Cardiology

a: mnemonic: FEAR CASES

Minor Criteria*

Major Criteria*

Fever

Carditis

ECG changes (PR prolonged)

Arthritis, migratory

Sydenham's chorea

Arthralgias

Erythema marginatum

Reactant, acute phase

Subcutaneous nodules

*To fulfill the Jones criteria, either two major criteria or one major and two minor criteria plus evidence of an antecedent streptococcal infection are required.

*To fulfill the Jones criteria, either two major criteria or one major and two minor criteria plus evidence of an antecedent streptococcal infection are required.

Tumor plop: ATRIAL MYXOMA

AORTIC REGURGITATION: Corrigan pulse, waterhammer pulse, "pistol shot" femoral sound, Duroziez sign, (+) Hill sign (BP in thigh 20 mm Hg higher than arm BP), Quincke pulses, Austin Flint murmur

Continuous machinery murmur: PATENT DUCTUS ARTERIOSUS

Mnemonic for the four auscultatory sites: APT M or All People Try Mushrooms

Aortic (2 RICS) Pulmonic (2 LICS) Tricuspid (4 LICS) Mitral (5 LICS)

Bacterial endocarditis: Roth spots, splinter hemorrhages, Janeway lesions (nontender), Osler nodes (painful)

Systolic ejection murmur with a THRILL ON THE UPPER LEFT STERNAL BORDER: pulmonic stenosis

Holosystolic murmur with a THRILL ON THE LOWER LEFT STERNAL BORDER: VSD

Holosystolic murmur best heard on the apex, radiating to the AXILLA: mitral regurgitation

Systolic murmur along with LSB THRILL RADIATING TO THE RIGHT SIDE OF THE NECK: aortic stenosis

Midsystolic click with late systolic murmur: mitral valve prolapse Opening snap, loud SL, diastolic rumble, atrial fibrillation: mitral stenosis

• Pericardial knock: constrictive pericarditis

• Atrial flutter: "saw-tooth" pattern on ECG

• Atrial fibrillation: "irregularly irregular" pulse, absent P waves, and irregular baseline on ECG

IMPORTANT PULSE PATTERNS:

Pulsus alternans: Cardiac tamponade

Pulsus bisferiens: Aortic regurgitation and HCM/IHSS

Pulsus paradoxus: Cardiac tamponade, asthma, constrictive pericarditis

Pulsus tardus: Aortic stenosis

HEART SOUNDS:

Midsystolic click: MVP

Opening snap: Mitral/tricuspid stenosis

Pericardial knock: Constrictive pericarditis Pericardial friction rub: Pericarditis

FIRST HEART SOUND:

Loud Soft

1.

Mitral stenosis

1. Mitral regurgitation

2.

Short PR interval (WPW)

2. Long PR interval

3.

Left atrial myxoma

3.LBBB

4. MVP with regurgitation 4. AR, TR

4. MVP with regurgitation 4. AR, TR

SECOND HEART SOUND:

Narrow or Fixed

Wide Split Paradoxical Split Summary

1. RBBB

1. LBBB

1. ASD

Fixed Split = ASD (the only one)

2. MR, VSD

2. HTN

Narrow/paradoxical If—LHAIM

3. RV volume overload (l-r shunt)

3. Aortic stenosis

All others have a wide split

4. RV pressure overload (PS, PAH)

4. IHSS

5. MI, acute

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