Causes of Atrial Fibrillation: PIRATES Contraindications to ACE inhibitors: PARK

Pulmonary embolism, pulmonary disease, post-operative Pregnancy

Ischemic heart disease, idiopathic (“lone atrial fibrillation”) Allergy/Angioedema
Rheumatic valvular disease (mitral stenosis or Renal artery stenosis/Renal failure
regurgitation) K - hyperkalemia (potassium > 5.5)
Anemia, alcohol (“holiday heart”), age, autonomic tone
(vagal atrial fibrillation) ECG Causes of ST segment elevation: ELEVATION
Thyroid disease (hyperthyroidism) Electrolyte abnormalities
Elevated blood pressure (hypertension), electrocution Left bundle branch block
Sleep apnea, sepsis, surgery Aneurysm of left ventricle
Findings in acute limb ischemia: The 5 P’s Ventricular hypertrophy
Arrhythmia disease (Brugada syndrome, ventricular
Pain tachycardia)
Pallor Takotsubo/Treatment (iatrogenic pericarditis)
Pulselessness Injury (myocardial infarction or cardiac contusion)
Paralysis Osborne waves (hypothermia or hypocalcemia)
Paraesthesia Non-atherosclerotic (vasospasm or Prinzmetal’s angina)

Atrioventricular node (AV node) blocking agents: ABCD Treatment of acute coronary syndromes: MONA B

Adenosine, amiodarone Morphine

Beta-blockers Oxygen
Calcium channel blockers Nitrates
Digoxin Aspirin
Beta-blockers
Cardiac auscultation listening
posts: All Physicians Take Money Cyanotic congenital heart disease (right to left
shunts): The 5 T’s
From right upper sternal border, to left upper sternal
border, to left lower sternal border, to cardiac apex. Truncus arteriosus
Transposition of the great arteries
Aortic valve listening post Tricuspid atresia
Pulmonic valve listening post Tetralogy of Fallot
Tricuspid valve listening post Total anomalous pulmonary venous return
Mitral valve listening post
Tetralogy of Fallot: PROVe
Cardioselective beta-blockers: Beta-
blockers Acting Exclusively At Myocardium Pulmonary stenosis
Right ventricular hypertrophy
Betaxolol Overriding aorta
Atenolol Ventricular septal defect
Esmolol
Acebutolol Secondary hypertension causes: ABCDEF
Metoprolol
Apnea (obstructive sleep apnea), Acromegaly, Accuracy
Side-effects of ACE inhibitors: CAPTOPRIL (incorrect measurement)
Birth control, Bad kidney
Cough Coarctation of the aorta, Cushing’s syndrome, Conn’s
Angioedema syndrome, Catecholamines
Potassium excess Drugs (alcohol, nasal decongestants, estrogens)
Taste changes Endocrine disorders, erythropoietin
Orthostatic hypotension Fibromuscular dysplasia
Pregnancy contraindication/Pressure drop (hypotension)
Renal failure/Rash Amiodarone Side-Effects + Toxicity: BITCH
Indomethacin inhibition
Leukopenia (rare) Bradycardia/Blue man
Interstitial Lung Disease
Thyroid (hyper and hypo)
Corneal (occular)/Cutaneous (skin)
Hepatic/Hypotension when IV (due to solvents)
Ventricular Tachycardia Treatment: LAMB Murmurs: systolic types SAPS:
Systolic
Lidocaine Aortic
Amiodarone Pulmonic
Mexiletine/Magnesium (for polymorphic VT or Torsades) Stenosis
Beta-blockers/Bang (cardioversion) · Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and
Causes of elevated jugular venous pressure: PQRST
pulmonary stenosis it could also be mitral
Pericardial effusion (causing cardiac tamponade and and tricusp regurgitation].
"Kussmal's sign")
Quantity - volume overload from congestive heart failure MI: signs and symptoms PULSE:
Right heart failure Persistent chest pains
Superior vena cava obstruction (SVC syndrome) Upset stomach
Tricuspid regurgitation (V waves)/Tricuspid stenosis Lightheadedness
Shortness of breath
Complications of Myocardial Infarction: CRAP Excessive sweating

Cardiogenic shock/Congestive Heart Failure/CVA (from
LV thrombus)
RV infarct/Rupture of left ventricle (causing cardiac
tamponade)
Acute mitral regurgitation, Acute ventricular septal
defect, Aneurysm, Arrhythmia
Pericarditis (from infarct or Dressler's)
Heart compensatory mechanisms that 'save' organ
blood flow during shock "Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
· In all 5, system is activated/factor is released

Murmurs: right vs. left loudness "RILE":

Aortic stenosis characteristics SAD: Right sided heart murmurs are louder on Inspiration.
Syncope Left sided heart murmurs are loudest on Expiration.
Angina · If get confused about which is which,
Dyspnoea remember LIRE=liar which will be inherently false.

MI: basic management BOOMAR: ST elevation causes in ECG, ELEVATION:

Bed rest Electrolytes
Oxygen LBBB
Opiate Early repolarization
Monitor Ventricular hypertrophy
Anticoagulate Aneurysm
Reduce clot size Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
ECG: left vs. right bundle block "WiLLiaM MaRRoW": Osborne waves (hypothermia)
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle Non-occlusive vasospasm
block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block. Beck's triad (cardiac tamponade) 3 D's:
· Note: consider bundle branch blocks when QRS Distant heart sounds
complex is wide. Distended jugular veins
Decreased arterial pressure
Pericarditis: causes CARDIAC RIND:
Collagen vascular disease MI: therapeutic treatment ROAMBAL:
Aortic aneurysm Reassure
Radiation Oxygen
Drugs (such as hydralazine) Aspirin
Infections Morphine (diamorphine)
Acute renal failure Beta blocker
Cardiac infarction Arthroplasty
Rheumatic fever Lignocaine
Injury
Neoplasms
Dressler's syndrome
CHF: causes of exacerbation FAILURE: Murmur attributes "IL PQRST" (person has ill PQRST
Forgot medication heart waves):
Arrhythmia/ Anaemia Intensity
Ischemia/ Infarction/ Infection Location
Lifestyle: taken too much salt Pitch
Upregulation of CO: pregnancy, hyperthyroidism Quality
Renal failure Radiation
Embolism: pulmonary Shape
Timing
Murmurs: systolic vs. diastolic PASS: Pulmonic
& Aortic Stenosis=Systolic. Murmurs: locations and descriptions "MRS A$$":
PAID: Pulmonic & Aortic Insufficiency=Diastolic. MRS: Mitral Regurgitation--Systolic
A$$: Aortic Stenosis--Systolic
Murmurs: systolic vs. diastolic Systolic murmurs: MR · The other two murmurs, Mitral stenosis and Aortic
AS: "MR. ASner". regurgitation, are obviously diastolic.
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Betablockers: cardioselective
Ed Asner and Ms. Jane Arden. betablockers "Betablockers Acting Exclusively At Myoca
rdium"
Mitral stenosis (MS) vs. regurgitation (MR): · Cardioselective betablockers are:
epidemiology MS is a female title (Ms.) and it is female Betaxolol
predominant. Acebutelol
MR is a male title (Mr.) and it is male predominant. Esmolol
Atenolol
Pericarditis: EKG "PericarditiS": Metoprolol
PR depression in precordial leads.
ST elevation. Apex beat: abnormalities found on palpation, causes
of impalpable HILT:
Jugular venous pressure (JVP) elevation: Heaving
causes HOLT: Grab Harold Holt around the neck and Impalpable
throw him in the ocean: Laterally displaced
Heart failure Thrusting/ Tapping
Obstruction of venea cava · If it is impalpable, causes are COPD:
Lymphatic enlargement - supraclavicular COPD
Intra-Thoracic pressure increase Obesity
Pleural, Pericardial effusion
Depressed ST-segment: causes DEPRESSED ST: Dextrocardia
Drooping valve (MVP)
Enlargement of LV with strain MI: treatment of acute MI COAG:
Potassium loss (hypokalemia) Cyclomorph
Reciprocal ST- depression (in I/W AMI) Oxygen
Embolism in lungs (pulmonary embolism) Aspirin
Subendocardial ischemia Glycerol trinitrate
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage) Coronary artery bypass graft: indications DUST:
Dilated cardiomyopathy Depressed ventricular function
Shock Unstable angina
Toxicity of digitalis, quinidine Stenosis of the left main stem
Triple vessel disease
Murmurs: innocent murmur features 8 S's:
Soft Peripheral vascular insufficiency: inspection
Systolic criteria SICVD:
Short Symmetry of leg musculature
Sounds (S1 & S2) normal Integrity of skin
Symptomless Color of toenails
Special tests normal (X-ray, EKG) Varicose veins
Standing/ Sitting (vary with position) Distribution of hair
Sternal depression
Heart murmurs "hARD ASS MRS. MSD": Chorea
hARD: Aortic Regurg = Diastolic Erythema
ASS: Aortic Stenosis = Systolic Rheumatic anamnesis
MRS: Mitral Regurg = Systolic · Minor criteria: CAFE PAL:
MSD: Mitral Stenosis = Diastolic CRP increased
Arthralgia
Mitral regurgitation When you hear holosystolic Fever
murmurs, think "MR-THEM ARE holosystolic murmurs". Elevated ESR
Prolonged PR interval
Sino-atrial node: innervation Sympathetic acts Anamnesis of rheumatism
on Sodium channels (SS). Leucocytosis
Parasympathetic acts on Potassium channels (PS).
JVP: wave form ASK ME:
Supraventricular tachycardia: treatment ABCDE: Atrial contraction
Adenosine Systole (ventricular contraction)
Beta-blocker Klosure (closure) of tricusps, so atrial filling
Calcium channel antagonist Maximal atrial filling
Digoxin Emptying of atrium
Excitation (vagal stimulation) · See diagram.

Ventricular tachycardia: treatment LAMB: Coronary artery bypass graft: indications DUST:
Lidocaine Depressed ventricular function
Amiodarone Unstable angina
Mexiltene/ Magnesium Stenosis of the left main stem
Beta-blocker Triple vessel disease

Pulseless electrical activity: causes PATCH MED: Exercise ramp ECG: contraindications RAMP:
Pulmonary embolus Recent MI
Acidosis Aortic stenosis
Tension pneumothorax MI in the last 7 days
Cardiac tamponade Pulmonary hypertension
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hyp
ovolemia ECG: T wave inversion causes INVERT:
Myocardial infarction Ischemia
Electrolyte derangements Normality [esp. young, black]
Drugs Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
Sinus bradycardia: aetiology "SINUS BRADICARDIA" RBBB, LBBB
(sinus bradycardia): Treatments [digoxin]
Sleep
Infections (myocarditis) Rheumatic fever: Jones major criteria JONES:
Neap thyroid (hypothyroid) Joints (migrating polyarthritis)
Unconsciousness (vasovagal syncope) Obvious, the heart (carditis, pancarditis, pericarditis,
Subnormal temperatures (hypothermia) endocarditis or valvulits)
Biliary obstruction Nodes (subcutaneous nodules)
Raised CO2 (hypercapnia) Erythema marginatum
Acidosis Sydenham's chorea
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes Myocardial infarctions: treatment INFARCTIONS:
Cushing's reflex (raised ICP) IV access
Aging Narcotic analgesics (eg morphine, pethidine)
Rx (drugs, such as high-dose atropine) Facilities for defibrillation (DF)
Deep anaesthesia Aspirin/ Anticoagulant (heparin)
Ischemic heart disease Rest
Athletes Converting enzyme inhibitor
Thrombolysis
Rheumatic fever: Jones criteria · Major IV beta blocker
criteria: CANCER: Oxygen 60%
Carditis Nitrates
Arthritis Stool Softeners
Nodules
Atrial fibrillation: causes PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome

Atrial fibrillation: management ABCD:

Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin

Anti-arrythmics: for AV nodes "Do Block AV":

Digoxin
B-blockers
Adenosine
Verapamil

Murmurs: systolic MR PV TRAPS:

Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis

Apex beat: differential for impalpable apex

beat DOPES:
Dextrocardia
Obesity
Pericarditis or pericardial tamponade
Emphysema
Sinus inversus/ Student incompetence