Cardiology Mnemonic

9/11/2016
mrcp4all
CardiologyMnemonics
Antiarrythmics:forAVnodes
"DoBlockAV":
Digoxin
Bblockers
Adenosine
Verapamil
Aorticregurgitation:causes
CREAM:
Congenital
Rheumaticdamage
Endocarditis
Aorticdissection/Aorticrootdilatation
Marfans
Aorticstenosischaracteristics
SAD:
Syncope
Angina
Dyspnoea
Apexbeat:abnormalitiesfoundonpalpation,causesofimpalpable
HILT:
Heaving
Impalpable
Laterallydisplaced
Thrusting/Tapping
_Ifitisimpalpable,causesareCOPD:
COPD
Obesity
Pleural,Pericardialeffusion
Dextrocardia
Apexbeat:differentialforimpalpableapexbeat
DOPES:
Dextrocardia
Obesity
Pericarditis/Pericardialtamponade/Pneumothorax
Emphysema
Sinusinversus/Studentincompetence/Scoliosis/Skeletalabnormalities(egpectusexcavatum)
Atrialfibrillation:causes
ASHIT:
Alcohol
Stenosis(mitralvalve)
Hypertension
Infarction/Ischaemia
Thyrotoxicosis
Atrialfibrillation:causes
PIRATES:
Pulmonary:PE,COPD
Iatrogenic
Rheumaticheart:mirtralregurgitation
Atherosclerotic:MI,CAD
Thyroid:hyperthyroid
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Endocarditis
Sicksinussyndrome
Atrialfibrillation:management
ABCD:
Anticoagulate
Betablocktocontrolrate
Cardiovert
Digoxin
Beck'striad(cardiactamponade)
3D's:
Distantheartsounds
Distendedjugularveins
Decreasedarterialpressure
Betablockers:cardioselectivebetablockers
"BetablockersActingExclusivelyAtMyocardium"
_Cardioselectivebetablockersare:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
CHF:causesofexacerbation
FAILURE:
Forgotmedication
Arrhythmia/Anaemia
Ischemia/Infarction/Infection
Lifestyle:takentoomuchsalt
UpregulationofCO:pregnancy,hyperthyroidism
Renalfailure
Embolism:pulmonary
CHF:causesofexacerbation
ASMITHPEAR:
Anemia
Salt/Stress/Stoppingmeds
MI
Infection/Ischemia
Thyroid(high/low)
HTN
Pericarditis
Endocarditis(valvedisease)
Arrhythmia
Rx(betablocker,etc)
Coronaryarterybypassgraft:indications
DUST:
Depressedventricularfunction
Unstableangina
Stenosisoftheleftmainstem
Triplevesseldisease
Coronaryarterybypassgraft:indications
DUST:
Unstableangina
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Triplevesseldisease
DepressedSTsegment:causes
DEPRESSEDST:
Droopingvalve(MVP)
EnlargementofLVwithstrain
Potassiumloss(hypokalemia)
ReciprocalSTdepression(inI/WAMI)
Embolisminlungs(pulmonaryembolism)
Subendocardialischemia
Subendocardialinfarct
Encephalonhaemorrhage(intracranialhaemorrhage)
Dilatedcardiomyopathy
Shock
Toxicityofdigitalis,quinidine
ECG:leftvs.rightbundleblock
"WiLLiaMMaRRoW":
WpatterninV1V2andMpatterninV3V6isLeftbundleblock.
MpatterninV1V2andWinV3V6isRightbundleblock.
_Note:considerbundlebranchblockswhenQRScomplexiswide.
ECG:Twaveinversioncauses
INVERT:
Ischemia
Normality[esp.young,black]
Ventricularhypertrophy
Ectopicfoci[egcalcifiedplaques]
RBBB,LBBB
Treatments[digoxin]
ExerciserampECG:contraindications
RAMP:
RecentMI
Aorticstenosis
MIinthelast7days
Pulmonaryhypertension
Heartcompensatorymechanismsthat'save'organbloodflowduringshock
"HeartSAVER":
Symphatoadrenalsystem
Atrialnatriureticfactor
Vasopressin
Endogenousdigitalislikefactor
Reninangiotensinaldosteronesystem
_Inall5,systemisactivated/factorisreleased
Heartfailure:signs
TAPEDTORCH:
Tachycardia
Ascites
Pulsusalternans
Elevatedjugularvenouspressure
Displacedapexbeat
Thirdheartsound
Oedema
Rightventricularheave
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Crepitationsorwheeze
Hepatomegaly(tender)
Heartmurmurs
"hARDASSMRS.MSD":
hARD:AorticRegurg=Diastolic
ASS:AorticStenosis=Systolic
MRS:MitralRegurg=Systolic
MSD:MitralStenosis=Diastolic
Jugularvenouspressure(JVP)elevation:causes
HOLT:GrabHaroldHoltaroundtheneckandthrowhimintheocean:
Heartfailure
Obstructionofveneacava
Lymphaticenlargementsupraclavicular
IntraThoracicpressureincrease
JVP:waveform
ASKME:
Atrialcontraction
Systole(ventricularcontraction)
Klosure(closure)oftricusps,soatrialfilling
Maximalatrialfilling
Emptyingofatrium
MI:basicmanagement
BOOMAR:
Bedrest
Oxygen
Opiate
Monitor
Anticoagulate
Reduceclotsize
MI:signsandsymptoms
PULSE:
Persistentchestpains
Upsetstomach
Lightheadedness
Shortnessofbreath
Excessivesweating
MI:therapeutictreatment
ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine(diamorphine)
Betablocker
Arthroplasty
Lignocaine
"OBATMAN!":
Oxygen
Betablocker
ASA
Thrombolytics(egheparin)
Morphine
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Aceprn
Nitroglycerin
MONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
MI:treatmentofacuteMI
COAG:
Cyclomorph
Oxygen
Aspirin
Glyceroltrinitrate
Mitralregurgitation
Whenyouhearholosystolicmurmurs,think"MRTHEMAREholosystolicmurmurs".
Mitralstenosis(MS)vs.regurgitation(MR):epidemiology
MSisafemaletitle(Ms.)anditisfemalepredominant.
MRisamaletitle(Mr.)anditismalepredominant.
Murmurattributes
"ILPQRST"(personhasillPQRSTheartwaves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
Murmurs:innocentmurmurfeatures
8S's:
Soft
Systolic
Short
Sounds(S1&S2)normal
Symptomless
Specialtestsnormal(Xray,EKG)
Standing/Sitting(varywithposition)
Sternaldepression
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CardiologyMnemonics
>Aspirin:AdverseeffectsASPIRIN
Asthma,Salicylism,Pepticulcer/PrematureclosureofPDA,Intestinalbloodloss,Reye'ssyndrome,
Idiosyncracy,Noise(tinnitus)
>Aorticrootdilatation:causesADAMS
Aneurysm,Dissection,Ankylosingspondylitis,Marfan'ssyndrome,Syphilis
>Vitellineduct:TimeofclosureVItelline
TheVItellineductusuallyclosesaroundweekVIofintrauterinelife.
>LVF,ManagementofFOAM
Frusemide40mgiv,Oxygen,Atrovent(&Ventolin)nebs,Morphine2.55mg
>MitralStenosis,ComplicationsPASTRI
PulmBP,Afib,Systemicembolism,Tricuspidregurg,Rightheartfailure,Infective
endocarditis
>Myocardialinfarct,complicationsABCDEx2
Arrhythmias/Aneurysm
Bradycardia/BP
Cardiacfailure/cardiactamponade
Dresslers/Death!
Embolism/Extra(VSD,papmusclerupture)
>PericarditisDRUMSTICX
Dresslers,Rhfever/RA,Uraemia,MI,SLE,Trauma,Idiopathic,Coxsackie,Xray
>PosturalHypotensionHANDI
Hypovolaemia/hypopituitarism,Addisons,Neuropathy(autonomic),Drugs(vasodilators/
TCADs,diuretics,antipsychotics),Idiopathic
>Rheumaticfever:
MajorcriteriaCASES
Carditis,Arthritis(migratory),Subcutnodules,Erythemamarginatum,Syndenhamschorea
Minorcriteria4PA
Pyrexia,prolongedPR,pastHx,positive(ie)ESR/CRP,Arthralgia
>Occlusivearterialdisease6Ps
Pain,pallor,pulseless,parasthesia,paralysis,perishingwithcold
>SplinterhaemorrhagesTRIPSAM
Trauma,RA,InfectiveEndo,PAN
SLE/Sepsis,Anaemia(profound),Malignancy(haematological)
>STelevationELEVATION
Electrolytes,LBBB,EarlyRepolarization,Ventricularhypertrophy,Aneurysm,Treatment(eg
pericardiocentesis),Injury(AMI,contusion),Osbornewaves(hypothermia),Nonocclusive
vasospasm(prinzmetals)
>SVTCausesSNAP
Sinustachy,nodaltachy,afib,paroxysmalatrialtachy
>SymptomsofaorticstenosisASD
Angina2years}
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Syncope1year}prognosis
Dyspnoea6/12}
>NoapexbeatDOPES
Dextrocardia(dontsaythisfirst!),Obesity,Pleural/Pericardialeffusion,Emphysema,Shock.
>3rdHeartSoundFIPPY
Failure,Incompetence(mitral/tricuspid),Pregnancy/Pill/PE/Pericarditis,Youth
>4thHeartSoundSHIT
Stenosis(aortic/pulmonary),Hypertension/HeartBlock,IschaemicHD,Tamponade
>ArrhythmiasARHYTHMIAL4PC
AtrialMyxoma,Rhheartdis,HYpertension,THyrotoxicosis,Mitralvalvedis,IHD,
ALcohol
Pneumonia/PE/Pericardialeff,cardiomyopathy
>AtrialFibrillationARITHMATIC
Alcohol,Rhfever,IHD,Thyrotoxicosis,Hypertension,Mitralstenosis/MI/Myxoma
(atrial)
ASD,Toxins,Idiopathic/InfectiveendocarditisCardiomyopathy/Constrictivepericarditis
>Bradycardia,regularPADHIM
Physiological(athlete,sleep)/paroxysmal,AVblock(2II,3),Drugs(,dig,amiodarone)
Hypothyroid/hypothermia,Icteric(severe),MI
>DominantRwaveinV1WORD
WPW,OldMI,RBBB,Dextrocardia
>EMDArrest4Hs4Ts
Hypothermia,Hypo&hyperelectrolytes,Hypovolaemia,Hypoxia
Toxic(includingdrugs),Trauma,Tamponade,Tensionpneumothorax
>JVPMOPHAIR
Multiplewaveform,Occludable,Posturalchanges
Hepatojugularreflex,Above(fillsfrom),Impalpable,Respiratorychanges
>NonpittinglowerlimboedemaMICHAM
Milroys,infection(filariasis),Congenital,Hypothyroid,Allergy,Malignancy
>ShockHENSCAM
Hypovolaemia,Endocrine(adrenal,thyroid),Neuropathic(autonomic)
Spinalcordinjury/Sepsis,Cardiac,anapyhlaxis/anaesthesia,antiHPT,MassivePE
>ABCDE
TreatmentofHeartFailure:
ACEinhibitorsBetablockersCalciumchannelblockersDiureticsEndothelinconvertingenzymeinhibitors
>AllProstitutesTakeMoney
Theorderofresuscitationforheartsoundsfromrighttoleft:
Aortic,Pulmonary,Tricuspid,Mitra
>BOOMAR
BasicMImanagementBedrest,Oxygen,Opiate,Monitoring,Anticoagulation,Reduceclotsize
>CHIPCHANGE
Themanyunwantedaffectsofamiodarone:Cutaneousphotosensitivity,Hepaticdysfunction,IncreasesLDL,
Pulmonaryfibrosis,CNSeffects,Hyper/hypothyroidism,Asymptomaticcornealdeposits,peripheral
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Neuropathy,GIdysfunction,Enhancestheeffectsofwarfarin/digoxin
>DOLMA
Linesoftreatmentofpulmonaryoedema:
Digoxin,Oxygen,Lasix,Morfine,Aminophylline.(Dolmaisaveryfamousfoodinthemiddleeast.)
>M.O.N.A
MONAtreatmentforacuteMI.
Morphine,Oxygen,Nitrate,Aspirin
>PleaseReadHisText
Signsofcorpulmonale:
Peripheraloedema,RaisedJVP,Hepatomegaly,Tricuspidincompetence
>MitralregurgitationWhenyouhearholosystolicmurmurs,think"MRTHEMAREholosystolicmurmurs".
>Sinoatrialnode:innervationSympatheticactsonSodiumchannels(SS).
ParasympatheticactsonPotassiumchannels(PS).
>Supraventriculartachycardia:treatmentABCDE:
Adenosine
Betablocker
Calciumchannelantagonist
Digoxin
Excitation(vagalstimulation)
>Ventriculartachycardia:treatmentLAMB:
Lidocaine
Amiodarone
Mexiltene/Magnesium
Betablocker
>Rheumaticfever:RevisedJonescriteriaJONESPEACE:
Majorcriteria:
Joints:migratory
O(heartshaped)Carditis:newonsetmurmur
Nodules,subcutaneous:extensorsurfaces
Erythemamarginatum
Sydenham'schorea
Minorcriteria:
PRinterval,prolonged
ESRelevated
Arthralgias
CRPelevated
Elevatedtemperature(fever)
Need2majoror1majorand2minorcriteria,plusevidenceofrecentGASinfection(throatcx,rapidantigen
test,orrisingstrepantibodytiter).
>Pulselesselectricalactivity:causesPATCHMED:
Pulmonaryembolus
Acidosis
Tensionpneumothorax
Cardiactamponade
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Hypokalemia/Hyperkalemia/Hypoxia/Hypothermia/Hypovolemia
Myocardialinfarction
Electrolytederangements
Drugs
>Sinusbradycardia:aetiology"SINUSBRADICARDIA"(sinusbradycardia):
Sleep
Infections(myocarditis)
Neapthyroid(hypothyroid)
Unconsciousness(vasovagalsyncope)
Subnormaltemperatures(hypothermia)
Biliaryobstruction
RaisedCO2(hypercapnia)
Acidosis
Deficientbloodsugar(hypoglycemia)
Imbalanceofelectrolytes
Cushing'sreflex(raisedICP)
Aging
Rx(drugs,suchashighdoseatropine)
Deepanaesthesia
Ischemicheartdisease
Athletes
>Rheumaticfever:JonescriteriaMajorcriteria:CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumaticanamnesis
Minorcriteria:CAFEPAL:
CRPincreased
Arthralgia
Fever
ElevatedESR
ProlongedPRinterval
Anamnesisofrheumatism
Leucocytosis
>JVP:waveformASKME:
Atrialcontraction
Systole(ventricularcontraction)
Klosure(closure)oftricusps,soatrialfilling
Maximalatrialfilling
Emptyingofatrium
>Coronaryarterybypassgraft:indicationsDUST:
Unstableangina
Triplevesseldisease
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>ExerciserampECG:contraindicationsRAMP:
RecentMI
Aorticstenosis
MIinthelast7days
Pulmonaryhypertension
>ECG:TwaveinversioncausesINVERT:
Ischemia
Normality[esp.young,black]
Ectopicfoci[egcalcifiedplaques]
RBBB,LBBB
Treatments[digoxin]
>Rheumaticfever:JonesmajorcriteriaJONES:
Joints(migratingpolyarthritis)
Obvious,theheart(carditis,pancarditis,pericarditis,endocarditisorvalvulits)
Nodes(subcutaneousnodules)
Erythemamarginatum
Sydenham'schorea
>Myocardialinfarctions:treatmentINFARCTIONS:
IVaccess
Narcoticanalgesics(egmorphine,pethidine)
Facilitiesfordefibrillation(DF)
Aspirin/Anticoagulant(heparin)
Rest
Convertingenzymeinhibitor
Thrombolysis
IVbetablocker
Oxygen60%
Nitrates
StoolSofteners
>Atrialfibrillation:causesPIRATES:
Pulmonary:PE,COPD
Iatrogenic
Rheumaticheart:mirtralregurgitation
Atherosclerotic:MI,CAD
Thyroid:hyperthyroid
Endocarditis
Sicksinussyndrome
>Atrialfibrillation:managementABCD:
Anticoagulate
Betablocktocontrolrate
Cardiovert
Digoxin
>Antiarrythmics:forAVnodes"DoBlockAV":
Digoxin
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Bblockers
Adenosine
Verapamil
>Murmurs:systolicMRPVTRAPS:
Mitral
Regurgitationand
Prolaspe
VSD
Tricupsid
Regurgitation
Aorticand
Pulmonary
Stenosis
>Apexbeat:differentialforimpalpableapexbeatDOPES:
Dextrocardia
Obesity
Pericarditis/Pericardialtamponade/Pneumothorax
Emphysema
Sinusinversus/Studentincompetence/Scoliosis/Skeletalabnormalities(egpectusexcavatum)
>Rheumaticfever:Jones5majorcriteriaSTREP:
Sydenhamschorea
Transientmigratoryarthritis
Rheumaticsubcutaneousnodules
Erythemamarginatum
Pancarditis(endocarditis,myocarditis,pericarditis)
STREP,sinceRheumaticfeveriscausedbygroupAstrep.
>SinustachycardiaTACHFEVER:
Tamponade/Thyrotoxicosis
Anemia
CHF
Hypotension
Fever
Excrutiatingpain
Volumedepletion
Exercise
Rx(Theo,Dopa,Epi,etc)
>CHF:causesofexacerbationASMITHPEAR:
Anemia
Salt/Stress/Stoppingmeds
MI
Infection/Ischemia
Thyroid(high/low)
HTN
Pericarditis
Endocarditis(valvedisease)
Arrhythmia
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Rx(betablocker,etc)
>Murmurs:louderwithinspirationvsexpirationLEftsidedmurmurslouderwithExpiration
RIghtsidedmurmurslouderwithInspiration.
>Murmurs:questionstoaskSCRIPT:
Site
Character(egharsh,soft,blowing)
Radiation
Intensity
Pitch
Timing
>Aorticregurgitation:causesCREAM:
Congenital
Rheumaticdamage
Endocarditis
Aorticdissection/Aorticrootdilatation
Marfan's
>Heartfailure:signsTAPEDTORCH:
Tachycardia
Ascites
Pulsusalternans
Elevatedjugularvenouspressure
Displacedapexbeat
Thirdheartsound
Oedema
Rightventricularheave
Crepitationsorwheeze
Hepatomegaly(tender)
>Pericarditis:causesPRDIP,STUP:
Postpericardiectomy
Rheumaticfever
Drugs(egisoniazid,hydralazine,procainalmide)
Infection(egTB,coxsackie,strep)
PE
SLE/Scleroderma
Tumours/Thyroiddisease
Uraemia
PostMI(includesDressler's)
>Aorticdissection:riskfactorsABC:
Atherosclerosis/Ageing/Aorticaneurysm
Bloodpressurehigh/Baby(pregnancy)
Connectivetissuedisorders(egMarfan's,EhlersDanlos)/Cysticmedialnecrosis
>CHF:Leftsidedsystolicfailuresignsandsymptoms"LeftSystolicFailureCanHaveDialatedHeartCause
OfPulmpnaryBackflow":
Lossofhaironlegs
Skincoldandclammy
Fatigue
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Crackles
Highheartrate
Dyspnea
HTN
Cyanosis
Orthopnea
PinkSputum
>AcuteCoronarySyndrome:initialtreatmentABCD:
Aspirin
Betablocker
Coagulation(anticoagulationwithheparin/LMWHeparin)
Doubleproductcontrol(decreaseheartrateandbloodpressure)
>Heartfailure:causesHEARTFAILED:
Hypertension
Endocrine
Anemia
Rheumaticheartdisease
Toxins
Failuretotakemeds
Arrythmia
Infection
Lung(PE,pneumonia)
Electrolytes
Diet
>EKG:12leadEKGquickinterpretationofV1V6SSAALL:
ElevationsmatchedwiththeirclassiclocationofMI:
V1Septal
V2Septal
V3Anterior
V4Anterior
V5Lateral
V6Lateral
>Aorticregurgitation:causesMARRIS:
Marfans
Ankylosingspondylitis
Rheumaticfever
Rheumatoidarthritis
Infectiveendocarditis
Syphilis
>Cardiomyopathy:categoriesCardiomyopathyisHARD:
Hypertrophiccardiomyopathy
Arrhythmogenicrightventricularcardiomyopathy
Restrictivecardiomyopathy
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>Murmurs:innocentmurmurfeatures8S's:
Soft
Systolic
Short
Sounds(S1&S2)normal
Symptomless
Specialtestsnormal(Xray,EKG)
Standing/Sitting(varywithposition)
Sternaldepression
>Murmurattributes"ILPQRST"(personhasillPQRSTheartwaves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
>Murmurs:locationsanddescriptions"MRSA$$":
MRS:MitralRegurgitationSystolic
A$$:AorticStenosisSystolic
Theothertwomurmurs,MitralstenosisandAorticregurgitation,areobviouslydiastolic.
>Betablockers:cardioselectivebetablockers"BetablockersActingExclusivelyAtMyocardium"
Cardioselectivebetablockersare:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol
>Apexbeat:abnormalitiesfoundonpalpation,causesofimpalpableHILT:
Heaving
Impalpable
Laterallydisplaced
Thrusting/Tapping
Ifitisimpalpable,causesareCOPD:
COPD
Obesity
Pleural,Pericardialeffusion
Dextrocardia
>MI:treatmentofacuteMICOAG:
Cyclomorph
Oxygen
Aspirin
Glyceroltrinitrate
>Coronaryarterybypassgraft:indicationsDUST:
Unstableangina
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Triplevesseldisease
>Peripheralvascularinsufficiency:inspectioncriteriaSICVD:
Symmetryoflegmusculature
Integrityofskin
Coloroftoenails
Varicoseveins
Distributionofhair
>Rheumaticfever:RevisedJones'criteriaJONEScrITERIA:
Majorcriteria:
Joint(arthritis)
Obvious(Cardiac)
Nodule(Rheumatic)
Erythemamarginatum
Sydenhamchorea
Minorcriteria:
Inflammatorycells(leukocytosis)
Temperature(fever)
ESR/CRPelevated
RaisedPRinterval
Itself(previousHxofRheumaticfever)
Arthralgia
>Heartmurmurs"hARDASSMRS.MSD":
hARD:AorticRegurg=Diastolic
ASS:AorticStenosis=Systolic
MRS:MitralRegurg=Systolic
MSD:MitralStenosis=Diastolic
>MI:therapeutictreatmentROAMBAL:
Reassure
Oxygen
Aspirin
Betablocker
Arthroplasty
Lignocaine
>CHF:causesofexacerbationFAILURE:
Forgotmedication
Arrhythmia/Anaemia
Ischemia/Infarction/Infection
Lifestyle:takentoomuchsalt
UpregulationofCO:pregnancy,hyperthyroidism
Renalfailure
Embolism:pulmonary
>Murmurs:systolicvs.diastolicPASS:Pulmonic&AorticStenosis=Systolic.
PAID:Pulmonic&AorticInsufficiency=Diastolic.
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>Murmurs:systolicvs.diastolicSystolicmurmurs:MRAS:"MR.ASner".
Diastolicmurmurs:MSAR:"MS.ARden".
ThefamouspeoplewiththosesurnamesareMr.EdAsnerandMs.JaneArden.
>MI:therapeutictreatment"OBATMAN!":
Oxygen
Betablocker
ASA
Thrombolytics(egheparin)
Morphine
Aceprn
Nitroglycerin
>Mitralstenosis(MS)vs.regurgitation(MR):epidemiologyMSisafemaletitle(Ms.)anditisfemale
predominant.
MRisamaletitle(Mr.)anditismalepredominant.
>Pericarditis:EKG"PericarditiS":
PRdepressioninprecordialleads.
STelevation.
>Jugularvenouspressure(JVP)elevation:causesHOLT:GrabHaroldHoltaroundtheneckandthrowhim
intheocean:
Heartfailure
Obstructionofveneacava
Lymphaticenlargementsupraclavicular
IntraThoracicpressureincrease
>MI:therapeutictreatmentMONAH:
Morphine
Oxygen
Nitrogen
Aspirin
Heparin
>DepressedSTsegment:causesDEPRESSEDST:
Droopingvalve(MVP)
EnlargementofLVwithstrain
Potassiumloss(hypokalemia)
ReciprocalSTdepression(inI/WAMI)
Embolisminlungs(pulmonaryembolism)
Subendocardialischemia
Subendocardialinfarct
Encephalonhaemorrhage(intracranialhaemorrhage)
Shock
Toxicityofdigitalis,quinidine
>AorticstenosischaracteristicsSAD:
Syncope
Angina
Dyspnoea
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>MI:basicmanagementBOOMAR:
Bedrest
Oxygen
Opiate
Monitor
Anticoagulate
Reduceclotsize
>ECG:leftvs.rightbundleblock"WiLLiaMMaRRoW":
WpatterninV1V2andMpatterninV3V6isLeftbundleblock.
MpatterninV1V2andWinV3V6isRightbundleblock.
Note:considerbundlebranchblockswhenQRScomplexiswide.
>Pericarditis:causesCARDIACRIND:
Collagenvasculardisease
Aorticaneurysm
Radiation
Drugs(suchashydralazine)
Infections
Acuterenalfailure
Cardiacinfarction
Rheumaticfever
Injury
Neoplasms
Dressler'ssyndrome
>Murmurs:systolictypesSAPS:
Systolic
Aortic
Pulmonic
Stenosis
Systolicmurmursincludeaorticandpulmonarystenosis.
Similarly,it'scommonsensethatifitisaorticandpulmonarystenosisitcouldalsobemitralandtricusp
regurgitation].
>MI:signsandsymptomsPULSE:
Persistentchestpains
Upsetstomach
Lightheadedness
Shortnessofbreath
Excessivesweating
>Heartcompensatorymechanismsthat'save'organbloodflowduringshock"HeartSAVER":
Symphatoadrenalsystem
Atrialnatriureticfactor
Vasopressin
Endogenousdigitalislikefactor
Reninangiotensinaldosteronesystem
Inall5,systemisactivated/factorisreleased
>Murmurs:rightvs.leftloudness"RILE":
RightsidedheartmurmursarelouderonInspiration.
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LeftsidedheartmurmursareloudestonExpiration.
>STelevationcausesinECGELEVATION:
Electrolytes
LBBB
Earlyrepolarization
Aneurysm
Treatment(egpericardiocentesis)
Injury(AMI,contusion)
Osbornewaves(hypothermia)
Nonocclusivevasospasm
>Beck'striad(cardiactamponade)3D's:
Distantheartsounds
Distendedjugularveins
Decreasedarterialpressure
>Abdominalaorticaneurysm:geneticcomponentAAA(3A's)issometimesduetoadefectinthegene
encodingfortypeIIIprocollagen.
>Varicoseveins:symptomsAEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/Ugly(LDS,haemosiderin,varicosities)
>Whitetoe(arterialinsufficiencytoe)5P's:
Palecoloration
Pain(excruciating)
Paresthesia
Pulselessness
WarmcompressionandvasodilatoryPatchtoProximalarea
>Bluetoe(microembolictoe)CAVEMAN:
Cholesterolembolizations
Atrialfibwithelectricityordigitoxin
Valvularproblems
Endocarditis
Muralthrimbosis
Aneurysm/AVfistula
Nothing
>PeripheralvasculardiseasesABCDEF:
Atherosclerosis.
Buerger'sdisease(TAO)
Cyanosis/Coldagglutinin/Connectivetissuedisease(Raynaud'sphenomenon)
Deepveinphlebothrombosis
Embolism
inFlammationofveins
>TIA:internalcarotidvs.vertebrobasilarMDvs.DPM
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Internalcarotid:
Monocularblindness(amauroxfugax)
Dominanthemisphere(apahsia)
Theweaknessornumbnessisstilllessinthelegs.
Vetebrobasilar:
Diplopia/Doubleblindness
Paralysis(quadriplesia)
Motorweakness(ipsilateral)
Ataxiaischaracteristicinveterbrobasilarlesions.
>PGI2vs.TxA2coagulationfunctionTxA2Aggregatesplatelets.
PGI2Inhibitsaggregation.
Note:fullnameofPGI2isprostaglandinI2orprostacyclin,fullnameofTxA2isthromboxaneA2.
>Einthoven'sTriangle:organizationCornersareatRA(rightarm),LA(leftarm),LL(leftleg).
NumberofL'satacornertellhowmany+signsareatthatcorner[egLLis++].
SumofnumberofL'sofany2cornerstellsthenameofthelead[egLLLAisleadIII].
Forreferenceaxes,thenegativeanglehemisphereisonthehalfofthetriangledrawingthathasallthe
negativesignspositiveanglehemispherecontainsonlypositivesigns.
>Heart:tropicdefinitionsLusitropic:looseisrelaxed.Definition:relaxheart.
Inotropic:whenheartwallcontracts,movesinward.Definition:contractheart.
Chronotropic:'chrono'means'time'.Defintion:heartrate(ofSAnodeimpulses).
Dromotropic:onlyoneleft,itmustbeconductionspeedbydefault.
>Heartvalves:sequenceofflowTRIPSBIAS:
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar
Alternatively:"TRIPS,MIASs!"(usesMItralinsteadofBIcuspid)
>Intrinsicvs.extrinsicpathwaytests"PeTPiTTbull":
PeT:PTisforextrinsicpathway.
PiTTbull:PTTisforintrinsicpathway.
>Carotidsinusvs.carotidbodyfunctioncarotidSinuS:measurespreSSure.
carotidbO2dymeasuresO2.
>Hemoglobinandmyoglobin:bindingstrengths,sites"ABC"ofglycosylatedHb(Hb1c):
GlucosebindstoAminoterminalofBetaChain.
"HbFbindsForcefully":
HbFbindsoxygenmoreforcefullythanHbA,soOxyHbdissociationcurveshiftstoleft.
StoredbloodisSOS:
StoredbloodHbbindstoOxygenStronglybecauseofdecreasein2,3BPG.
2,3BPGbindingsiteisBBC:
BPGbindstoBetaChainofHb.
MyoglobinbindingstrengthisMOM:
MyoglobinbindsOxygenMorestronglythanHb.
>Hboxygendissociationcurveshifts:effect,locationLeftshift:causesLoadingofO2inLungs.
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Rightshift:causesReleaseofO2fromHb.
>Heartelectricalconductionpathway"Ifpatient'sfamilyareallhavingHeartattacks,youmustSAVeHIS
KIN!"
SAnode>
AVnode>
His(bundleof)>
PurKINjefibers
>Heartvalves:closuresequence"ManyThingsArePossible":
Mitral,Tricuspid,Aortic,Pulmonic
>Fluidcompartments:volumes12345:
12litersofinterstitialfluid
3litersplasmavolumeand30litersinsidecells
45literstotalbodywater
>Heartvalves:placementofvalvesonstandardheartanteriorview"TrybeforeyouBuy":Whenreadacross
thepage,thetricuspidvalvecomesbeforethebicuspidvalve.
Also,thelunarvalvesarenearthetop(inthesky),likethemoon.
>Propranololandrelated'olol'drugs:usage"olol"isjusttwobackwardslowercaseb's.
Backwardb'sstandfor"betablocker".
Betablockersincludeacebutolol,betaxolol,bisoprolol,oxprenolol,propranolol.
>Warfarin:action,monitoringWePT:
WarfarinworksontheextrinsicpathwayandismonitoredbyPT.
>Betablockers:sideeffects"BBCLosesViewersInRochedale":
Bradycardia
Bronchoconstriction
Claudication
Lipids
Vividdreams&nightmares
veInotropicaction
Reducedsensitivitytohypoglycaemia
>Captopril(anACEinhibitor):sideeffectsCAPTOPRIL:
Cough
Angioedema/Agranulocystosis
Proteinuria/Potassiumexcess
Tastechanges
Orthostatichypotension
Pregnancycontraindication/Pancreatitis/Pressuredrop(firstdosehypertension)
Renalfailure(andrenalarterystenosiscontraindication)/Rash
Indomethacininhibition
Leukopenia/Livertoxicity
>Betablockers:maincontraindications,cautionsABCDE:
Asthma
Block(heartblock)
COPD
Diabetesmellitus
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Electrolyte(hyperkalemia)
>Ca++channelblockers:usesCA++MASH:
Cerebralvasospasm/CHF
Angina
Migranes
Atrialflutter,fibrillation
Supraventriculartachycardia
Hypertension
Alternatively:"CHASM":
Cererbralvasospasm/CHF
Hypertension
Angina
Suprventriculartachyarrhythmia
Migranes
>Warfarin:metabolismSLOW:
Hasaslowonsetofaction.
AquicKVitaminKantagonist,though.
Smalllipidsolublemolecule
Liver:siteofaction
Oralrouteofadministration.
Warfarin
>Amiodarone:action,sideeffects6P's:
Prolongsactionpotentialduration
Photosensitivity
Pigmentationofskin
Peripheralneuropathy
Pulmonaryalveolitisandfibrosis
PeripheralconversionofT4toT3isinhibited>hypothyroidism
>Patentductusarteriosus:treatment"ComeInandClosethedoor":
INdomethacinisusedtoClosePDA.
>Hypertension:treatmentABCD:
ACEinhibitors/AngIIantagonists(sometimesAlphaagonistsalso)
Betablockers
Calciumantagonists
Diuretics(sometimesvasoDilatorsalso)
>Clopidogrel:useCLOPIdogrelisadrugthatprevents
CLots,anOralPlateletInhibitor(OPI).
>BetablockerswithintrinsicsympathomimeticactivityPicturediabeticandasthmatickidsridingawayona
cartthatrollsonpinwheels.
PindololandCarteololhavehighandmoderateISArespectively,makingthemacceptableforuseinsome
diabeticsorasthmaticsdespitethefactthattheyarenonseletivebetablockers.
>Enoxaprin(prototypelowmolecularweightheparin):action,monitoringEnoXaprinonlyactsonfactorXa.
MonitorXaconcentration,ratherthanAPTT.
>Betablockers:nonselectivebetablockers"TimPinchesHisNasalProblem"(becausehehasarunny
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nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol
>ThrombolyticagentsUSA:
Urokinase
Streptokinase
Alteplase(tPA)
>Antiarrhythmics:classificationItoIVMBACollege
InorderofclassItoIV:
Membranestabilizers(classI)
Betablockers
Actionpotentialwideningagents
Calciumchannelblockers
>HMGCoAreductaseinhibitors(statins):sideeffects,contraindications,interactionsHMGCoA:
Sideeffects:
Hepatotoxicity
Myositis[akarhabdomyolysis]
Contraindications:
Girlduringpregnancy/Growingchildren
Interactions:
Coumarin/Cyclosporine
>Antiarrhythmics:classIIImembersBIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol
>Adrenoceptors:vasomotorfunctionofalphavs.betaABCD:
Alpha=Constrict.
Beta=Dilate.
>Betablockers:B1selectivevs.B1B2nonselectiveAthroughN:B1selective:Acebutalol,Atenolol,
Esmolol,Metoprolol.
OthroughZ:B1,B2nonselective:Pindolol,Propanalol,Timolol.
>Betablockers:members"TheNEPALPrimeMinister":
Timolol
Nadolol
Esmolol
Pindolol
Atenolol
Labetalol
Propranolol
Metoprolol
>Thalidomide:effectoncancercells"Thalidomidemakesthebloodvesselshide":
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Usethalidomidetostopcancercellsfromgrowingnewbloodvessels.
>Patentductusarteriosus:whichprostaglandinkeepsitopenkEEpopEnwithprostaglandinE.
>Cyanoticheartdiseases:5typesUseyourfivefingers:
1fingerup:TruncusArteriosus(1vessel)
2fingersup:DextropositionoftheGreatArteries(2vesselstransposed)
3fingersup:TricuspidAtresia(3=Tri)
4fingersup:TetralogyofFallot(4=Tetra)
5fingersup:TotalAnomalousPulmonaryVenousReturn(5=5words)
>Cyanoticcongenitalheartdiseases5T's:
Truncusarteriosus
Transpositionofthegreatarteries
Tricuspidatresia
TetrologyofFallot
Totalanomalouspulmonaryvenousreturn
>HemolyticUremicSyndrome(HUS):components"RemembertodecreasetheRATEofIVfluidsinthese
patients":
Renalfailure
Anemia(microangiopathic,hemolytic)
Thrombocytopenia
Encephalopathy(TTP)
>Cyanoticheartdiseases:5types5T's:
TetralogyofFallot
Transpositionofthegreatarteries
Truncusarteriosus
Tricuspidatresia,pulmonaryaTresia
Totalanomalouspulmonaryvenousdrainage
>APGARscorecomponentsFiveB's:
Breathing(respiratoryeffort)
Beating(heartrate)
Buff(tone)
Bothered(responsetostimulation)
Blue(cyanosis)
>Takayasu'sdiseaseisPulselessdisease"Can'tTak'ayapulse"(Can'ttakeyourpulse):
Takayasu'sdiseaseknownasPulselessdisease,sincepulseisweakenedintheupperextremities.
>Acuteischemia:signs[especiallylimbs]6P's:
Pain
Pallor
Pulselessness
Paralysis
Paraesthesia
Perishinglycold
>Hypertension:secondaryhypertensioncausesCHAPS:
Cushing'ssyndrome
Hyperaldosteronism[akaConn'ssyndrome]
Aortacoarctation
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Phaeochromocytoma
Stenosisofrenalarteries
Note:only5%ofhypertensioncasesaresecondary,restareprimary.
>MI:sequenceofelevatedenzymesafterMI"CASTLe"(castle):
CKMBfirst
ASTsecond
LDHthird
Also:canusethelast'E'forESR.
>Atherosclerosisriskfactors"You'reaSADBETwiththeseriskfactors":
Sex:male
Age:middleaged,elderly
Diabetesmellitus
BPhigh:hypertension
Elevatedcholesterol
Tobacco
>AtherosclerosisriskfactorsSHIFTMAID:
Smoking
Hypertension
(N)IDDM
Familyhistory
Triglycerdides&fats
Male
Age
Inactivity
Diet/Drink
>Thrombus:possiblefatesDOPE:
Dissolution
Organization&repair
Propagation
Embolization
>MI:sequenceofelevatedenzymesafterMI"TimetoCALL911":
Fromfirsttoappeartolast:
Troponin
CKMB
AST
LDH1
>Blooddisorders:commonersexHE(male)gets:
HEmophilia(Xlinked)
HEinzbodies(G6PDdeficiency,causingHEmolyticanemia:Xlinked)
HEmochromatosis(malepredominance)
HEartattacks(malepredominance)
HEnochSchonleinpurpura(malepredominance)
SHE(female)gets:
SHEehan'ssyndrome
>Deepvenousthrombosis:geneticcausesALASCA:
AntithrombinIII
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Leiden(FactorV)
APC(ActivatedProteinC)
Sproteindeficiency
Cproteindeficiency
Antiphospholipidantibody
>Buerger'sdiseasefeatures"burgerSCRAPS":
Segmentingthrombosingvasculitis
Claudication(intermittent)
Raynaud'sphenomenon
Associatedwithsmoking
Pain,evenatrest
Superficialnodularphlebitis
Alternatively,ifhungryformoredetail[sic],"CRISPPIGburgers":
Chroniculceration
Raynaud'sphenomenon
Intermittentclaudication
Segmenting,thrombosingvasculitis
Pain,evenatrest
Phlebitis(superficialnodular)
Idiopathic
Gangrene
>Deepvenousthrombosis:diagnosisDVT:
Dilatedsuperficialveins/Discoloration/Dopplerultrasound
Venographyisgoldstandard
TendernessofThighandcalf
>Virchow'striad(venousthrombosis)"VIRchow":
Vasculartrauma
Increasedcoagulability
Reducedbloodflow(stasis)
>Kawasakidisease:featuresDiseasename:aKawasakimotorcycle.
Usuallyyoungchildren,epidemicinJapan:Japanesechildridesthemotorcycle.
Conjunctival,oralerythema:redeyes,mouth.
Fever:thermometer.
Erythemaofpalms,soles:redpalms,soles.
Generalizedrash:rashdots.
Cervicallymphadenitis:enlargedcervicalnodeswithinflammationarrows.
Vasculitisofarteries:inflammationarrowsonarteries.
Cardiovascularsequelae[20%]:inflammationarrowsoncardiacarteries.
Treatwithaspirin:aspirinheadlight.
Seediagram.
>VonHippelLindau:signsandsymptomsHIPPEL:
Hemanigoblastomas
Increasedrenalcancer
Pheochromocytoma
Portwinestains
Eyedysfunction
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Liver,pancreas,kidneycysts
Barebonesversion:HippelLindau,withHandLasabove.
>Heartfailurecauses"HEARTMAyDIE":
Hypertension
Embolism
Anemia
Rheumaticheartdisease
Thyrotoxicosis(incl.pregnancy)
Myocardialinfarct
Arrythmia
Y
Diet&lifestyle
Infection
Endocarditis
>Anemiacauses(simplified)ANEMIA:
Anemiaofchronicdisease
NofolateorB12
Ethanol
Marrowfailure&hemaglobinopathies
Irondeficient
Acute&chronicbloodloss
>Pick'sdisease:location,action,epidemiologySeefigure.
PickaxesarePickingawayattheoldwoman'scerebralcortex,causingcorticalatrophy.
2pickaxesonherbrain:frontallobeandanterior1/3oftemporal.
Anoldwoman,sinceepidemiologyiselderly&morecommoninwomen.
>Pericarditis:findingsPERICarditis:
Pulsusparadoxus
ECGchanges
Rub
IncreasedJVP
Chestpain[worseoninspiration,betterwhenleanforward]
>Fatembolism:findings"Fat,Bat,Fract":
Fatinurine,sputum
Batwinglungxray
Fracturehistory
Also,fractureofFEMurcausesFatEMboli.
>HemolyticanemiatypesSHEEPT!T:
Sicklecell
Heriditarysplenocytosis
Enzymedeficiencies:[G6P,pyruvatekinase]
Erythroblastosisfetalis
Paroxysmalnocturnalhemoglobinuria
TraumatoRBCs
Immunohemolytics:[warmAb,coldAg]
Thalassemias:[alpha,beta]
>DisseminatedIntravascularCogulation:causesDIC:
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DeliveryTEAR(obstetriccomplications)
Infections(gramnegative)/Immunological
Cancer(prostate,pancreas,lung,stomach)
ObstretricalcomplicationsareTEAR:
Toxemiaofpregnancy
Emboli(amniotic)
Abrutioplacentae
Retainfetusproducts
>Thromboticthrombocytopenicpurpura:signsFATRN:
Fever
Anemia
Thrombocytopenia
Renalproblems
Neurologicdysfunction
>Kawasakidisease:diagnosticcriteriaCHILD:
5letters=5days,>5yearsold,5out6criteriafordiagnosis:
Conjuctivitis(bilateral)
Hyperthermia(fever)>5days
Idiopathicpolymorphicrash
Lymphoadenopathy(cervical)
Dryness&rednessof(i)lips&month(ii)palms&soles[2separatecriteria]
>ProteinC,ProteinS:functionCandSare:
Clot
Stoppers
Theseproteinsinhibitcoagulation.
>AneurysmtypesMADSCAB:
Mycotic
Atherosclerotic
Dissecting
Syphilitic
Capillarymicroaneurysm
Arteriovenousfistula
Berry
>Kawasaki'sdisease:featuresFEARME:
Fever
Eye:perilimbicsparingconjunctivalinjection
Adenopathy:usuallycervical
Rash
Mouth:redlips
Extremities:redhandsandfeet
Diseasetobefearedbecauseofriskofcoronaryaneurysms.
>MI:complications"LEAPontheMAP":
LVF
Embolism(systemic)
Aneurysm(ventricular)
Progressiveinfarction
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Myocardialrupture
Arrhythmia
Pericarditis
>Portalhypertension:featuresABCDE:
Ascites
Bleeding(haematemesis,piles)
Caputmedusae
Diminishedliver
Enlargedspleen
>Anemia(normocytic):causesABCD:
Acutebloodloss
Bonemarrowfailure
Chronicdisease
Destruction(hemolysis)
>TTP:clinicalfeaturesThrombosisandthrombocytopeniaPARTNERtogether:
Plateletcountlow
Anemia(microangiopathichemolytic)
Renalfailure
Temperaturerise
Neurologicaldeficits
ERadmission(asitisanemergency)
>Macrocyticanaemia:differentialFATRBC:
Fetus(pregnancy)
Alcohol
Thyroiddisease(iehypothyroidism)
Reticulocytosis
B12andfolatedeficiency
Cirrhosisandchronicliverdisease
>MI:postMIcomplicationsACTRAPID:
Arrhythmias(SVT,VT,VF)
Congestivecardiacfailure
Tamponade/Thromboembolicdisorders
Rupture(ventricle,septum,papillarymuscle)
Aneurysm(ventricle)
Pericarditis
Infaction(asecondone)
Death/Dressler'ssyndrome
>CardiovascularriskfactorsFLASHBODIES:
Familyhistory
Lipids
Age
Sex
Homocystinaemia
Bloodpressure
Obesity
Diabetesmellitus
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Inflammation(raisedCRP)/Increasedthrombosis
Exercise
Smoking
>Cardiovascularriskfactors(Framingham)FRAMINGHAM:
Familyhistory
Running(exercise)
Adiposity(obesity)
Marlboros(tobacco)
Insulinresistance(diabetes)
Nonregulatedlipids(dyslipidaemia)
GeorgiePie(highfatdiet)
Hypertension
Age
Male
>Syncope(fainting)treatmentIfthefaceisred,raisethehead.
Ifthefaceispale,raisethetail.
>Preeclampsia:classictriadPREeclampsia:
Proteinuria
Risingbloodpressure
Edema
>StrokeriskfactorsHEADS:
Hypertension/Hyperlipidemia
Elderly
Atrialfib
Diabetesmellitus/Drugs(cocaine)
Smoking/Sex(male)
>BattlesignBattlE:
BehindEar
>Stroke:youngpatient'slikelycauses7C's:
Cocaine
Consanguinity[familialsuchasneurofibromatosisandvonHippelLindau]
Cancer
Cardiogenicembol
hyperCoagulation
CNSinfection[eg:HIVconditions]
Congenitalarteriallesion
>Stroke:basicworkupThe3P's:
Pump
Pipes
Plasma
>Endocarditis:labresultssuggestingit"HighTechLabResultsPointAtEndocarditis":
Hematuria
Thrombocytopenia
Leukocytosis,penia
Redbloodcellcasta
Proteinuria
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Anemia
ElevatedESR
>Endocarditis:causesofculturenegativeendocarditis"WithNegativeTests,InvestigatorsShouldFocus
AttentionSomewhereMeaningful":
Wrongdiagnosis
Noninfectiousendocarditis
Timing(culturesdrawnatendofchroniccourse)
obligateIntracellularorganisms
Slowgrowingfastidiousorganisms
Fungalinfection
Antibioticusedpreviously
Subacuterightsidedendocarditis
Muralendocarditis
>Endocarditis:indicationsforsurgeryPUSRIVER:
Prostheticvalveendocarditis(mostcases)
Uncontrolledinfection
Supporativelocalcomplicationswithconductionabnormalities
Resectionofmycoticaneurysm
Ineffectiveantimicrobialtherapy(egVsfungi)
Valvulardamage(significant)
Embolization(repeatedsystemic)
Refractorycongestiveheartfailure
>Heartvalveauscultationsites"AllPatientsTakeMeds":
Readingfromtopleft:
Aortic
Pulmonary
Tricuspid
Mitral
Seediagram.
Alternatively:AllProstitutesTakeMoney.
Alternatively:APeToMan.
Alternatively:AlwaysPumpsTooMuch.
>Heartvalveauscultationsites"AllPeopleTryMarijuana":
Aortic
Pulmonic
Tricuspid
Mitral
>Branhamsign:definitionBRAnhamsign:
BRAdycardiaaftercompressionorexcisionofalargeAVfistula.
>Heartausculationsites:ribsApt.M225A:
Aorticvalve
Pulmonaryvalve
Tricuspidvalve
Mitralvalve
Inordertheycorrespondwiththefollowinglandmarks:
2ndintercostalspace(right)
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2ndintercostalspace(left)
5thintercostalspace(left)
Apex(stillthe5thintercostalspace)
>Pancytopaeniadifferential"AllOfMyBloodHasTakenSomePoison":
Aplasticanaemias
Overwhelmingsepsis
Megaloblasticanaemias
Bonemarrowinfiltration
Hypersplenism
TB
SLE
Paroxysmalnocturnalhaemoglobinuria
>Haematology:keynumbers3and4arekeyininhaematology:
1.34cm3ofoxygeniscarriedbyagramofhemoglobin.
There's3.4mgofironineachgramofhemoglobin.
There'sanaverageof3.4lobesperneutrophil.
There's34mgbilirubinfromeachgramofhemoglobin.
>SicklecelldiseasecomplicationsSICKLE:
Strokes/Swellingofhandsandfeet/Spleenproblems
Infections/Infarctions
Crises(painful,sequestration,aplastic)/Cholelithiasis/Chestsyndrome/Chronichemolysis/Cardiacproblems
Kidneydisease
Liverdisease/Lungproblems
Erection(priapism)/Eyeproblems(retinopathy)
>ADP:roleinplateletaggregationADP=AggregationfromtheDensebodiesofPlatelets.
>Aniongapmetabolicacidosis:causesAMUDPILECAT:
Alcohol
Methanol
Uremia
Diabeticketoacidosis
Paraldehyde
Iron/Isoniazid
Lacticacidosis
Ethyleneglycol
Carbamazepine
Aspirin
Toluene
>HbA2:concentrationinnormalbloodHbA2:
ConcentrationofHbA2is2%innormaladultblood.
>Metabolicacidosis:causesUSEDCAR:
Ureteroenterostomy
Salinehydration
Endocrinopathies(hyperparathyroid,hyperthyroid,Addison's)
Diarrhea/DKA/Drugs
Carbonicanhydraseinhibitors
Ammoniumchloride
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Renaltubularacidosis
Alternatively:USEDCARP,toincludeParenteralnutrition/Pancreaticfistula.
>Nongapacidosis:causesHARDUP:
Hyperalimentation
Acetazolamide(carbonicanhydraseinhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreaticfistula
>Toxicity/sepsis:signs6T's:
Tachycardia
Tachypnea
Tremors
Toxiclook
Tiredness
Temperature(fever)
>Macrocyticanemia:causesABCDEF:
Alcohol+liverdisease
B12deficiency
Compensatoryreticulocytosis(bloodlossandhemolysis)
Drug(cytotoxicandAZT)/Dysplasia(marrowproblems)
Endocrine(hypothyroidism)
Folatedeficieny/Fetus(pregnancy)
>Metabolicacidosis:causesKUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lacticacidosis
>Raynaud'sdisease:causesBADCT:
Blooddisorders(egpolycythaemia)
Arterial(egatherosclerosis,Buerger's)
Drugs(egbetablockers)
Connectivetissuedisorders(rheumatoidarthritis,SLE)
Traumatic(egvibrationinjury)
>Ulcers:typesVAN:
Venous/Vasculitic
Arterial
Neuropathic
>Anemia:nonmegaloblasticcausesofmacrocyticanemiaHANDLAMP:
Hypothyroidism
Aplasticanaemia
Neonates
Drugs
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Liverdisease
Alcohol
Myelodyplasia
Pregnancy
>NSAIDs:contraindicationsNSAID:
Nursingandpregnancy
Seriousbleeding
Allergy/Asthma/Angioedema
Impairedrenalfunction
Drug(anticoagulant)
>ACEI:contraindictionsPARK:
Pregnancy
Allergy
Renalarterystenosis
Kincrease(hyperkalemia)
>Haemoptysis:causesCAVITATES:
CHF
Airwaydisease,bronchiectasis
Vasculitis/Vascularmalformations
Infection(egTB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach
>Aniongapmetabolicacidosis:causesMUDPILES:
Methanol
Uremia
Diabeticketoacidosis
Paraldehyde
Infection
Lacticacidosis
Ethyleneglycol
Salicylates
>Cyanosis:DDxCOLDPALMS:
Peripheralcyanosis:
Cold
Obstruction
LVFandshock
Decreasedcardiacoutput
Centralcyanosis:
Polycythemia
Altitude
Lungdz
Met,sulphaemoglobinaemia
Shunt
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>Vascularendothelium:simplifiedcrosssectionLIMA:
Lumen
Intima
Media
Adventitia
>Haemachromatosiscomplications"HaemoChromatosisCanCauseDepositsAnywhere":
Hypogonadism
Cancer(hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetesmellitus
Arthropathy
>Vfib/VtachdrugsusedaccordingtoACLS"EveryLittleBoyMustPray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide
>Shock:signsandsymptomsTVSPARCCUBE:
Thirst
Vomiting
Sweating
Pulseweak
Anxious
Respirationsshallow/rapid
Cool
Cyanotic
Unconscious
BPlow
Eyesblank
>AcuteLVFmanagementLMNOP:
Lasex(frusemide)
Nitrates
Oxygen(sitpatientup)
Pulmonaryventilation(ifdoingbadly)
>Subarachnoidhemorrhage(SAH)causesBATS:
Berryaneurysm
Arteriovenousmalformation/Adultpolycystickidneydisease
Trauma(egbeingstruckwithbaseballbat)
Stroke
>Ventricularfibrillation:treatment"Shock,Shock,Shock,EverybodyShock,LittleShock,BigShock,Momma
Shock,PoppaShock":
Shock=Defibrillate
Everybody=Epinephine
Little=Lidocaine
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Big=Bretylium
Momma=MgSO4
Poppa=Pocainamide
>Chestpaintreatment,fornurses"MOVEyourpatient!":
Monitor:putpatientoncardiacmonitor
Oxygen:putpatientonO2
Venous:gainlargeborevenousaccess
EKG:12leadEKG
>EndotrachialtubedeliverabledrugsONAVEL:
Oxygen
Naloxone
Atropine
Ventolin(albuterol)
Epinephrine
Lidocaine
Ifyoucan'tgetIVaccessestablished,andhavenecessitytoadministerresuscitativemeds,rememberyou
havetheairwayandcangivetheabovedrugs.
Drugdeliveryisenhancedifdilutedwith10ccNSandrapidintroducedforaeresolization.
Alternatively,bareboneversionisALE,asabove.
>Syncopecauses,bysystemHEADHEARTVESSELS:
CNScausesincludeHEAD:
Hypoxia/Hypoglycemia
Epilepsy
Anxiety
Dysfunctionalbrainstem(basivertebralTIA)
CardiaccausesareHEART:
Heartattack
Embolism(PE)
Aorticobstruction(IHSS,ASormyxoma)
Rhythmdisturbance,ventricular
Tachycardia
VascularcausesareVESSELS:
Vasovagal
Ectopic(remindsoneofhypovolemia)
Situational
Subclaviansteal
ENT(glossopharyngealneuralgia)
Lowsystemicvascularresistance(Addison's,diabeticvascularneuropathy)
Sensitivecarotidsinus
>Atrialfibrillation:causesofnewonsetTHEATRIALFIBS:
Thyroid
Hypothermia
Embolism(P.E.)
Alcohol
Trauma(cardiaccontusion)
Recentsurgery(postCABG)
Ischemia
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Atrialenlargement
Loneoridiopathic
Fever,anemia,highoutputstates
Infarct
Badvalves(mitralstenosis)
Stimulants(cocaine,theo,amphet,caffeine)
>Malaria:complicationsoffalciparummalariaCHAPLIN:
Cerebralmalaria/Coma
Hypoglycemia
Anaemia
Pulmonaryedema
Lacticacidosis
Infections
Necroisofrenaltubules(ATN)
>MI:immediatetreatmentDOGASH:
Diamorphine
Oxygen
GTNspray
Asprin300mg
Streptokinase
Heparin
>PainhistorychecklistOLDERSAAB:
Onset
Location
Description(whatdoesitfeellike)
Exacerbatingfactors
Radiation
Severity
Associatedsymptoms
Alleviatingfactors
Before(everexperiencethisbefore)
>PulselessElectricalActivity(PEA):checklistPEA:
Pulsescheck
Epinepherine
Atropine
>PEA/Asystole(ACLS):etiologyITCHPAD:
Infarction
Tensionpneumothorax
Cardiactamponade
Hypovolemia/Hypothermia/Hypo,Hyperkalemia/Hypomagnesmia/Hypoxemia
Pulmonaryembolism
Acidosis
Drugoverdose
>Vfib/pulselessvtach(newACLSasof2001)"EVALMyPumper":
Epinephrine
Vasopressin
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Amiodarone(classIIbbetterforheartfailure)
Lidocaine(indeterminatebetterforyoung,healthyorpersistent)
MgSO4(IIbforhypomagnesemicstateortorsades)
Procainamide(IIbforintermittent/recurrentVF/VT)
>Asystole:treatment"Havesomeasystole"TEA":
Transcutaneouspacing
Epi
Atropine
>JVP:raisedJVPdifferentialPQRST(EKGwaves):
Pericardialeffusion
Quantityoffluidraised(fluidoverload)
Rightheartfailure
Superiorvenacavalobstruction
Tricuspidstenosis/Tricuspidregurgitation/Tamponade(cardiac)
>JVP:raisedJVP:extracardiaccausesFATPEA:
Fever
Anaemia
Thyrotoxicosis
Pregnancy
Exercise
AVfistula
Theseareinadditiontoallthecardiacones(pericardialeffusion,RHF,tricuspidstenosis,SVCobstruction,
etc).
>Shock:generalfeaturesCHORDITEM:
Cold,clammyskin
Hypotension
Oliguria
Rapid,shallowbreathing
Drowsiness,confusion
Irritability
Tachycardia
Elevatedorreducedcentralvenouspressure
Multiorgandamage
>Myocardialinfarction:someemergencytreatmentdrugsABCD:
Aspirin
Betablockers
Clotbusters(thromboytics)
Dynamite(nitrates)
>Branchialarchgivingrisetoaorta"AorfromFour":
Aortaisfromfourtharch.
>TetrologyofFallot"Don'tDROPthebaby":
Defect(VSD)
Rightventricularhypertrophy
Overridingaorta
Pulmonarystenosis
>TetrologyofFallot"IHOPInternationalHouseofPancakes":
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Interventricularseptaldefect
Hypotrophyofrightventricle
Overridingaorta
Pulmonarystenosis
>TetrologyofFallotPROVe:
Pulmonarystenosis
Rightventricularhypertrophy
Overridingaorta
Ventricularseptaldefect
>Heart:primitiveheartchambersinfetalheart"TheBrokenVeinAlwaysStenoses,ButVeinsAreSmooth":
Theorderofthecompartmentsis:runcus,bulbus
PrimitiveVentricle
PrimitiveAtrium
Sinusvenosus
Theconnectionsare:
BulbotruncaljunctionVentriculobulbarforamen
Atrioventricularcanal
Sinuatrialjunction
>TetrologyofFallot"ProblemsOfSmallHearts":
Pulmonarystenosis
Overridingaorta
VentricularSeptaldefect
Hypertrophyofrightventricle
>Coagulationcommonpathway:factorsinorder10+52=13
Coagulationcommonpathway:
FactorXtoFactorVtoFactorIItoFactorXIII
>VitaminKdependentcofactors"SeveralTendToNicelyStopClots":
FactorSeven,Ten,Two,Nine.
ProteinS,ProteinC.
>Femoraltriangle:arrangementofcontentsNAVEL:
Fromlateralhiptowardsmedialnavel:
Nerve(directlybehindsheath)
Artery(withinsheath)
Vein(withinsheath)
Emptyspace(betweenveinandlymph)
Lymphatics(withdeepinguinalnode)
Nerve/Artery/VeinareallcalledFemoral.
>Femoraltriangle:arrangementofnerve,artery,veinVAN:
Frommedialtolateral:
Vein
Artery
Nerve
Nerve/Artery/VeinareallcalledFemoral.
>Aorticarch:majorbranchorder"KnowyourABC'S":
Aorticarchgivesriseto:
Brachiocephalictrunk
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leftCommonCarotid
leftSubclavian
Bewarethoughtrickquestionof'Whatisfirstbranchofaorta?'Technically,it'sthecoronaryarteries.
>Lunglobenumbers:rightvs.leftTricuspidheartvalveandtrilobedlungbothontherightside.
Bicuspidandbilobedlungbothontheleftside.
>UlnarnervetoulnararteryandradialnervetoradialarteryrelationsThink"peripheralnerves":
Theulnarnerveis"ulnar"totheulnarartery.
Radialnerveis"radial"totheradialartery.
>Superiorthyroidarterybranches"MayISoftlySqueezeCharlie'sGirl?":
Muscular
Infrahyoid
Superiorlaryngeal
Sternomastoid
Cricothyroid
Glandular
>Femalepelvicorgans'bloodsupply"3organs,eachget2bloodsupplies":
Uterus:uterine,vaginal.
Rectum:middlerectal,inferiorrectal[inferiorrectalistheendofpudendal].
Bladder:superiorvesical,inferiorvesical.
>Liver:sidewithligamentumvenosum/caudatelobevs.sidewithquadratelobe/ligamentumteres"VCgoes
withVC":
TheVenosumandCaudateisonsamesideasVenaCava[posterior].Therefore,quadrateandteresmustbe
onanteriorbydefault.
>Saphenousveins:pathofgreatvs.smallatmalleolus"MAGdelainehasvaricoseveins"[Thesaphenous
veinsareimportantforvaricoseveins]:
Medialmaleolus,Anteriortomaleolus,andGreatsaphenousgotogether.
Thentheoppositesofthesegotogether:Smallsaphenousisposteriortothelateralmaleolus.
>Thoraciccage:relationstotheimportantvenousstructuresBehindthesternoclavicularjoints:the
brachiocephalicveinsbegin.
Behindthe1stcostalcartilageontherightthesuperiorvenacavabegins.
Behindthe2ndcostalcartilageontherighttheazygosveinends.
Behindthe3rdcostalcartilageontherightthesuperiorvenacavaends.
>Externalcarotidarterybranches"SisterLucy'sPowderedFaceOftenAttractsSillyMedicos":
Beforeenteringtheparotidgland:
Superiorthyroid
Lingual
Posteriorauricular
Facial
Occipital
Ascendingpharyngeal
Endsas:
Superficialtemporaland
Maxillarybifurcatingintheintheparotidgland
>Externalcarotidarterybranches"SomeAngryLadyFiguredOutPMS":
Superiorthyroid
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Ascendingpharyngeal
Lingual
Facial
Occipital
Posteriorauricular
Maxillary
Superificialtemporal
>Descendingabdominalaorta:sevendivisions"SometimesIntestinesGetReallyStretchedCausing
Leakage":
Suprarenals[paired]
Inferiormesenteric
Gonadal[paired]
Renals[paired]
Superiormesenteric
Celiac
Lumbar[paired]
>Internaljugularvein:tributaries"MedicalSchoolsLetConfidentPeopleIn":
Frominferiortosuperior:
Middlethyroid
Superiorthyroid
Lingual
Commonfacial
Pharyngeal
Inferiorpetrosalsinus
>Portalsystemicanastomoses:main2placesthatretroperitonealsconnectintosystemicRetroPeritoneals
hookupwithRenalandParavertebralveins.
>Brachialartery:recurrentandcollateralbranches"IAmPrettySexy"
InferiorulnarcollateralarterygoeswithAnteriorulnarrecurrentartery.
PosteriorulnarrecurrentarterygoeswithSuperiorulnarcollateralartery.
Alternatively:"IAmPrettySmart".
>Thoracoacromialarterybranches"CAliforniaPoliceDepartment":
Clavicular
Acromial
Pectoral
Deltoid
>Axillaryarterybranches"SendTheLordtoSayAPrayer":
Fromproximaltodistal:
Superiorthoracic
Thoracacromial
Lateralthoracic
Subscapular
Anteriorcircumflexhumeral
Posteriorcircumflexhumeral
>Carotidsheathcontents"ISee10CC'sintheIV":
ISee(I.C.)=InternalCarotidartery
10=CN10(Vagusnerve)
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CC=CommonCarotidartery
IV=InternalJugularVein
>Internaliliacartery:posteriorbranchPILS:
Posteriorbranch
Iliolumbar
Lateralsacral
Superiorgluteal
>ExternalcarotidarterybranchesStApLEOPIS:
Superiorthyroid
Ascendingpharyngeal
Lingual
Externalmaxillary(facial)
Occipital
Posteriorauricular
Internalmaxillary
Superficialtemporal
>Axillaryarterybranches"SuzyThompkinsLovesSex,Alcohol,andPot":
Fromproximaltodistal:
Superiorthoracic
Thoracacromial
Lateralthoracic
Subscapular
>Maxillaryarterybranches"DAMIAMPissDrunkButStupidDrunkIPrefer,MustPhoneAlcoholics
Anonymous":
Deepauricular
Anteriortympanic
Middlemeningeal
Inferioralveolar
Accessorymeningeal
Masseteric
Pterygoid
Deeptemporal
Buccal
Sphenopalatine
Descendingpalatine
Infraorbital
Posteriorsuperioralveolar
Middlesuperioralveolar
Pharyngeal
Anteriorsuperioralveolar
Arteryofthepterygoidcanal
>Femoralhernia:epidemiologyFEMoralherniasaremorecommoninFEMales.
>Externalcarotidarterybranches"SoLongForActingOldParentingMeansStability":
Superiorthyroid
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Lingual
Facial
Ascendingpharyngeal
Occiptal
Posteriorauricular
Maxillary
Superficialtemporal
>Inferiorvenacavatributaries"ILikeToRiseSoHigh":
Illiacs
Lumbar
Testicular
Renal
Suprarenal
Hepaticvein.
ThinkoftheIVCwantingtorisehighuptotheheart.
>CavernoussinuscontentsOTOMCAT:
OTOMarelateralwallcomponents,inorderfromsuperiortoinferior.
CAarethecomponentswithinthesinus,frommedialtolateral.CAendsatthelevelofTfromOTOM.
Seediagram.
Occulomotornerve(III)
Trochlearnerve(IV)
Ophthalmicnerve(V1)
Maxillarynerve(V2)
Carotidartery
Abducentnerve(VI)
T:Whenwritten,connectstotheTofOTOM.
>Femoraltriangle:contentsNAVY:
Inorderfromlateraltomedial:
Nerve
Artery
Vein
Yofthegroin
Alternatively:Y=Yfronts[maleunderwear].
>Internaliliacartery:anteriorbranchesWhatBilladmittedtoHilary:"IMilkedOurInsatiableIntern'sUdders
UndertheDesk":
Inferiorgluteal
Middlerectal
Obturator
Inferiorvesicalartery
Internalpudendalartery
Umbilical
U/D=Uterineartery(female)/Deferentialartery(male)
>ThoracoacromialarterybranchesABCD:
Acromial
Breast(pectoral)
Clavicular
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>Axillaryarterybranches"ScrewTheLawyerSaveAPatient":
Superiorthoracic
Thoracoacromiol
Lateralthoracic
Subscapular
Alternatively:"SomeTimesLifeSeemsAPain".
>Externalcarotidarterybranches"SallyAteLotsOfFreshProduceMarchThroughSeptember":
Superiorthyroid
Ascendinglaryngeal
Lingual
Occipital(ObeforeFisanextremelycommonvariation)
Facial
Posteriorauricular
Maxillary
Transversefacial
Superficialtemporal
>Atrioventricularvalves"LABRAT":
LeftAtrium:Bicuspid
RightAtrium:Tricuspid
>Externalcarotidarterybranches"SheLayFlaccidAsOlaf'sPenisSlippedIn":
Fromcaudaltocephalad:
Superiorthyroid
Lingual
Facial
Ascendingpharyngeal
Occipital
Posteriorauricular
Superficialtemporal
(Internal)maxillary
>Brachialarteryismedialtobicepstendon"BAMBI":
BrachialArteryisMedialtoBicepsInelbow.
>Externalcarotidarterybranches"SuzyAlwaysLaysFlatOnPillowsMakingSexTerrific":
Superiorthyroid
Ascendingpharyngeal
Lingual
Facial
Occipital
Posteriorauricular
Maxillary
SuperificialTemporal
>Coelictrunk:branchesLeftHandSide(LHS):
Leftgastricartery
Hepaticartery
Splenicartery
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>Heartvalvesequence"TryPullingMyAorta":
Tricuspid
Pulmonary
Mitral
Aorta
>Femoralarterydeepbranches"PutMyLegDownPlease":
Profundusfemoris(deepfemoralartery)
Medialcircumflexfemoralartery
Lateralcircumflexfemoralartery
Descendinggeniculararteries
Perforatingarteries
>Subclavianarterybranches"VeryTiredIndividualsSipStrongCoffeeServedDaily":
Vertebralartery
Thyrocervicaltrunk
Inferiorthyroid
Superficialcervical
Suprascapular
Costocervical
Superiorintercostal
Deepcervical
>Cardiacvalves:orderincircuit"TRIberoreyouBI":
TricuspidvalveislocatedinleftheartandBicuspidvalveislocatedinrightheart.Bloodflowsthroughthe
tricuspidbeforebicuspid.
>Heartvalves:orderincircuit"FirstlearnaTricycle,thenlearnaBicycle":
FlowthroughTricuspidfirst,thenBicuspid.
>Externaljugularvein:tributariesPAST:
Posteriorexternaljugularvein
Anteriorjugularvein
Suprascapularvein
Transversecervicalvein
>BranchesofInternalIliacArtery"ILoveGoingPlacesInMyVeryOwnUnderwear":
Ileolumbar
Lateralsacral
Gluteal(superiorandinferior)
Pudendal(internal)
Inferiorvesicle(uterineinfemales)
Middlerectal
Vaginal
Obturator
Umbilical
>Thoracoacromialtrunk:branches"CadaversAreDeadPeople":
Clavicular
Acromial
Deltoid
Pectoral
>Posteriormediastinum:contentsDATES:
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Descendingaorta
Azygosandhemiazygousveins
Thoracicduct
Esophagus
Sympathetictrunk/ganglia
>Rheumaticfever:Jones5majorcriteriaSPACE:
Subcutaneousnodules
Pancarditis
Arthritis
Chorea
ErythemaMarginatum
IfyouwanttoaddaMnemonicrelatedtofieldofCardiology,pleasedropitinthecommentssectionbelow.
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ShinyMoonand17otherslikethis.
AhmedElSayaadamazing
March6,2012at4:31pmLike
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ABapexbeatshifted
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MNMurmurNone
OPOrthopneaPresent
QRSTECGchanges
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