/ Thromboembolic disorders
Rupture (ventricle, septum, papillary muscle)
Aneurysm (ventricle)
Pericarditis
Infaction (a second one)
Death/ Dressler's syndrome

MI: signs and symptoms

PULSE:

Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating

MI: sequence of elevated enzymes after MI

"Time to CALL 911":

From first to appear to last:

Troponin
CK-MB
AST
LDH1

Mitral stenosis (MS) vs. regurgitation (MR): epidemiology

MS is a female title (Ms.) and it is female predominant.
MR is a male title (Mr.) and it is male predominant.

Murmur attributes

IL PQRST (person has ill PQRST heart waves):

Intensity
Location
Pitch
Quality
Radiation
Shape
Timing

Murmurs: innocent murmur features

8 S's:

Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression

Murmurs: locations and descriptions

"MRS ASS":

MRS: Mitral Regurgitation--Systolic
ASS: Aortic Stenosis--Systolic

The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.

Murmurs: louder with inspiration vs expiration

LEft sided murmurs louder with Expiration
RIght sided murmurs louder with Inspiration.

Murmurs: questions to ask

SCRIPT:

Site
Character (eg harsh, soft, blowing)
Radiation
Intensity
Pitch
Timing

Murmurs: right vs. left loudness

"RILE":

Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.

Murmurs: systolic

MR PV TRAPS:

Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis

Murmurs: systolic types

SAPS:

Systolic
Aortic
Pulmonic
Stenosis

Systolic murmurs include aortic and pulmonary stenosis. Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricuspid regurgitation.

Murmurs: systolic vs. diastolic

PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

Image result for systolic vs diastolic murmurs

Pericarditis: causes

CARDIAC RIND:

Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome

Pericarditis: findings

PERICarditis:

Pulsus paradoxus
ECG changes
Rub
Increased JVP
Chest pain [worse on inspiration, better when lean forward]

Peripheral vascular insufficiency: inspection criteria

DISC V:

Distribution of hair
Integrity of skin
Symmetry of leg musculature
Color of toenails
Varicose veins

Rheumatic fever: Revised Jones criteria

JONES PEACE:

*Major criteria: (JONES)

Joints: migratory
O (heart shaped) Carditis: new onset murmur
Nodules, subcutaneous: extensor surfaces
Erythema marginatum
Sydenham's chorea

*Minor criteria: (PEACE)

PR interval, prolonged
ESR elevated
Arthralgias
CRP elevated
Elevated temperature (fever)

Need 2 major or 1 major and 2 minor criteria, plus evidence of recent GAS infection (throat cx, rapid antigen test, or rising strep antibody titer).

Rheumatic fever: Revised Jones' criteria

JONES crITERIA:

*Major criteria: (JONES)

Joint (arthritis)
Obvious (Cardiac)
Nodule (Rheumatic)
Erythema marginatum
Sydenham chorea

*Minor criteria: (crITERIA)

Inflammatory cells (leukocytosis)
Temperature (fever)
ESR/CRP elevated
Raised PR interval
Itself (previous Hx of Rheumatic fever)
Arthralgia

Shock: general features

CHORD ITEM:

Cold, clammy skin
Hypotension
Oliguria
Rapid, shallow breathing
Drowsiness, confusion
Irritability
Tachycardia
Elevated or reduced central venous pressure
Multi-organ damage

Syncope causes, by system:

HEAD, HEART & VESSELS:

CNS causes include: (HEAD):

Hypoxia/ Hypoglycemia
Epilepsy
Anxiety
Dysfunctional brain stem (basivertebral TIA)

Cardiac causes are: (HEART)

Heart attack
Embolism (PE)
Aortic obstruction (IHSS, AS or myxoma)
Rhythm disturbance, ventricular
Tachycardia

Vascular causes are : VESSELS

Vasovagal
Ectopic (reminds one of hypovolemia)
Situational
Subclavian steal
ENT (glossopharyngeal neuralgia)
Low systemic vascul
Sensitive carotid sinus

3. CARDIAC PHARMACOLOGYMNEMONICS

ACEI: Contraindications

PARK:

Pregnancy
Allergy
Renal artery stenosis
K increase (hyperkalemia)

Anti- arrhythmics (classification I to IV ):

MBA College

In order of class I to IV:

Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers

Anti- arrhythmics: class III members

BIAS:

Bretylium
Ibutilide
Amiodarone
Sotalol

Anti-arrythmics: for AV nodes

Do Block AV":

Digoxin
B-blockers
Adenosine
Verapamil

Asprin: side effects

ASPRIN

Aplastic anemia
Salt & water retention
Peptic ulcer
Rash (skin Rash)
Induce bronchial asthma
Nephrotoxicity

Beta blockers: cardio selective beta blockers

"Beta blockers Acting Exclusively At Myocardium"

Cardio selective beta blockers are:

Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol

Beta-blockers: main contraindications, cautions

ABCDE:

Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)

Beta-blockers: side effects

"BBC Loses Viewers In Rochedale":

Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia

Captopril (an ACE inhibitor): side effects

CAPTOPRIL:

Cough
Angioedema/ Agranulocystosis
Proteinuria/ Potassium excess
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
Renal failure (and renal artery stenosis contraindication)/ Rash
Indomethacin inhibition
Leukopenia/ Liver toxicity