Cardiology WorkBook

CARDIOLOGY
WORKBOOK
By
DR. PRIYANSH JAIN
Cardiology
DR. PRIYANSH JAIN

Index
INDEX OF CARDIOLOGY WORKBOOK

CHAPTER 1: HYPERTENSION………………………………….…..3
CHAPTER 2: RVF & LVF………………………………….………….9
CHAPTER 3: HEART FAILURE……………………………………..12
CHAPTER 4: CORONARY ARTERY DISEASE……………….18
CHAPTER 5: JUGULAR VENOUS PRESSURE……………….35
CHAPTER 6: PERICARDIAL DISORDERS…………………….39
CHAPTER 7: CARDIOMYOPATHY…………..…………………….45
CHAPTER 8: RHEUMATIC FEVER………………………………..54
CHAPTER 9: INFECTIVE ENDOCARDITIS……………………59
CHAPTER 10: ECG ……………………………………………………..62
CHAPTER 10: MITRAL STENOSIS………………………………84
CHAPTER 11: AORTIC REGURGITATION……………………86
CHAPTER 12: MURMUR………………………………………………88
DR. PRIYANSH JAIN MEDICINE 1

2 DR. PRIYANSH JAIN MEDICINE
CARDIOLOGY:HYPERTENSION
CHAPTER-1
HYPERTENSION
DEFINITION:
Bladder Size
- width - ……% of arm circumference
—length - ……% of arm circumference

If cuff size is smaller than required -
/
180
(NO SOUND )
150
BP- BP-
So, ausculatatory gap can lead to
If only increase in systolic or

diastolic BP- ………………. HTN.
Cause of
I
- I
-> >
⑮
-
CAUSES OF HYPERTENSION
3
-
·
-
Na+ cl-
!
E Na C
TARGET ORGAN DAMAGE
RA LA
RV LV
-
fi-
- AORTA

*
- ⑳
X
MANAGEMENT OF HYPERTENSION
-
120-129
Elevated
< 80
130-139
Stage - I
-80-89
I
·
≥90
Stage - II ≥140
Extra point
HTN After 20 week of pregnancy + proteinuria - ………………………..
HTN After 20 week of pregnancy + proteinuria + seizure - ………………………..
Tumor of adrenal medulla - ………………………..
CARDIOLOGY:HYPERTERSION
ANTI-HTN MEDICATION
A-Angiotensin converting enzyme inhibitors [ACE#]
-Eg:
-Additional effect:
-So, preffered in:

-S/E
-Angiotensin Receptor Blocker [ARB]
-Eg:
-Additional effect:
-So, preffered in:
B-
-Eg:
-Preffered in:
>
C-
-Eg:
-S/E:
-
D-
-Eg:
I -S/E:

Ist visit IInd visit IIIrd visit IVth visit
⑮ BP- BP- BP- BP-

Rx- Rx- Rx-
-If BP not controlled despite_____ classes of
anti-HTN drug including _______________.
C/a- -
Rx-
ORTHOSTATIC HYPOTENSION OR POSTURAL HYPOTENSION
BP on standing after ……. Min
S
supine BP
- -
If SBP falls :
OR DBP falls :
Rx of Orthostatic Hypotension:

HYPERTENSIVE URGENCY vs HYPERTENSIVE EMERGENCY

If SBP > …………or /& DBP > ………..
Target organ damage
↓ al
HYPERTENSIVE…………………. HYPERTENSIVE …………………….

-
Control the BP in next ……. Hrs

-
-
Al X
Control the BP
T
Control the BP in next …….Hr

RX =
- in next ……. Hrs
MALIGNANT HYPERTENSION
If BP more than ………………..

+
………………….
Associated with -
……………………..Appearance

🙇
🫀 🫀
SUMMARY FOR HYPERTENSION
Deflation rate = ______mm go Hg/sec. ( < 2 / <3 / <4 / <5 )
If small cuff is used = _____ _____ BP. ( false high / false low)
HTN pt. taking Allopurinol which anti-HTN should
be avoided __________. ( ACE# / ARB / Diuretic / B-blocker)
DM+HTN — _________. ( ACE# / ARB / Diuretic / B-blocker)
HTN+Protienuria — _________. ( ACE# / ARB / Diuretic/ B-blocker)
Post MI — HTN — Rx 1st line-
2nd line-
BP+Papilloedema — c/a — ______ ______.
Mean Arterial Pressure -
Pulse Pressure -
High pulse pressure -
Low pulse pressure -
permissive HTN -
DOC for scleroderma crisis - ( ACE# / ARB / Diuretic/ B-blocker)
DOC for u/l renal artery stenosis -( ACE# / ARB / Diuretic/ B-blocker)

CARDIOLOGY:RVF vs LVF
CHAPTER 2
RIGHT VENTRICULAR FAILURE
vs
LEFT VENTRICULAR FAILURE
RIGHT VENTRICULAR FAILURE [RVF]
J
Jugular vein
5
RA LA Pul. Vein
RV LV
Hepatic vein
Pul. Artery
Portal vein
PCWP — pulmonary capillary wedge pressure
COR PULMONALE Chronic pulmonary pathology
⑰
RA LA
Lung becomes stiff
-
RV LV
Strain on ……….
-D
P. Artery
Leads to ………
↳
ULTIMATELY……….
↓
CALLED AS ………. ……………

CARDIOLOGY:RVF vs LVF
LEFT VENTRICULAR FAILURE [LVF]
Pul vein
"
RA LA
RV LV
AORTA
Pul artery
C/F-
On auscultation- lungs -
Heart -
Pulse -
PAROXYSMAL NOCTURNAL DYSPNEA [PND]
60 yr
N ->
Uncontrolled HTN

💡
🙇
🫀
CARDIOLOGY: RVF vs LVF
ORTHOPNEA
N >
..
-
EXTRA POINT
PLATYPNEA
-
> N
Platypnea is seen in —
SUMMARY
Hepatojugular Reflex — __________. ( RVF / LVF )

JVP — ________. ( RVF / LVF )
N
PCWP — _______. ( RVF / LVF )

M
P. alternance — _________. ( RVF / LVF )

Hepatomegaly & Ascites — __________. ( RVF / LVF )
PND & ORTHOPNEA — _________. ( RVF / LVF )
Platypnea - seen in - _______ _______.

CARDIOLOGY:HEART FAILURE
CHAPTER 3
HEART FAILURE
DEFINITION
Pumping of oxygenated blood Demand of body
ETIOPATHOGENESIS
Risk factor / ethology -
-
RA LA
RV LV
n AORTA
CONCEPT OF EJECTION FRACTION
DIASTOLE
I LA
I LA
SYSTOLE
LV
LV
Aorta
Amount of blood in LV at the Blood pumped in aorta during systole -

end of diastole -

Type of Heart Failure based on EF
C/F
NYHA [NEW YORK HEART ASSOCIATION] STAGE FOR DYSPNEA
NYHA CLASS Level of Impairment

I No symptom limitation with ordinary physical activity
II Ordinary physical activity somewhat limited by dyspnea
(eg: long-distance walking, climbing flights of stairs)
III Exercise limited by Dyspnea with moderate workload
(eg: short-distance walking.
IV Dyspnea at rest with very little exertion
Objective Examination [O/E]

Investigation
Marker of HF -
ECHO -
STAGES OF HEART FAILURE

Risk factor for heart failure -
STAGE A STAGE B STAGE C STAGE D
RISK FACTOR
ECHO CHANGE
C/F
NYHA
MANAGEMENT OF HEART FAILURE

🙇 🫀
EXTRA POINT
If - DM+HF —> Prefferd anti-diabetic drug —>
a
11
HF+Atrial fibrillation [AF] —
SUMMARY OF HEART FAILURE

MCC of LVF- ……………. ( HTN / RHD / CAD / CMP / RVF )
MCC OF RVF- ………………( HTN / RHD / CAD / CMP / LVF )
If — Risk factor + —
— Echo-LVH — HF STAGE -
— Asymptomatic -
Drugs which survival in HF — A
—B

ACUTE DECOMPENSATION OF HEART FAILURE
Definition:
->
N
Goma Singh
— 55yr/M Pul. Vein
— Ch. smoker
"x1
— Uncontrolled HTN
RA LA
RV LV
AORTA
Pul artery
-0
C/F —
O/E — Lungs auscultation —

-
— SpO2 —
CxR —

Rx - DOC —
But if the BP is low ( ……………………. ………) - then 1st - …………………………………. &

once BP is stable then …………………………..
Other ways to effective blood volume reaching to Heart
To improve oxygenation [SpO2]

CARDIOLOGY:CORONARY ARTERY DISEASE
CHAPTER 4
CORONARY ARTERY DISEASE
- (
0
· ·
Cardiomyocyte Cardiomyocyte Cardiomyocyte
chest pain
Cardiac enzyme in blood

( TROPONIN)

RISK FACTORS OF CORONARY ARTERY DISEASE
Extra point
Alcohol
CHEST PAIN
1 - character -…….. ……………………………. Location - …………
- radiation to - ……………………………………………………
- associated with - ……………………………
2 - triggered by -……………
3. - relieved by -……………
Patient puts fist on chest c/a -

Investigation in CAD
ECG:
Pericardium
&B
Myocardium
RA LA
↳ Endocardium
RV LV
Endocardium Myocardium
1x Pericardium
LV
RV
- -
-
mini
me I
under sameunder me
· me"to

⑫
⑮
⑬ ⑯
⑪ au
⑪
aVL
⑭ NE
VI V4
T I
VL v5
I T
v3 V6
T
-
O E ⑨
① ⑨
I I
# I

LOCALISATION OF LESION VIA ECG

LMCA
#
RCA
ECG Leads Localisation of MI Artery involved
V1-V4
I/aVL/V5/V6
I/aVL/V1-V6
II/III/aVF
V1-V2
I/aVL
Options - anterior wall MI / lateral wall / high lateral wall

/ septal/ inferior / extensive
Blood vessel - LAD / LCX / LMCA / RCA

💡
EXTRA POINT
*
RCA
Inf. Wall MI
!
If V4R lead — showing changes —
CARDIAC MARKERS
Earliest to increase -
Best - 8o.o?·*
8@·
Marker of reinfraction - D
Future predictor -
CT-SCAN — NCCT
-
Coronary artery Myocardium
Atherosclerosis
MC artery to undergo atherosclerosis

CONCEPT OF STRESS TEST
-
I
->
HR —
Myocardial ischemia -
Chest Pain -
X
-
- Ischemia-
Stress - >
I -
Treadmill test
Protocol -
Target HR -
#
85 % of target HR
Achieved Not Achieved

2-D ECHO
LV LV
RWMA -Regional wall motion abnormality
Unfavourable condition Favourable condition
LV
-
-
-
LV
RWMA -
Myocardium viability -
LV Y LV
RWMA -
Myocardium viability -
CORONARY ARTERY DISEASE/ISCHEMIC HEART DISEASE
I I
↓ "
>
-> ->
-
Healthy Mild atherosclerosis Ischemia only if HR

*
(Asymptomatic)
"
->
- ...
:
-
Plaque disruption ->
&
is
·
Platelet aggregation X
Ischemia even at normal HR
-
'
= "
B
Infraction in myocardium but Infraction in myocardium

no ST elevation inECG With ST elevation inECG
Clot formation
Started
Chest Pain
N Al
ECG Troponin
STABLE ANGINA [ ]
C/F:
👩🦱
7th
N 6th
3rd floor
>
-- ⑳?
>
I
⑧
INV.
Rx —
Maximum mortality reduction by —
MC side effect of Nitrate —

USA [Unstable Angina] - NSTEMI COMPLEX
Pathogenesis:
"1-)) ))
->
C/F:
Investigation:
ECG -
Cardiac enzyme-
Rx:
So in USA-NSTEMI — plan for PCI if …………….score is………… ……
*PCI- Percutenous coronary intervention DR. PRIYANSH JAIN MEDICINE 27

ST-ELEVATED MI [STEMI]
= - 18)
Pathogenesis:
C/F:
Investigation: ECG -
TROPONIN -
Rx: ->
-> if PCI facility is more than ………. Hours away

-
Then go for ……………………….
Door to needle time
Agents
*
** if PCI facility is more than ………. Hours away
-
Then go for ……………………….
Door to needle time

💡
Other treatment - same as ……………….
EXTRA POINTS
After PCI — dual antiplatelet is given for — ___________.
Inf. Wall MI — RVMI — HR
— BP
ANGIOGRAPHY
If single vessel disease [SVD] or double vessel disease [DVD]
PTCA-Percutenous transluminal coronary angioplasty*

If TVD ( triple vessel disease)
TYPES OF MI
Type 1 Type 2
"
Type 3
Type 4 Type 5
-
-
.
I .

COMPLICATIONS OF MI
a) with 1st few hours
b) after 4 - 7 days of MI
RA LA RA LA
8.
RV LV RV LV
MI
c) after 4 - 7 days of MI
RA LA RA LA
->
RV
i LV RV LV
MI
D after 4 - 7 days of MI
c)
Papillary muscle
RA LA RA LA Papillary muscle rupture
- X
**
RV LV RV LV

d)
RA LA RA LA
RV LV RV LV
Pericardium
e)
Pul. Vein
-
RA LA
RV LV
n AORTA
Pul. Artery
KILIP CLASSIFICATION
No sign of HF
B/L crep. in 50% lungs
Frank Pul. edema
Pul. edema + Shock

PRINZMETAL ANGINA
Pathogenesis:
-(1) F()
Coronary artery
Myocardium
Winter exposure
=
C/F:
Associated with-
ECG-
Rx-
Match the following
1) chest pain at rest + no st elevation + troponin ↑ A) stable angina

2) chest pain at exertion only + no st elevation + troponin N B) unstable angina
3) chest pain at rest + st elevation + troponin C) N-STE-MI
4) ↑
chest pain at rest + no st elevation + troponin D) STEMI
5) recurrent chest pain on winter exposure + ST elevation E) free wall rupture
6) chest pain after 4 weeks of MI F) prinzmetal angina
7) shock on 5th day POST MI G) dressler syn
1 .... 2….3……4……5…..6……7…..

🫀
🫀🙇
SU\MMARY OF CORONARY ARTERY DISEASE
ECG-Change — Transmural infarction - ST Elevation / ST depression
— Subendocardial ischemia -ST Elevation / ST depression
Localisation of MI — II/III/aVF-______wall. ( ant / inferior / lateral)
— I/aVL/V5/V6-_______wall (ant / inferior / lateral)
— V1-V4 -_______wall. (ant / inferior / lateral)
MI— associated with bradycardia— _____wall MI (ant / inferior / lateral)
Marker of reinfarction — ________ ___>___
Best viability test - ___________ ( PET scan / thallium scan)
TMT— is + if — ST depression ≥ ____mm for ___ms
Stable angina — max. Mobility by- nitrate / B-blocker / aspirin ‘ statin
Door to needle time - thrombolysis — < __min ( < 30/ <60/<90/ <120)
- 1 PCI — < __min ( < 30/ <60/<90/ <120)
PCI - after successfull thrombolysis - ____PCI ( check / rescue/ delayed)
- after unsuccessful thrombolysis - ____PCI (check / rescue/ delayed)
- after USA-NSTEMI - ______PCI ( check / rescue/ delayed)
Variant angina — Rx -1)________ 2)_________.

CARDIOLOGY:JVP
CHAPTER 5
JUGULAR VENOUS PRESSURE
— Why -↳
R IJV L IJV
L EJV
— Where -
.RA
RV
LA
LV
— Normal JVP -
— How -
Carotid artery pulsation are _______ & JV _______.
CAUSES OF RAISED JVP

R IJV R IJV R IJV R IJV
SVC SVC SVC SVC
RA RA RA RA
RV RV RV RV
P.A P.A P.A P.A
Lungs Lungs Lungs Lungs

CARDIOLOGY:JVP
JVP WAVE-FORM
A
-
Pressure
-
Y -
Time
+E
* RA RA RA RA
IVC IVC IVC IVC
TV TV TV TV
RV RV RV RV
PATHOLOGICAL JVP WAVE FORM

a-wave — Absent -
-
— Large -
R IJV
SVC
— Cannon - RA
RV
v wave P.A
Lungs
IVC Atrial septum IVC Atrial septum
-
RA LA RA LA
RV LV RV LV

CARDIOLOGY:JVP
X-Descent
In view of
Cardiac Temponade Constructive Pericarditis
Y-Descent
In view of

💡 🫀
CARDIOLOGY:JVP

X
Y
KUSSMAUL SIGN
— seen in —
— Not seen in —
EXTRA POINT &
↑
SUMMARY OF JVP
Measured in — __ ____. ( R IJV / R EJV / L IJV/ LEJV )
Method — ___ ____ technique.
C wave — d/t ___ ____ during _______ phase.
Large a wave — ____/____/____. CHB/TR/ASD
-
-
Cannon a wave — ____/________. junctional Rythm
Large v wave — ____/_________. PS/TS/PAH

~
-
Prominent Y — [cT/<P]
Cardiac temponade — X _____ / Y_____. I prominent/diministed
Kussmaul sign NOT seen in _____ _____. [CT/<P]
cv wave — ____. [ ASD/TSITR/PR]
38 DR. PRIYANSH JAIN MEDICINE Absent
A. a wave of
CARDIOLOGY:PERICARDIAL DISORDERS
CHAPTER 6
PERICARDIAL DISORDERS
Outer Pericardial Layer
Inner Pericardial Layer

RA LA
RV LV
ACUTE PERICARDITIS
Etiopathogenesis:
RA LA RA LA
RV LV RV LV
Etiology — MCC -
— Other -

C/F —
Also know - friction rub in …………………

But On holding the breath -
O/E —
RA
RV
LA
LV
S2
ECG — "er ..................
Rx—
CONSTRICTIVE PERICARDITIS
RA LA RA LA
RV LV RV LV

Etiology —
C/F —
O/E — JVP …… -> X descent …………… …….. & Y descent ………………..

—> kussmaul sign -……………………..
Normally -On inspiration SBP ……………………. But not more than ………… mm of Hg.
If - On inspiration SBP ……………………. But more than ………… mm of Hg c/a -………………………………
Pulsus paradoxsus is also seen in ………………………………. & …………………. …………….. ……..
For ascites - ………………. ……………..test ……….

- ………………….. …………………
- ………………….. …………………
On auscultation - during
B
Atria
………………. —>
-
Ventricle

Cxr Echo
Also seen in -
Rx—

PERICARDIAL EFFUSION
CARDIAC TEMPONADE
Etiology —

en
SVC
28 RA LA
AORTA
SVC
-
S G
- RA LA
AORTA
RV
RV
LV LV
C/F —
O/E — Bulging in epigastric area -

On inspiration - SBP ………….. > ….mm of hg c/a -
But if patient in shock -
ECG —
JVP — X
—Y
Kussmaul sign -
CxR —
ECHO —

🙇
Rx —
SUMMARY OF PERICARDIAL DISEASE
CONSTRICTIVE PERICARDITIS CARDIAC TEMPONADE

Etiology
Etiology:
NOT a common C/F C/F - BP

-
-
JVP - X JVP - X
-Y
-Y
Kussmaul Sign ______ Kussmaul sign ____

Pulsus paradoxsus _________ Pulsus paradoxsus ___
CxR CxR:
Echo -
ECG:
-
Rx:
Rx

CARDIOLOGY:CARDIOMYOPATHY
CHAPTER 7
CARDIOMYOPATHY
DEFINITION
CLASSIFICATION BASED ON ETIOLOGY

—
1. STRESS CARDIOMYOPATHY
Pathogenesis:

C/F :
ECG :
Angiography:
Ventriculogram:
Rx:
Prognosis:
2. HYPERTROPHIC CARDIOMYOPATHY [H.CMP]

Pathogenesis
IVS FREE WALL IVS FREE WALL
RV
· LV RV
· LV

AORTA
I LA
C/F — ________. Hypertrophy
is
LV cavity size ___
LV
………………………. Failure —> c/f —>
Progressive increase in hypertrophy leads to

AORTA
-
W
I LA …………………….. so c/a
A
-
Leads to ……………………….. failure
· LV
-
So stroke volume ( blood in aorta) - ………………

-
Blood supply to hypertrophied muscle

Blood supply to brain -
Hypertrophied ventricular muscle can lead to - ………………………………

Which can lead to ………………………………………………
O/E -
-' A A
Pressure Pressure
In In
Artery Artery
7
Time
7
Time
MURMUR
AORTA
AORTA
18 LA
& LA
(b)(1) LV
Diastole
LV
Systole
ECG -

AORTA
Echo — LV cavity size …………
&
LA LA
and shape looks like …………
(1) LV
AORTA AORTA
d
Ye
LA LA
(1) LV
Diastole
LV
Systole
Rx — To improve diastolic filling -

To decrease cardiac remodelling and disease progression -
To prevent arrhythmia -
If there is high risk of sudden cardiac death - such as -

…………………………………………………………………………………………………………
Y
Implantable cardioverter defibrillator
MC S/E of ICD is —
pharma connection -
Drug C/I in HOCM-

Extra point
HOCM Aortic stenosis
I 18
AORTA AORTA
LA LA
W
Aortic 0
⑧
Aortic
(1) *
Valve Valve
LV LV
Systole Systole
--
D A D A
S1 S2 S1 S2
3. ARRYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA [ARVD]

Pathology:
RA RA
RA
> Can
RV
>
RV
-
RV Lead to
⑱ ⑰ …………………
ECG- Rx -
4. RESTRICTIVE CARDIOMYOPATHY
Pathogenesis:
1
RA LA
RV LV
MCC —
Other Causes —
C/F -
⑮
LA
O/E -
ECHO - LV diastolic dimension=

LV
- LA size -
- If Amyloid deposited
Rx - DOC
- C/I
-

5. DILATED CARDIOMYOPATHY [DCMP]

Pathogenesis:
⑮
LA
LV
Etiology — MCC — 1)
— 2)
— 3)
— Other
Drugs —

💡
C/F —
O/E —
N
LA
LV
ECHO - LV cavity size
- SV ______
- EF ______
Rx -
EXTRA POINT
MCC of sudden cardiac death in young — 1)
— 2)
— 3)

🙇🫀
SUMMARY OF CARDIOMYOPATHY
Stress CMP - a/c/a ______ CMP/ _______ _______ syndrome.

- C/F— Trigger — F/b
- DOC —
HOCM - Ch. ____ - __ ____ _____ ______ mutation.
- ____________ Hypertrophy
- C/F - __________ failure — …………………………
F/b
__________ failure —……………………………
- O/E — S ____ + / P. ____________.
— _______ _______ murmur at _____ area.
- Echo - LV cavity ________ shape.
- _______ of MV
- Rx - DOC
- C/I - _______ / _______ / ________.
Restrictive CMP - MCC
- C/F — same as _____
- ECHO — _________ myocardium
Dilated CMP - MCC - 1)
- 2)
- 3)
- Drugs —
- Peri-partum is d/t ___________.
- C/F — same as HF __ EF.

CARDIOLOGY:RHEUMATIC FEVER
CHAPTER 8
RHEUMATIC FEVER
PATHOGENESIS
Age -
Y X
Antibody levels

👶
CARDIOLOGY:RHEUMATIC FEVER 👶 👶 👶
C/F
a) Cardiac involvement
Pericardium
RA LA
Myocardium
Endocardium
RV LV
MC valve to be involved -
Most rare valve to be involved -
ENDOCARDITIS
Acute inflammation Chronic inflammation
⑧ LA
- LA
- LA
D D
Mitral valve *
*
LV LV
LV
b) Joint Involvement
↑ x N

c) Neuronal Involvement
d) Skin Involvement
e) Subcutaneous tissue involvement
INVESTIGATION
CRITERIA FOR DIAGNOSIS

Revised JONES criteria for High Endemic Area
MAJOR 1)
2)
3)
4)
5)
MINOR 1)
2)
3)
4)
Rx — for joint pain -
- for carditis -
- for chorea -
- for skin rash/ subcutaneous nodule -
For prophylaxsis of B-H.G.A.streptococcus-
HOW LONG
RF without cardiac involvement —
RF+Cardiac involvement but Recovered —
RF+Residual cardiac involvement —
If allergic to penicillin. -

🙇 🫀
SUMMARY OF RHEUMATIC FEVER
Etiology — Infection of —
Antibody against — _____ protein cross reacts
Eg. Of type ___ Hypersensitivity Reaction
Cardiac involvement — Hallmark —
Acute endocarditis — leads to — Mirtal ____— ____ ____murmur
Ch. Endocarditis — leads to Mitral ______
Skin findings —
Neuronal Finding —
- __________ _______ Criteria
Prophylaxis — by ________ _______ every _____ day.

CARDIOLOGY:INFECTIVE ENDOCARDITIS
CHAPTER 9
INFECTIVE ENDOCARDITIS
RA LA
Endocardium
RV LV
Overall MCC —
Cardiac lesion with — Highest risk of I.E. —
— Lowest risk of I.E. —
I.E. — after valvular Sx — < 2 month of surgery
— > 2 month of surgery -
For I/V drug abuser MC valve involved is -…………………. & MC organism is -

………………..
For colon cancer patient MCC -

PATHOGENESIS
⑧
g
LA
LA
5) LV LV
-
LA
LV
8
LA
LV

VASCULAR PHENOMENON
g
LA
LV
AORTA
IMMUNOLOGICAL PHENOMENON
g
LA
LV
AORTA

🙇 🫀
For - Diagnosis — ________ ________ criteria.
MAJOR - 1)
2)
MINOR - 1)
2)
3)
4)
5)
Rx —
SUMMARY OF INFECTIVE ENDOCARDITIS

MCC —
Cardiac lesion — Highest risk — ______
— Least risk — _______
SABE - Etiology —
Vascular Phenomenon — Nails —
— Palm & sole — _____ _____ [pain____]
— Spleen —
Immunological phenomenon — Eye —
— Finger — _____ _____ [pain___]
_____ ______ criteria.

CARDIOLOGY:ECG
CHAPTER 10
ECG
1 Big Box = ______ small box
1 Small Box = ______mS.
ECG LEADS

CARDIOLOGY:ECG
CONDUCTION SYSTEM OF HEART
SA
·
AV
ECG NORMS
P
P wave
....................
P
PR interval ii
P
q wave

CARDIOLOGY:ECG
R
p T
qRS complex
q s
T wave R
p T
.......
q s
p T
R
qT interval
I q s
I
Calculation of Heart Rate
HR =

CARDIOLOGY:ECG
ECG AXIS
Normal Left axis Right axis Extreme Axis
aVF
in
So — RVH —
— LVH —
Axis
— Uncontrolled HTN —
— Aortic Stenosis — ↳ LV
Aorta
— Pw. Artery HTN —
— Ch. Lung Pathology —
— Tetrology of Fallot —

CARDIOLOGY:ECG
Axis
R
p wave p T
q s
R
RA LA p
T
.........
TV MV
RV LV q s
p R
RA LA
T
TV MV ......
RV LV q s
If tall P wave — without RA — c/a - I
Hypertrophy

CARDIOLOGY:ECG
PR INTERVAL P
ii
Normal =
PR interval = >
SA
·
AV
Etiology —
Ist DEGREE HEART BLOCK

— PR-Interval —
ii i ; ii

CARDIOLOGY:ECG
IInd DEGREE — MOBITZ I

T T T
P P P
PR-interval =
IInd DEGREE — MOBITZ II

T T T
P P P
PR - Interval =
IIIrd DEGREE [COMPLETE HEART BLOCK]
SA
·
AV

💡
CARDIOLOGY:ECG
11 e
Atrial rate Ventricular rate
SUMMARY OF HEART BLOCK

PR Interval Drop Beat
Ist Degree
Mobitz I
2°
Mobitz II
3rd Degree
EXTRA POINT

CARDIOLOGY:ECG
LET’S PRACTICE — 1°/MOBITZ I /MOBITZ II /3° / 2:1

CARDIOLOGY:ECG
SHORT PR INTERVAL [< _____ mSec]
SA
·
AV
W mien
↳
So, — •
— LA — LV
WPW Synd — Between —
— RA — RV
Accessory
Pathway
Rx

CARDIOLOGY:ECG
💡
q wave — Normally should fit in __ small box
If bigger
C/a —
Seen in
EXTRA POINT
Most common
Pul. Embolism
ECG change
Most specific
ECG change
III

CARDIOLOGY:ECG
qRS COMPLEX PATHOLOGY & ARRYTHMIA

A) Atrial Fibrillation [Af]
B) Atrial Flutter [AF]
C) Multifocal Atrial Tacchycardia [MAT]
D) Paroxysmal Supraventricular Tachycardia [PSVT]
E) Ventricular Tachycardia [VT]
F) Ventricular Flutter [VF]
G) Ventricular Fibrillation [Vf]
A) Atrial Fibrillation
Pathology -
ECG — lead —

CARDIOLOGY:ECG
B) Atrial Flutter
— ECG —
— Leads —
C) MULTI-FOCAL-ATRIAL-TACCHYCARDIA [MAT]
• Hint —
• ECG — Lead ___
• Pulse deficit —
D) PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA [PSVT]

— C/F —
— ECG — Lead —

CARDIOLOGY:ECG
Rx — Ist line
CAROTID SINUS MASSAGE
Ill
Pharma connection
Adenosine is C/I in — ______ ______.
D) VENTRICULAR TACHYCARDIA [VT]
VT= ≥ ___ continuous VPC + qRS > ___ mS + HR > ___/min.

If - ≥ ___ continuous VPC + qRS > ___mS + HR < ___/min.
c/a
CARDIOLOGY:ECG
Ventricular tachycardia
-I
Shape of VPC
-
l -
. .
~ ~
Rx - unstable W
Rx - unstable
- stable
- stable
Trigger of TDP —
Extra point
* Synchronised / Y DC shock is sync

cardioversion with R wave
DC SHOCK n
DC shock is NOT sync

- Non -Synchronised
S
with R wave
/ defibrillation

💡
DC shock
Delivered
Cardioversion Button press
unfette
DC SHOCK button
press and delivery
same time
effe
Defibrillation
EXTRA POINT
— <30sec -
VT —— Lasting
— >30sec -
Arrhythmia —— leading to Hypotension — Rx
I I I
🙇
CARDIOLOGY:ECG
F) VENTRICULAR FLUTTER [VF]
G) VENTRICULAR FIBRILLATION [Vf]
SUMMARY OF ARRYTHMIA
A. Fibrillation — ____ lead.
__ ____ R-R interval + No Identifiable __ wave.
A. Flutter —— ______ leads — _______ pattern
PSVT —— ______ lead —
— Rx — Ist —
— IInd —

🫀
CARDIOLOGY:ECG
MAT —— lead __ — ≥ __ morphology of ___ wave.
VT —— ≥ ___ VPC + qRS > ___mS + HR > ___/min.
180° Rotation same —— ________ ________.
LET’S PRACTICE
• A. Fibrillation
• A. Flutter
• PSVT
• VT
• A. Fibrillation
• MAT
• PSVT
• VT
• A. Fibrillation
• Monomorphic VT
• PSVT
• TDP
• A. Fibrillation
• MAT
• PSVT
• VT

CARDIOLOGY:ECG
ST - SEGMENT
— V1-V4 —
ST Elevation — 1) STEMI
— I/aVL/V5-V6 —
— II/III/aVF —
— 2) Acute pericarditis
— 3)
— 4)
— 5)
— 6)
— 7)
— 8)
ST Depression ——

💡
CARDIOLOGY:ECG
R
QT INTERVAL T
P
n QT —
S
QT interval
Prolong QT can lead to ——
Congenital prolong QT interval
— with deafness —
— without deafness —
QT interval x
EXTRA POINT
Corrected QT interval [QTc] ——
ECG CHANGES OF HYPERKALEMIA [K > _____ mEq]

CARDIOLOGY:ECG
• Risk factor for Hyperkalemia —
• Rx of Hyperkalemia —
•
ECG CHANGES OF HYPoKALEMIA [K < _____ mEq]
• Risk factor of K l —
• Rx —
CHAMBER HYPERTROPHY
LVH
RVH

CARDIOLOGY:ECG
BUNDLE BRANCH BLOCK [BBB]

SA
— qRS —
·
AV
RV LV
Ne
— V1 —
SA
— qRS —
it are
AV
RV LV
— V1 —
is
Rx - if symptomatic —
a) RBBB b) LBBB a) RBBB b) LBBB

CARDIOLOGY:Mitral stenosis
CHAPTER 10
MITRAL STENOSIS
N Mitral valve MV opening < ___

Orifice
g g
LA LA
_____cm
2
LV LV
So, during diastole — opening of pathological mitral valve
g
LA
LV
S2 S1 S2
P. Vein
ECG
— L.A. — ______ ——— _____ _____.
&
LA
— P. Vein pressure —
LV — if MS+ASD —
— S1 —

💡
CARDIOLOGY:Mitral stenosis
CxR — Echo —
Rx - 1)
↳
Clot in LA
2) M. Stenosis + Clot in LA LV
Aorta
EXTRA POINT
So, LA enlargement can lead
Compression of

CARDIOLOGY:Aortic Regurgitation
CHAPTER 11
AORTIC REGURGITATION
AORTA AORTA
1919
LA LA
LV LV
Systole Diastole
Etiology —
C/F — P.
— Head Bobbing —
— Movement in Uvula —
— Murmur in Femoral Artery —
Pulse Pressure =
Rx —

💡
CARDIOLOGY:Aortic Regurgitation
EXTRA POINT
CLASSIFICATION — STANFORD A & B

CARDIOLOGY:Murmur
CHAPTER 12
MURMUR
TYPES OF MURMUR
A) CONTINOUS MURMUR
B) SYSTOLIC MURMUR
x
RA LA
MV
RV LV
Aorta

CARDIOLOGY:Murmur
Ejection systolic
S1 SYSTOLE S2
Pansystolic
S1 SYSTOLE S2
Late Systolic
Normal S1 SYSTOLE S2
⑳
LA
LA LA
LV
LV LV
Aorta
3) DIASTOLIC MURMUR
— Early —
— Mid-Diastolic —
— Pan-Diastolic —

💡
CARDIOLOGY:Murmur
EXTRA POINT
HOCM & Mitral valve prolapse murmur
________ on valsalva
NAMED MURMUR
Carvallo Murmur —
Carey Coomb Murmur —
Austin Flint Murmur —
Graham Steel Murmur —
AS Murmur Radiates towards mitral area [apex]
— c/a — Phenomenon
Tumor Plop Sound —
NAMED PULSES
Anacrotic Pulse — AS
OR
P. Parvus et Tardus
Dicrotic Pulse — D CMP
P. BisFeriens — HOCM
P. Alternance — LVF
Corrigan / water hammer pulse — AR
THE CHAPTER YOU ARE LEARNING TODAY IS

GOING TO SAVE SOMEONE’S LIFE TOMORROW

DR. PRIYANSH JAIN MEDICINE
ARISE - DELHI ARISE - HYDERABAD
Contact : Contact :
+ 91 9560022836 + 91 7680929292
+ 91 9560022837 + 91 7396757585
#: 2nd Floor, Above Indian Bank,
+ 91 9560022838 Opp. : Olive Hospital
K261, 2nd Floor Lane No.5, Kakatiya Nagar Colony,
Westend Marg, Saidulajab, Mehdipatnam, Hyderabad - 500 028
Saket, New Delhi, Delhi 110030 :arisemedicalacademy@gmail.com
:arisemedicalacademy.delhi@gmail.com
ARISE - KERALA ARISE - CHENNAI

Contact : Contact :
+ 91 8136932666 + 91 8977941723
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#: 2nd Floor, Kingdom Tower, #: No. A Super 20, Thiru.
Manna, Taliparamba, Vi Ka Industrial Estate,
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ARISE - JAIPUR
Contact :
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CARDIOLOGY

DR. PRIYANSH JAIN

INDEX OF CARDIOLOGY WORKBOOK

CHAPTER 2: RVF & LVF………………………………….………….9

CHAPTER 3: HEART FAILURE……………………………………..12

CHAPTER 4: CORONARY ARTERY DISEASE……………….18

CHAPTER 5: JUGULAR VENOUS PRESSURE……………….35

CHAPTER 6: PERICARDIAL DISORDERS…………………….39

CHAPTER 8: RHEUMATIC FEVER………………………………..54

CHAPTER 9: INFECTIVE ENDOCARDITIS……………………59

CHAPTER 10: ECG ……………………………………………………..62

CHAPTER 10: MITRAL STENOSIS………………………………84

CHAPTER 11: AORTIC REGURGITATION……………………86

CHAPTER 12: MURMUR………………………………………………88

DR. PRIYANSH JAIN MEDICINE 1

- width - ……% of arm circumference

—length - ……% of arm circumference

So, ausculatatory gap can lead to

If only increase in systolic or

TARGET ORGAN DAMAGE

4 DR. PRIYANSH JAIN MEDICINE

-So, preffered in:

-Angiotensin Receptor Blocker [ARB]

-So, preffered in:

DR. PRIYANSH JAIN MEDICINE 5

Ist visit IInd visit IIIrd visit IVth visit

⑮ BP- BP- BP- BP-

-If BP not controlled despite_____ classes of

anti-HTN drug including _______________.

ORTHOSTATIC HYPOTENSION OR POSTURAL HYPOTENSION

BP on standing after ……. Min

6 DR. PRIYANSH JAIN MEDICINE

HYPERTENSIVE URGENCY vs HYPERTENSIVE EMERGENCY

Target organ damage

HYPERTENSIVE…………………. HYPERTENSIVE …………………….

Control the BP in next ……. Hrs

Control the BP in next …….Hr

If BP more than ………………..

DR. PRIYANSH JAIN MEDICINE 7

SUMMARY FOR HYPERTENSION

Deflation rate = ______mm go Hg/sec. ( < 2 / <3 / <4 / <5 )

HTN pt. taking Allopurinol which anti-HTN should

be avoided __________. ( ACE# / ARB / Diuretic / B-blocker)

DM+HTN — _________. ( ACE# / ARB / Diuretic / B-blocker)

HTN+Protienuria — _________. ( ACE# / ARB / Diuretic/ B-blocker)

Post MI — HTN — Rx 1st line-

BP+Papilloedema — c/a — ______ ______.

Mean Arterial Pressure -

High pulse pressure -

Low pulse pressure -

DOC for scleroderma crisis - ( ACE# / ARB / Diuretic/ B-blocker)

8 DR. PRIYANSH JAIN MEDICINE

PCWP — pulmonary capillary wedge pressure

COR PULMONALE Chronic pulmonary pathology

CALLED AS ………. ……………

DR. PRIYANSH JAIN MEDICINE 9

LEFT VENTRICULAR FAILURE [LVF]

PAROXYSMAL NOCTURNAL DYSPNEA [PND]

10 DR. PRIYANSH JAIN MEDICINE

BP+Papilloedema — c/a — .