CVS DISORDERS.

Anatomy of the Heart

✅ Definition:
The heart is a muscular, hollow organ that functions as a pump to circulate blood throughout the body. It is located in the mediastinum, between the lungs, behind the sternum, and tilted slightly to the left.

✅ Structure of the Heart:

• Size: About the size of a fist.
• Weight: 250-350 g in adults.
• Layers of the Heart Wall:
  • Endocardium – Inner smooth layer (prevents clotting).
  • Myocardium – Thick muscular layer (pumps blood).
  • Epicardium – Outer layer, contains coronary arteries.
  • Pericardium – Protective sac surrounding the heart (fluid-filled to reduce friction).

✅ Chambers of the Heart:

Chamber	Function	Clinical Relevance
Right Atrium (RA)	Receives deoxygenated blood from the body (via superior & inferior vena cava).	Atrial fibrillation affects RA contraction.
Right Ventricle (RV)	Pumps deoxygenated blood to the lungs (via pulmonary artery).	Pulmonary hypertension affects RV function.
Left Atrium (LA)	Receives oxygenated blood from the lungs (via pulmonary veins).	Mitral valve stenosis affects LA pressure.
Left Ventricle (LV)	Pumps oxygenated blood to the body (via aorta).	Heart failure (LVH) commonly affects LV.

✅ Heart Valves (Prevent Backflow of Blood):

Valve	Location	Function	Common Disorder
Tricuspid Valve	Between RA & RV	Prevents backflow into RA.	Tricuspid regurgitation.
Pulmonary Valve	Between RV & Pulmonary Artery	Prevents backflow into RV.	Pulmonary stenosis.
Mitral (Bicuspid) Valve	Between LA & LV	Prevents backflow into LA.	Mitral regurgitation, stenosis.
Aortic Valve	Between LV & Aorta	Prevents backflow into LV.	Aortic stenosis, regurgitation.

✅ Blood Supply of the Heart (Coronary Circulation):

Artery	Supplies	Clinical Significance
Left Coronary Artery (LCA)	Left heart, anterior LV, septum	Blockage → Anterior MI (widowmaker infarction).
Right Coronary Artery (RCA)	Right heart, SA node, AV node	Blockage → Bradycardia, inferior MI.

✅ Nerve Supply of the Heart (Autonomic Nervous System):

System	Effect on Heart	Example
Sympathetic (Fight/Flight)	↑ HR, ↑ BP, ↑ force of contraction	Exercise, stress.
Parasympathetic (Rest/Digest)	↓ HR, ↓ BP	Vagus nerve stimulation, sleep.

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2. Physiology of the Heart

✅ Cardiac Cycle (One Complete Heartbeat):

• Duration: 0.8 sec
• Phases:
  1. Atrial Systole (0.1 sec): Atria contract → Blood fills ventricles.
  2. Ventricular Systole (0.3 sec): Ventricles contract → Blood pumped to lungs/body.
  3. Diastole (0.4 sec): Heart relaxes → Chambers refill with blood.

✅ Heart Sounds:

Sound	Cause	Normal or Abnormal?
S1 (“Lub”)	Closure of mitral & tricuspid valves.	Normal.
S2 (“Dub”)	Closure of aortic & pulmonary valves.	Normal.
S3 (Gallop Sound)	Rapid ventricular filling.	CHF (Heart Failure).
S4 (Atrial Contraction Sound)	Stiff ventricle.	Hypertension, LVH.

✅ Cardiac Output (CO) = Heart Rate × Stroke Volume

Parameter	Definition	Normal Value
Heart Rate (HR)	Number of beats per minute.	60-100 bpm
Stroke Volume (SV)	Blood pumped per beat.	70 mL/beat
Cardiac Output (CO)	Blood pumped per minute.	5 L/min (at rest)

✅ Factors Affecting CO:

• Preload: Volume of blood returning to the heart (↑ in fluid overload).
• Afterload: Resistance the heart pumps against (↑ in hypertension).
• Contractility: Strength of heart contraction (↓ in heart failure).

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3. Circulatory System

✅ Definition:
The circulatory system transports blood, oxygen, nutrients, and waste products throughout the body.

✅ Types of Circulation:

Type	Function	Major Vessels
Pulmonary Circulation	Carries deoxygenated blood from the heart to lungs and back.	Pulmonary arteries & veins.
Systemic Circulation	Carries oxygenated blood from the heart to the body and returns deoxygenated blood.	Aorta, vena cava.
Coronary Circulation	Supplies oxygen & nutrients to the heart muscle.	Coronary arteries.
Fetal Circulation	Supplies oxygen to the fetus (bypassing the lungs).	Placenta, umbilical vein.

✅ Major Blood Vessels:

Vessel	Function	Example
Arteries	Carry oxygenated blood away from the heart.	Aorta, Pulmonary artery.
Veins	Carry deoxygenated blood to the heart.	Vena Cava, Pulmonary vein.
Capillaries	Allow exchange of gases, nutrients, waste.	Network in all tissues.

✅ Blood Pressure (BP) Regulation:

• BP = Cardiac Output × Peripheral Resistance.
• Normal BP: 120/80 mmHg.
• High BP (>140/90 mmHg) → Hypertension.
• Low BP (<90/60 mmHg) → Hypotension.

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4. Electrical System of the Heart (Cardiac Conduction System)

✅ Pathway of Electrical Impulses:

Structure	Function	Normal Rate
Sinoatrial (SA) Node	Pacemaker of the heart (initiates impulse).	60-100 bpm
Atrioventricular (AV) Node	Delays impulse to allow atrial contraction.	40-60 bpm
Bundle of His	Conducts impulses to ventricles.	40-60 bpm
Purkinje Fibers	Rapidly spread impulse for coordinated contraction.	20-40 bpm

✅ ECG Interpretation:

Wave	Represents	Clinical Relevance
P wave	Atrial depolarization.	Absent in Atrial fibrillation.
QRS complex	Ventricular depolarization.	Widened in bundle branch block.
T wave	Ventricular repolarization.	Peaked in hyperkalemia.

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5. Exam-Oriented Questions

✅ What is the normal stroke volume of the heart?
👉 70 mL per beat.

✅ Which coronary artery supplies the SA node?
👉 Right Coronary Artery (RCA).

✅ Which part of the heart generates the first electrical impulse?
👉 Sinoatrial (SA) node.

✅ What is the function of the aortic valve?
👉 Prevents backflow of blood from aorta to LV.

✅ What is the normal cardiac output?
👉 5 L/min (at rest).

History Taking in Cardiovascular Assessment

✅ Definition:
A detailed history helps in identifying risk factors, symptoms, and potential cardiovascular conditions.

✅ Key Questions to Ask the Patient:

1.1. Chief Complaints & Symptoms

Symptom	Possible Cause
Chest pain (Angina, tightness)	Coronary Artery Disease (CAD), Myocardial Infarction (MI).
Shortness of breath (Dyspnea)	Heart failure, Pulmonary edema.
Palpitations (Irregular heartbeats)	Atrial fibrillation, Anxiety, Hyperthyroidism.
Swelling in legs (Edema)	Heart failure, Deep Vein Thrombosis (DVT).
Fainting (Syncope, Dizziness)	Arrhythmia, Low BP (Hypotension).
Fatigue, Weakness	Heart failure, Anemia.
Bluish skin (Cyanosis)	Congenital heart disease, Severe heart failure.

1.2. Past Medical History

• Hypertension, Diabetes, Hyperlipidemia.
• Previous heart attack, stroke, congenital heart defects.
• History of deep vein thrombosis (DVT) or pulmonary embolism (PE).

1.3. Family History

• History of sudden cardiac death, heart disease, hypertension, diabetes.

1.4. Social & Lifestyle History

• Smoking (Risk of atherosclerosis, CAD).
• Alcohol consumption (Risk of cardiomyopathy, hypertension).
• Sedentary lifestyle (Risk of obesity, diabetes, hypertension).
• Diet (High cholesterol diet → Atherosclerosis).

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2. Physical Examination of the Heart & Vascular System

✅ Definition:
A systematic examination of the cardiovascular system detects abnormalities in heart function, blood flow, and vascular integrity.

✅ Steps of Cardiovascular Examination:

2.1. General Inspection

• Skin Color: Cyanosis (blue lips) → Poor oxygenation.
• Edema: Swollen ankles → Heart failure.
• Jugular Venous Distension (JVD): Right heart failure.
• Clubbing of Fingers: Chronic hypoxia (Congenital heart disease).

2.2. Pulse Examination

Pulse Location	Normal Rate	Clinical Significance
Radial Pulse	60-100 bpm	Weak → Low BP, Strong → Hypertension.
Carotid Pulse	Equal on both sides	Weak → Shock, Stroke.
Dorsalis Pedis	Palpable in foot	Absent → Peripheral Artery Disease (PAD).

✅ Pulse Abnormalities:

• Bradycardia (<60 bpm): Heart block, Hypothyroidism.
• Tachycardia (>100 bpm): Fever, Shock, Anemia.
• Irregular Pulse: Atrial fibrillation, Arrhythmia.

2.3. Blood Pressure (BP) Measurement

• Normal: 120/80 mmHg.
• Hypertension: >140/90 mmHg.
• Hypotension: <90/60 mmHg (Shock, Heart failure).
• Difference in BP between arms: Aortic dissection.

2.4. Heart Auscultation (Using a Stethoscope)

✅ Heart Sounds:

Sound	Cause	Clinical Significance
S1 (“Lub”)	Mitral & Tricuspid valve closure	Normal.
S2 (“Dub”)	Aortic & Pulmonary valve closure	Normal.
S3 (Gallop Sound)	Rapid ventricular filling	Heart failure.
S4 (Atrial Contraction Sound)	Stiff ventricle	Hypertension, LVH.

✅ Heart Murmurs (Abnormal Sounds):

• Systolic Murmur → Aortic Stenosis.
• Diastolic Murmur → Mitral Stenosis.

✅ Lung Examination (To Detect Heart Failure):

• Crackles (Rales) → Pulmonary Edema (Left Heart Failure).
• Wheezing → Fluid Overload.

✅ Extremities Examination:

• Pitting Edema → Right Heart Failure.
• Cold Hands/Feet → Poor Circulation (Shock, PAD).

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3. Diagnostic Tests for Cardiovascular Assessment

✅ Definition:
Diagnostic tests help confirm cardiac diseases, assess severity, and guide treatment.

✅ Common Cardiovascular Diagnostic Tests:

3.1. Electrocardiogram (ECG/EKG)

✅ Purpose:

• Detects heart rhythm abnormalities.
• Identifies ischemia, heart attacks, electrolyte imbalances.

✅ Common ECG Findings & Their Meanings:

ECG Finding	Condition
ST Elevation	Acute Myocardial Infarction (STEMI).
ST Depression	Ischemia (Angina, NSTEMI).
Irregular Rhythm	Atrial Fibrillation (AF).
T Wave Inversion	Ischemia, Electrolyte Imbalance.

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3.2. Echocardiography (ECHO)

✅ Purpose:

• Ultrasound of the heart to assess heart chambers, valves, and function.
• Detects heart failure, valve disease, congenital defects.

✅ Types of ECHO:

Type	Use
Transthoracic (TTE)	Non-invasive, commonly used.
Transesophageal (TEE)	Detailed imaging (Endocarditis, Clots).
Doppler ECHO	Checks blood flow abnormalities.

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3.3. Stress Test (Treadmill Test)

✅ Purpose:

• Assesses heart function under stress/exercise.
• Detects Coronary Artery Disease (CAD).

✅ Procedure:

• Patient walks/runs on a treadmill while ECG monitors heart response.
• If abnormal ECG appears → Coronary Blockage Suspected.

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3.4. Coronary Angiography (Cardiac Catheterization)

✅ Purpose:

• Gold standard for detecting coronary artery blockages.
• Used before angioplasty or bypass surgery.

✅ Procedure:

• Dye injected into coronary arteries via catheter.
• X-ray detects narrowed or blocked arteries.

✅ Findings:

Finding	Condition
>70% Narrowing of artery	Severe CAD (Needs stenting or bypass).
Thrombus in artery	Acute Heart Attack (STEMI).

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3.5. Cardiac Biomarkers (Blood Tests for Heart Damage)

Test	Purpose	Normal Value	Significance
Troponin I & T	Detects heart attack (MI).	<0.03 ng/mL	↑ in MI (Gold Standard).
CK-MB	Identifies heart muscle damage.	<6% of total CK	↑ in MI, Myocarditis.
BNP (Brain Natriuretic Peptide)	Detects heart failure.	<100 pg/mL	↑ in CHF.
D-Dimer	Identifies blood clots.	<0.5 mg/L	↑ in DVT, Pulmonary Embolism.

Coronary Artery Disease (CAD)

✅ Definition:
Coronary Artery Disease (CAD) is a condition where coronary arteries become narrowed or blocked due to atherosclerosis, reducing blood supply to the heart.

✅ Pathophysiology:

• Plaque formation (cholesterol deposits) → Artery narrowing → ↓ Blood flow → Myocardial ischemia.
• Severe blockage (>70%) → Angina (chest pain due to ischemia).
• Complete blockage → Myocardial Infarction (Heart Attack).

✅ Risk Factors:

Modifiable Risk Factors	Non-Modifiable Risk Factors
Smoking, Alcohol	Age >45 (men), >55 (women)
Hypertension	Family history of CAD
Diabetes Mellitus	Genetic predisposition
High cholesterol (LDL)	Gender (Men at higher risk)
Obesity, Sedentary lifestyle	Ethnicity (Higher in South Asians)

✅ Symptoms of CAD:

• Chest pain (Angina Pectoris) – Tightness, heaviness, burning in the chest.
• Shortness of breath (Dyspnea).
• Fatigue, Dizziness, Sweating (Diaphoresis).
• Palpitations or Irregular Heartbeat.

✅ Types of Coronary Artery Disease:

Type	Pathology	Symptoms
Stable Angina	Predictable, occurs with exertion, relieved by rest.	Chest pain during exercise/stress, relieved by Nitroglycerin.
Unstable Angina	Occurs unpredictably, not relieved by rest.	High risk of MI, medical emergency.
Myocardial Infarction (MI)	Complete artery blockage, heart muscle death.	Severe chest pain, nausea, sweating.

✅ Diagnosis of CAD:

Test	Purpose	Findings
ECG	Detects ischemia/infarction.	ST depression (ischemia), ST elevation (MI).
Echocardiography (ECHO)	Assesses heart function & wall motion.	Wall motion abnormality in MI.
Stress Test	Detects CAD under exertion.	ST changes during exercise.
Coronary Angiography	Gold standard for CAD.	Detects coronary blockages.
Cardiac Biomarkers (Troponin, CK-MB)	Confirms heart muscle damage.	Elevated in Myocardial Infarction (MI).

✅ Management of CAD:

1. Lifestyle Changes (First-line treatment)

• Quit smoking, Control BP, Sugar, and Cholesterol.
• Healthy diet (low fat, high fiber, omega-3 fatty acids).
• Exercise (30 min daily).

2. Medications for CAD

Drug Class	Examples	Mechanism of Action
Antiplatelets	Aspirin, Clopidogrel	Prevent clot formation.
Beta-blockers	Metoprolol, Atenolol	Reduce heart workload & BP.
Nitrates	Nitroglycerin, Isosorbide Mononitrate	Dilate coronary arteries, relieve angina.
Statins	Atorvastatin, Rosuvastatin	Lower cholesterol.
Calcium Channel Blockers	Amlodipine, Diltiazem	Improve blood flow, reduce BP.
ACE Inhibitors	Enalapril, Ramipril	Prevent heart failure.

3. Surgical Management

Procedure	Purpose	Indications
Angioplasty (PCI)	Opens blocked artery using a balloon & stent.	Blockages >70% causing symptoms.
Coronary Artery Bypass Graft (CABG)	Uses a graft to bypass blocked artery.	Severe multi-vessel CAD or Left Main Disease.

✅ Complications of Untreated CAD:

• Heart Failure.
• Arrhythmias (Atrial Fibrillation, Ventricular Tachycardia).
• Sudden Cardiac Arrest.

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2. Angina Pectoris

✅ Definition:
Angina Pectoris is chest pain caused by reduced blood flow to the heart due to narrowed coronary arteries.

✅ Types of Angina:

Type	Cause	Symptoms
Stable Angina	Predictable, triggered by exertion, relieved by rest.	Chest pain lasting <15 min, relieved by Nitroglycerin.
Unstable Angina	Sudden, occurs at rest, high risk of MI.	Chest pain >20 min, not relieved by rest.
Prinzmetal’s Angina (Variant Angina)	Spasm of coronary arteries, occurs at rest.	Occurs at night or early morning, relieved by CCBs.

✅ Symptoms of Angina Pectoris:

• Chest pain (tightness, squeezing sensation).
• Pain radiating to left arm, jaw, neck.
• Shortness of breath, sweating.

✅ Diagnosis of Angina:

• ECG: ST depression (ischemia).
• Stress Test: Induces angina symptoms.
• Coronary Angiography: Detects artery blockages.

✅ Management of Angina:

Treatment	Purpose
Nitroglycerin (GTN)	First-line for acute angina (Dilates coronary arteries).
Beta-blockers	Reduce heart workload (Prevention).
Calcium Channel Blockers	Prevents coronary spasm (Prinzmetal’s Angina).
Aspirin + Statins	Prevents future heart attacks.

✅ Emergency Management of Unstable Angina (MONA Protocol):

Morphine	Oxygen	Nitroglycerin	Aspirin
Pain relief	Improves oxygenation	Reduces chest pain	Prevents clot formation

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3. Arrhythmias (Heart Rhythm Disorders)

✅ Definition:
Arrhythmias are abnormal heart rhythms due to irregular electrical impulses in the heart.

✅ Types of Arrhythmias:

Type	HR	Common Cause	Symptoms
Bradycardia (<60 bpm)	Slow heart rate.	SA node dysfunction, AV block.	Dizziness, Syncope.
Tachycardia (>100 bpm)	Fast heart rate.	Fever, Shock, Anxiety.	Palpitations, Chest pain.
Atrial Fibrillation (AF)	Irregular, fast atrial beats.	CAD, Hypertension, Heart Failure.	Stroke risk, Irregular pulse.
Ventricular Tachycardia (VT)	Fast, abnormal ventricular beats.	MI, Electrolyte Imbalance.	Sudden Cardiac Arrest.

✅ Diagnosis of Arrhythmias:

• ECG: Identifies abnormal heart rhythms.
• Holter Monitor: 24-hour ECG monitoring.

✅ Management of Arrhythmias:

Type	Treatment
Bradycardia	Atropine (1 mg IV), Pacemaker.
Tachycardia	Beta-blockers, Amiodarone.
Atrial Fibrillation	Anticoagulants (Warfarin), Rate Control (Digoxin).
Ventricular Tachycardia	Defibrillation, Amiodarone IV.

✅ Emergency Management of Cardiac Arrest:

• CPR + Defibrillation (For Ventricular Fibrillation & VT).

Coronary Atherosclerosis

✅ Definition:
Coronary atherosclerosis is a progressive disease where fatty plaques (cholesterol deposits) accumulate in coronary arteries, leading to narrowing and reduced blood supply to the heart muscle.

✅ Pathophysiology:

1. LDL Cholesterol Deposits → Triggers inflammation.
2. Foam Cell Formation → Macrophages consume cholesterol.
3. Plaque Development → Narrows coronary arteries.
4. Ruptured Plaque → Clot Formation (Thrombosis) → Can lead to Myocardial Infarction (Heart Attack).

✅ Risk Factors for Atherosclerosis:

Modifiable Risk Factors	Non-Modifiable Risk Factors
High LDL, Low HDL	Age > 45 (Men), > 55 (Women)
Hypertension	Family history of heart disease
Smoking, Alcohol	Genetic predisposition
Obesity, Diabetes	Gender (Men > Women)
Sedentary lifestyle	Ethnicity (Higher in South Asians)

✅ Symptoms of Coronary Atherosclerosis:

• Asymptomatic in early stages.
• Angina pectoris (chest pain due to reduced blood flow).
• Shortness of breath (Dyspnea).
• Fatigue, dizziness, palpitations.

✅ Complications of Atherosclerosis:

• Coronary Artery Disease (CAD).
• Myocardial Infarction (Heart Attack).
• Stroke (Cerebrovascular Disease).
• Heart failure.

✅ Diagnosis of Atherosclerosis:

Test	Purpose	Findings
Lipid Profile	Checks cholesterol levels.	↑ LDL, ↓ HDL, ↑ Triglycerides.
ECG	Detects ischemia.	ST Depression (Ischemia).
Stress Test	Assesses exercise-induced ischemia.	ST changes on exertion.
Coronary Angiography	Gold standard for blockages.	Shows narrowed arteries.

✅ Management of Atherosclerosis:

1. Lifestyle Changes

• Low-fat diet (Mediterranean diet, high in Omega-3).
• Exercise (at least 30 minutes daily).
• Quit smoking and limit alcohol.

2. Medications

Drug Class	Examples	Mechanism
Statins	Atorvastatin, Rosuvastatin	Lower cholesterol.
Antiplatelets	Aspirin, Clopidogrel	Prevent clot formation.
Beta-blockers	Metoprolol, Atenolol	Reduce heart workload.
ACE Inhibitors	Ramipril, Enalapril	Lower BP, prevent heart failure.

✅ Surgical Interventions for Severe Atherosclerosis:

Procedure	Indication
Angioplasty (PCI with Stent Placement)	Blockages >70% causing symptoms.
Coronary Artery Bypass Graft (CABG)	Multiple vessel blockages.

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2. Myocardial Infarction (Heart Attack)

✅ Definition:
A myocardial infarction (MI) occurs when blood flow to the heart muscle is completely blocked, leading to heart tissue death (necrosis).

✅ Types of MI:

Type	ECG Findings	Description
ST-Elevation MI (STEMI)	ST-segment elevation	Complete artery blockage, emergency.
Non-ST-Elevation MI (NSTEMI)	ST depression or T-wave inversion	Partial artery blockage, less severe.

✅ Causes of MI:

• Atherosclerosis (most common).
• Blood clot (thrombosis).
• Coronary artery spasm (Prinzmetal’s angina).

✅ Symptoms of Myocardial Infarction:

• Severe chest pain (crushing, squeezing).
• Pain radiating to the left arm, jaw, neck.
• Shortness of breath, sweating, nausea.
• Syncope (fainting in severe cases).

✅ Diagnosis of MI:

Test	Purpose	Findings
ECG	Detects ischemia/infarction.	ST Elevation (STEMI), ST Depression (NSTEMI).
Cardiac Biomarkers (Troponin I & T, CK-MB)	Confirms heart attack.	Elevated in MI.
Coronary Angiography	Identifies blocked artery.	Complete occlusion in STEMI.

✅ Management of Myocardial Infarction:

1. Emergency Treatment – MONA Protocol

Morphine	Oxygen	Nitroglycerin	Aspirin
Pain relief	Improves oxygenation	Dilates coronary arteries	Prevents clot formation

2. Reperfusion Therapy (Opening the Blocked Artery)

Treatment	Timing	Indication
Thrombolytics (Alteplase, Streptokinase)	Within 3-6 hours	STEMI with no PCI available.
Percutaneous Coronary Intervention (PCI – Angioplasty + Stent)	Best within 90 min	STEMI.
CABG (Bypass Surgery)	Severe multi-vessel disease	Failed PCI or Left Main Disease.

✅ Complications of MI:

• Heart failure.
• Arrhythmias (Atrial fibrillation, Ventricular tachycardia).
• Cardiogenic shock.

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3. Valvular Heart Diseases

Valvular heart disease occurs when heart valves become stenotic (narrowed) or regurgitant (leaky), affecting blood flow.

3.1. Mitral Stenosis

✅ Definition:
Mitral stenosis is narrowing of the mitral valve, obstructing blood flow from the left atrium to the left ventricle.

✅ Causes:

• Rheumatic heart disease (most common).
• Congenital mitral stenosis.

✅ Symptoms of Mitral Stenosis:

• Dyspnea on exertion.
• Palpitations (Atrial fibrillation).
• Cough with hemoptysis (blood-tinged sputum).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Thickened mitral valve, reduced opening.
Auscultation	Loud S1, Opening Snap, Diastolic Murmur.

✅ Management of Mitral Stenosis:

• Diuretics (for fluid overload).
• Beta-blockers (for heart rate control).
• Balloon Valvuloplasty (Preferred in severe cases).
• Mitral Valve Replacement (If severe stenosis).

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3.2. Aortic Stenosis

✅ Definition:
Aortic stenosis is narrowing of the aortic valve, obstructing blood flow from the left ventricle to the aorta.

✅ Causes:

• Congenital bicuspid aortic valve.
• Age-related calcification (Elderly).

✅ Symptoms of Aortic Stenosis:

• Syncope (Fainting during exertion).
• Angina (Chest pain).
• Dyspnea (Heart failure signs).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Thickened aortic valve, pressure gradient.
Auscultation	Systolic Murmur (Crescendo-Decrescendo).

✅ Management of Aortic Stenosis:

• Surgical Aortic Valve Replacement (SAVR).
• Transcatheter Aortic Valve Replacement (TAVR) in high-risk patients.

Incompetence & Regurgitation (Valve Insufficiency)

✅ Definition:
Incompetence (or regurgitation) is a valvular heart disease where valve leaflets fail to close properly, causing backflow of blood in the heart chambers.

✅ Types of Valve Regurgitation & Their Effects:

Valve Affected	Backward Flow Direction	Clinical Consequences
Mitral Regurgitation	LV → LA	Left atrial dilation, Pulmonary hypertension, CHF.
Aortic Regurgitation	Aorta → LV	LV dilation, LV failure, Pulmonary edema.
Tricuspid Regurgitation	RV → RA	Right atrial dilation, Liver congestion, Peripheral edema.
Pulmonary Regurgitation	Pulmonary artery → RV	Right ventricular overload, Right heart failure.

✅ Causes of Valve Regurgitation:

• Rheumatic heart disease (post-streptococcal infection).
• Congenital defects (bicuspid aortic valve, Ebstein anomaly).
• Infective endocarditis (bacterial infection of valve).
• Myocardial infarction (damaged papillary muscles affecting valve function).
• Connective tissue disorders (Marfan syndrome, Ehlers-Danlos).

✅ Symptoms of Valve Regurgitation:

• Fatigue & Weakness (↓ cardiac output).
• Dyspnea on exertion (lung congestion in left-sided regurgitation).
• Palpitations & Arrhythmias (due to atrial enlargement).
• Peripheral edema, ascites (right-sided regurgitation).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Dilated atrium/ventricle, backflow of blood.
Doppler Ultrasound	Measures severity of regurgitation.
Auscultation	Blowing murmur (Holosystolic for Mitral/Tricuspid).

✅ Management of Valve Regurgitation:

1. Medications (For Symptom Control)

Drug Class	Examples	Mechanism
Diuretics	Furosemide, Spironolactone	Reduces fluid overload.
ACE Inhibitors	Enalapril, Ramipril	Reduces afterload & delays heart failure.
Beta-Blockers	Metoprolol, Carvedilol	Controls heart rate & BP.
Anticoagulants	Warfarin (If AF present)	Prevents stroke in atrial fibrillation.

2. Surgical Management (For Severe Regurgitation)

Procedure	Indications
Valve Repair (Annuloplasty, Chordal Reconstruction)	Preferred in younger patients.
Valve Replacement (Bioprosthetic or Mechanical)	Severe regurgitation with heart failure symptoms.

✅ Complications of Untreated Valve Regurgitation:

• Heart failure (due to chronic volume overload).
• Atrial fibrillation (leading to stroke).
• Pulmonary hypertension (from left-sided valve regurgitation).

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2. Tricuspid Stenosis

✅ Definition:
Tricuspid stenosis is narrowing of the tricuspid valve, impeding blood flow from the right atrium (RA) to the right ventricle (RV).

✅ Causes:

• Rheumatic Heart Disease (Most common).
• Congenital Tricuspid Stenosis.
• Carcinoid Syndrome (Neuroendocrine tumors affecting right heart valves).

✅ Pathophysiology:

1. Narrowed tricuspid valve → Blood backs up in right atrium → Right atrial dilation.
2. Reduced blood flow to right ventricle → ↓ Right ventricular output → Systemic congestion.

✅ Symptoms of Tricuspid Stenosis:

• Peripheral edema, ascites, hepatomegaly (liver congestion).
• Jugular venous distension (JVD).
• Fatigue & Weakness (↓ Cardiac Output).
• Right upper quadrant pain (Liver congestion).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Thickened tricuspid valve, right atrial enlargement.
Doppler Ultrasound	Increased pressure gradient across valve.
Auscultation	Diastolic Murmur (Low-pitched rumble at left sternal border).

✅ Management of Tricuspid Stenosis:

1. Medications (For Symptom Control)

Drug Class	Examples	Purpose
Diuretics	Furosemide, Spironolactone	Reduces systemic congestion.
ACE Inhibitors	Enalapril	Decreases afterload.
Anticoagulants	Warfarin (If AF present)	Prevents clot formation.

2. Surgical Management (For Severe Cases)

Procedure	Indications
Balloon Valvuloplasty (Preferred in Young Patients).	Mild to moderate stenosis.
Tricuspid Valve Replacement (Bioprosthetic or Mechanical).	Severe stenosis with symptoms.

✅ Complications of Untreated Tricuspid Stenosis:

• Right-sided heart failure.
• Hepatic congestion & cirrhosis.
• Atrial fibrillation leading to stroke.

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3. Pulmonary Stenosis

✅ Definition:
Pulmonary stenosis is narrowing of the pulmonary valve, reducing blood flow from the right ventricle (RV) to the pulmonary artery (PA).

✅ Causes:

• Congenital Pulmonary Valve Stenosis (Most common).
• Rheumatic heart disease (Rare).
• Carcinoid syndrome (Affects right heart valves).

✅ Pathophysiology:

1. Pulmonary valve narrows → Right ventricle hypertrophy (RVH).
2. ↓ Pulmonary blood flow → Hypoxia & Cyanosis (In severe cases).

✅ Symptoms of Pulmonary Stenosis:

• Dyspnea on exertion (↓ Oxygenation).
• Fatigue & Dizziness.
• Cyanosis (Bluish skin due to low oxygen levels).
• Right ventricular heave (Palpable due to RVH).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Thickened pulmonary valve, RV hypertrophy.
Doppler Ultrasound	Increased pressure across the pulmonary valve.
Auscultation	Systolic Ejection Murmur at Left Upper Sternal Border (Crescendo-Decrescendo).

✅ Management of Pulmonary Stenosis:

1. Medications (For Symptom Control)

Drug Class	Examples	Purpose
Beta-Blockers	Propranolol	Reduce heart workload.
Diuretics	Furosemide	Reduce RV overload.

2. Surgical Management (For Severe Cases)

Procedure	Indications
Balloon Valvuloplasty (First-line in Mild/Moderate Cases).	Preferred in children & young adults.
Pulmonary Valve Replacement (Bioprosthetic or Mechanical).	Severe stenosis with RV dysfunction.

✅ Complications of Untreated Pulmonary Stenosis:

• Right ventricular failure.
• Cyanosis & Hypoxia.
• Arrhythmias (Ventricular tachycardia).

Pericarditis

✅ Definition:
Pericarditis is inflammation of the pericardium (outer sac covering the heart), causing chest pain and pericardial effusion (fluid accumulation).

✅ Causes of Pericarditis:

Category	Examples
Infectious	Viral (Coxsackievirus, HIV), Bacterial (Tuberculosis, Staphylococcus), Fungal.
Autoimmune	Rheumatoid arthritis, Systemic Lupus Erythematosus (SLE).
Post-Myocardial Infarction (MI)	Dressler’s Syndrome (Pericarditis after MI).
Other Causes	Uremia (Kidney failure), Radiation, Trauma.

✅ Symptoms of Pericarditis:

• Sharp, pleuritic chest pain (worse on lying down, relieved by sitting up and leaning forward).
• Pericardial friction rub (Scratchy sound on auscultation).
• Fever, weakness, shortness of breath.

✅ Complications of Pericarditis:

• Pericardial Effusion (fluid buildup).
• Cardiac Tamponade (compression of the heart due to excessive fluid, emergency condition).

✅ Diagnosis of Pericarditis:

Test	Findings
ECG	ST elevation in all leads, PR depression.
Echocardiography	Pericardial effusion (fluid accumulation).
Chest X-ray	Enlarged cardiac silhouette (if effusion present).

✅ Management of Pericarditis:

1. Medications

Drug Class	Examples	Mechanism
NSAIDs	Ibuprofen, Aspirin	Reduces inflammation & pain.
Colchicine	Used for recurrent pericarditis.	Reduces recurrence risk.
Corticosteroids	Prednisolone (if NSAIDs fail).	Used for autoimmune causes.
Antibiotics	For bacterial pericarditis.	Treats the underlying infection.

2. Surgical Management (For Severe Cases)

Procedure	Indication
Pericardiocentesis	Pericardial effusion with cardiac tamponade.
Pericardiectomy	Chronic constrictive pericarditis.

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2. Myocarditis

✅ Definition:
Myocarditis is inflammation of the heart muscle (myocardium), leading to heart dysfunction and arrhythmias.

✅ Causes of Myocarditis:

Category	Examples
Viral (Most Common)	Coxsackievirus B, Influenza, HIV.
Bacterial	Diphtheria, Lyme disease.
Fungal & Parasitic	Candida, Trypanosoma cruzi (Chagas Disease).
Autoimmune	Systemic Lupus Erythematosus (SLE), Giant Cell Myocarditis.
Toxins	Alcohol, Cocaine, Radiation, Chemotherapy drugs.

✅ Symptoms of Myocarditis:

• Chest pain (similar to MI).
• Palpitations, arrhythmias (irregular heartbeats).
• Shortness of breath, fatigue (heart failure symptoms).
• Edema, weight gain (fluid retention in severe cases).

✅ Complications of Myocarditis:

• Dilated Cardiomyopathy (weakened, enlarged heart).
• Arrhythmias (Atrial fibrillation, Ventricular tachycardia).
• Heart failure, Sudden Cardiac Arrest.

✅ Diagnosis of Myocarditis:

Test	Findings
ECG	Non-specific ST changes, Arrhythmias.
Echocardiography (ECHO)	Dilated, weak heart chambers.
Cardiac MRI	Detects myocardial inflammation.
Endomyocardial Biopsy	Definitive test (rarely used).

✅ Management of Myocarditis:

1. Medications

Drug Class	Examples	Mechanism
ACE Inhibitors	Enalapril, Lisinopril	Reduce heart strain.
Beta-Blockers	Metoprolol, Carvedilol	Control arrhythmias.
Diuretics	Furosemide	Reduce fluid overload.
Antivirals	For viral myocarditis	Treats underlying infection.

2. Advanced Treatment (For Severe Cases)

• Pacemaker or Defibrillator (For arrhythmias).
• Heart Transplant (For end-stage heart failure).

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3. Endocarditis

✅ Definition:
Endocarditis is infection of the inner lining of the heart (endocardium), usually affecting heart valves.

✅ Types of Endocarditis:

Type	Cause	Commonly Affected Valves
Infective Endocarditis (IE)	Bacterial infection (Staphylococcus, Streptococcus)	Mitral, Aortic (most common), Tricuspid (IV drug users).
Non-infective Endocarditis	Autoimmune diseases, Cancer	Affects multiple valves.

✅ Risk Factors for Endocarditis:

• Rheumatic heart disease, prosthetic heart valves.
• IV drug use (Tricuspid Valve Involvement).
• Recent dental procedures (Bacteria enter bloodstream).

✅ Symptoms of Endocarditis:

• Fever, chills, night sweats.
• Heart murmur (New or changing).
• Petechiae (small red spots on skin).
• Splinter hemorrhages (under fingernails).

✅ Complications of Endocarditis:

• Valvular regurgitation (leading to heart failure).
• Septic emboli (causing stroke, kidney damage).
• Abscess formation (around heart valves).

✅ Diagnosis of Endocarditis:

Test	Findings
Blood Cultures	Detects causative bacteria.
Echocardiography (ECHO)	Vegetations on valves (Best seen in Transesophageal ECHO – TEE).

✅ Management of Endocarditis:

1. Medications

Drug Class	Examples	Duration
IV Antibiotics	Vancomycin + Gentamicin	4-6 weeks
Anticoagulants	Not recommended (High embolism risk).	N/A

2. Surgical Management

• Valve replacement (For severe valve destruction).
• Drainage of abscesses.

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4. Rheumatic Fever

✅ Definition:
Rheumatic fever is an inflammatory disease caused by an autoimmune reaction to Group A Streptococcus infection (Strep throat), leading to heart valve damage (Rheumatic Heart Disease – RHD).

✅ Symptoms of Rheumatic Fever (JONES Criteria):

Major Symptoms	Minor Symptoms
Joint Pain (Polyarthritis).	Fever.
O (Heart) Carditis (Pancarditis).	Increased ESR/CRP.
Nodules (Subcutaneous).	Prolonged PR interval (ECG).
Erythema Marginatum (Rash).	Arthralgia.
Sydenham’s Chorea (Involuntary movements).	N/A

✅ Diagnosis:

• Throat Swab (For Strep A Infection).
• ASO Titer (Antistreptolysin O Test – Confirms past Strep infection).

✅ Management of Rheumatic Fever:

• Penicillin (For Strep infection).
• Aspirin + Steroids (For inflammation).
• Lifelong Penicillin Prophylaxis (To prevent recurrence).

Heart Failure

✅ Definition:
Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs. It can be acute (sudden onset) or chronic (progressive deterioration).

✅ Types of Heart Failure:

Type	Description	Key Features
Left-Sided HF	Failure of the left ventricle to pump blood.	Pulmonary congestion, dyspnea, orthopnea.
Right-Sided HF	Failure of the right ventricle.	Peripheral edema, JVD, hepatomegaly.
Acute HF (Pulmonary Edema)	Sudden fluid buildup in the lungs.	Severe breathlessness, frothy sputum.
Chronic HF (Congestive HF – CCF)	Gradual worsening over time.	Fatigue, weight gain, pitting edema.

✅ Causes of Heart Failure:

• Hypertension (↑ Afterload).
• Coronary Artery Disease (CAD, past MI).
• Valvular heart disease.
• Dilated cardiomyopathy, Myocarditis.
• Arrhythmias (Atrial fibrillation).

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1.1. Acute Heart Failure (Pulmonary Edema)

✅ Definition:
Acute heart failure occurs suddenly with rapid fluid accumulation in the lungs (pulmonary edema) due to left ventricular failure.

✅ Symptoms of Pulmonary Edema:

• Severe shortness of breath (Dyspnea).
• Pink, frothy sputum (Fluid in alveoli).
• Crackles on lung auscultation.
• Cold, clammy skin (Shock-like symptoms).

✅ Emergency Management of Pulmonary Edema (LMNOP Protocol):

Treatment	Purpose
Lasix (Furosemide)	Removes excess fluid (Diuretic).
Morphine	Reduces breathlessness (Vasodilator).
Nitroglycerin	Reduces afterload (Dilates arteries).
Oxygen	Improves oxygenation.
Positioning	High Fowler’s to reduce lung congestion.

✅ Complications of Acute Heart Failure:

• Hypoxia & Respiratory failure.
• Multi-organ dysfunction.

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1.2. Chronic Heart Failure (Congestive Cardiac Failure – CCF)

✅ Definition:
CCF is a long-term condition where the heart gradually weakens, leading to fluid overload in the lungs and body.

✅ Symptoms of CCF:

• Dyspnea on exertion.
• Fatigue, Weakness.
• Edema (Swelling in legs, ankles).
• Nocturnal dyspnea (Shortness of breath at night).
• Ascites (Fluid in abdomen).

✅ Diagnosis of CCF:

Test	Findings
BNP (Brain Natriuretic Peptide)	↑ in Heart Failure (>100 pg/mL).
Echocardiography (ECHO)	EF <40% (Reduced pumping).
Chest X-ray	Pulmonary congestion, cardiomegaly.

✅ Management of CCF:

1. Medications

Drug Class	Examples	Purpose
Diuretics	Furosemide, Spironolactone	Reduce fluid overload.
ACE Inhibitors	Ramipril, Enalapril	↓ Afterload, prevent HF progression.
Beta-Blockers	Metoprolol, Carvedilol	Control HR, reduce workload.
Digoxin	Used in Atrial fibrillation.	↑ Cardiac contraction.

✅ Complications of CCF:

• Pulmonary hypertension.
• Kidney failure due to reduced perfusion.

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2. Pericardial Effusion & Cardiac Tamponade

2.1. Pericardial Effusion

✅ Definition:
Pericardial effusion is the accumulation of fluid in the pericardial sac around the heart.

✅ Causes of Pericardial Effusion:

• Pericarditis (Viral, Tuberculosis).
• Cancer, Trauma, Post-Heart Surgery.

✅ Symptoms of Pericardial Effusion:

• Chest discomfort, shortness of breath.
• Muffled heart sounds (Fluid dampens sound).

✅ Diagnosis:

Test	Findings
Echocardiography (ECHO)	Detects fluid accumulation.
ECG	Low voltage QRS.

✅ Management:

• Small Effusion → NSAIDs, Colchicine.
• Large Effusion → Pericardiocentesis (Needle Drainage).

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2.2. Cardiac Tamponade

✅ Definition:
Cardiac tamponade is severe pericardial effusion causing compression of the heart, impairing cardiac output.

✅ Symptoms of Cardiac Tamponade (Beck’s Triad):

Sign	Description
Hypotension	Low BP due to poor cardiac output.
JVD (Jugular Venous Distension)	Blood backup in veins.
Muffled Heart Sounds	Fluid obstructs heart sounds.

✅ Management:

• Emergency Pericardiocentesis (Drain fluid immediately).
• IV fluids (To maintain BP).

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3. Cardiac Arrest

✅ Definition:
Cardiac arrest is a sudden cessation of heart function, leading to loss of consciousness and death if untreated.

✅ Causes of Cardiac Arrest:

• Arrhythmias (Ventricular Fibrillation, Asystole).
• Severe Myocardial Infarction (Massive heart attack).
• Electrolyte Imbalance (Hyperkalemia).

✅ Signs of Cardiac Arrest:

• Unconscious, No Pulse.
• No Breathing, Dilated Pupils.

✅ Management – CPR & Defibrillation (ACLS Protocol):

Step	Action
Compressions	100-120/min, Depth: 2 inches (5 cm).
Airway	Open airway (head tilt, chin lift).
Breathing	2 rescue breaths every 30 compressions.
Defibrillation	Shock if Ventricular Fibrillation (VF) is present.

✅ Drugs in Cardiac Arrest:

Drug	Use
Epinephrine	First-line drug, improves circulation.
Amiodarone	Used for VF/VT.

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4. Arterial Disorders

4.1. Buerger’s Disease (Thromboangiitis Obliterans – TAO)

✅ Definition:
Buerger’s Disease is a non-atherosclerotic inflammatory disorder causing blood clot formation (thrombosis) in small and medium arteries of the limbs.

✅ Causes & Risk Factors:

• Heavy smoking (Strongest Risk Factor).
• Young males (20-40 years).

✅ Symptoms:

• Claudication (Pain in legs, worsens with walking).
• Cold, pale fingers & toes (Raynaud’s phenomenon).
• Non-healing ulcers & gangrene.

✅ Management:

• STOP Smoking (Most Effective Treatment).
• Vasodilators (Nifedipine).
• Amputation in severe cases.

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4.2. Arterial Ulcers

✅ Definition:
Arterial ulcers occur due to reduced blood supply (ischemia) to the skin, often on toes, feet, and lower legs.

✅ Features:

• Punched-out, deep ulcers.
• No granulation tissue, minimal bleeding.
• Cold, pale surrounding skin.

✅ Management:

• Control Diabetes & Hypertension.
• Antiplatelet drugs (Aspirin, Clopidogrel).
• Bypass surgery for severe ischemia.

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4.3. Arteriosclerosis

✅ Definition:
Arteriosclerosis is a thickening & hardening of arterial walls, reducing elasticity.

✅ Types:

Type	Description
Atherosclerosis	Plaque buildup in arteries.
Arteriolosclerosis	Hardening of small arteries (Common in Hypertension).

✅ Management:

• Statins (Reduce cholesterol).
• Lifestyle changes (Exercise, diet).

Aneurysm

✅ Definition:
An aneurysm is a localized dilation (ballooning) of an artery due to weakening of the arterial wall. It can rupture, causing life-threatening hemorrhage.

✅ Types of Aneurysm:

Type	Location	Clinical Relevance
Abdominal Aortic Aneurysm (AAA)	Aorta (below renal arteries)	Most common, risk of rupture.
Thoracic Aortic Aneurysm (TAA)	Aortic arch, chest	Can compress nearby organs (hoarseness, dysphagia).
Cerebral Aneurysm (Berry Aneurysm)	Brain arteries (Circle of Willis)	Rupture causes Subarachnoid Hemorrhage (SAH).
Peripheral Aneurysm	Popliteal, femoral, carotid arteries	Rare, may cause limb ischemia.

✅ Causes & Risk Factors:

• Atherosclerosis (Most Common Cause).
• Hypertension (↑ Pressure on arterial walls).
• Genetic Disorders (Marfan Syndrome, Ehlers-Danlos Syndrome).
• Smoking, Aging (>60 years).

✅ Symptoms of Aneurysm:

• Often asymptomatic until large or ruptured.
• Pulsatile abdominal mass (AAA).
• Sudden severe headache (Berry Aneurysm rupture).
• Hoarseness & dysphagia (TAA compressing nearby structures).

✅ Complications of Aneurysm:

• Rupture → Severe hemorrhage → Shock → Death.
• Thrombus formation inside aneurysm → Embolism → Ischemia.

✅ Diagnosis of Aneurysm:

Test	Findings
Ultrasound (AAA Screening)	Detects size & location.
CT Angiography	Best for detailed imaging.
MRI Angiography	Used for cerebral aneurysms.

✅ Management of Aneurysm:

Size	Management
<5 cm (Small)	Monitor every 6 months, Control BP.
>5.5 cm or symptomatic	Surgical repair or Endovascular Aneurysm Repair (EVAR).
Ruptured Aneurysm	Emergency Surgery (High mortality).

✅ Prevention:

• Control Hypertension (ACE inhibitors, Beta-blockers).
• Quit Smoking.
• Routine Screening for High-Risk Patients.

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2. Thrombosis & Emboli

✅ Definition:

• Thrombosis: Formation of a blood clot (thrombus) inside a blood vessel, obstructing blood flow.
• Embolism: A dislodged thrombus (embolus) that travels and blocks another vessel.

✅ Types of Thrombosis & Embolism:

Type	Location	Clinical Consequence
Deep Vein Thrombosis (DVT)	Leg veins (Femoral, Popliteal)	Swollen, painful leg, risk of Pulmonary Embolism.
Pulmonary Embolism (PE)	Lungs (Pulmonary arteries)	Sudden breathlessness, chest pain, fatal in severe cases.
Arterial Thrombosis	Coronary (Heart), Carotid (Brain), Renal, Leg arteries	Heart attack, Stroke, Renal failure, Limb ischemia.
Cerebral Embolism	Brain arteries	Ischemic Stroke (Sudden paralysis, slurred speech).

✅ Risk Factors for Thrombosis & Embolism (Virchow’s Triad):

Factor	Examples
Endothelial Injury	Surgery, Trauma, Hypertension.
Hypercoagulability	Cancer, Pregnancy, Smoking, Oral Contraceptives.
Stasis (Slowed Blood Flow)	Bedridden patients, Long flights.

✅ Symptoms of Thrombosis & Embolism:

• DVT: Swollen, red, painful leg.
• PE: Sudden breathlessness, chest pain, hemoptysis (coughing blood).
• Stroke: Weakness in one side of the body, slurred speech.

✅ Diagnosis:

Test	Findings
D-Dimer (Blood Test)	↑ in DVT & PE (Not specific).
Doppler Ultrasound (DVT)	Detects clot in leg veins.
CT Pulmonary Angiography (PE)	Gold standard for PE diagnosis.
ECG (Stroke or Heart Attack)	ST elevation (MI), Atrial fibrillation (Stroke risk).

✅ Management of Thrombosis & Embolism:

Condition	Treatment
DVT & PE	Heparin (IV) → Warfarin (Long-term).
Arterial Clots (Heart Attack, Stroke)	Aspirin, Clopidogrel, Thrombolytics (Alteplase).
Massive PE or DVT	Thrombectomy (Surgical clot removal).

✅ Prevention:

• Early Mobilization in bedridden patients.
• Compression stockings for DVT prevention.
• Anticoagulants in high-risk individuals.

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3. Raynaud’s Disease

✅ Definition:
Raynaud’s disease is a vasospastic disorder causing episodes of reduced blood flow to the fingers and toes, triggered by cold or stress.

✅ Types:

Type	Cause	Affected Area
Primary Raynaud’s	Idiopathic (No underlying disease).	Fingers & Toes.
Secondary Raynaud’s (Raynaud’s Phenomenon)	Autoimmune diseases (SLE, Scleroderma).	More severe, involves organs.

✅ Symptoms of Raynaud’s Disease:

• Pallor → Cyanosis → Redness (Triphasic Color Change).
• Cold, numb, tingling fingers & toes.
• Triggers: Cold weather, Stress, Vibrations.

✅ Diagnosis:

Test	Findings
Cold Stimulation Test	Hands turn pale/cyanotic when exposed to cold.
Nailfold Capillaroscopy	Abnormal capillaries (In Secondary Raynaud’s).

✅ Management of Raynaud’s Disease:

Treatment	Purpose
Calcium Channel Blockers (Nifedipine, Amlodipine)	Vasodilation (1st line treatment).
Avoid Cold Exposure & Stress	Prevents attacks.
Wear Warm Gloves, Avoid Smoking & Caffeine	Reduces vasospasms.

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4. Hypertension (High Blood Pressure)

✅ Definition:
Hypertension is persistently high blood pressure (BP ≥140/90 mmHg).

✅ Types of Hypertension:

Type	Cause
Primary (Essential) Hypertension	No known cause (90% cases).
Secondary Hypertension	Due to Kidney Disease, Cushing’s, Pheochromocytoma.

✅ Risk Factors for Hypertension:

• Obesity, Smoking, Sedentary Lifestyle.
• Excess Salt Intake, Alcohol, Stress.
• Diabetes, Family History of Hypertension.

✅ Symptoms of Hypertension:

• Usually asymptomatic (“Silent Killer”).
• Headache, Dizziness, Nosebleeds (Severe cases).
• Blurry vision (Hypertensive Retinopathy).

✅ Complications of Untreated Hypertension:

• Stroke, Heart Attack.
• Heart Failure, Kidney Damage.
• Aneurysm, Retinal Damage.

✅ Management of Hypertension:

Medication	Example
ACE Inhibitors	Ramipril, Enalapril
Beta-Blockers	Metoprolol, Atenolol
Diuretics	Furosemide, Hydrochlorothiazide
Calcium Channel Blockers	Amlodipine, Nifedipine

✅ Lifestyle Changes:

• Reduce salt, alcohol, caffeine.
• Regular exercise, Weight loss.
• Quit smoking, Manage stress.

Deep Vein Thrombosis (DVT)

✅ Definition:
Deep Vein Thrombosis (DVT) is the formation of a blood clot in a deep vein, usually in the legs, which can dislodge and cause a life-threatening pulmonary embolism (PE).

✅ Risk Factors (Virchow’s Triad):

Factor	Examples
Venous Stasis (Slow blood flow)	Prolonged bed rest, Pregnancy, Long flights/travel.
Endothelial Injury	Surgery, Trauma, Hypertension.
Hypercoagulability (Increased clotting tendency)	Cancer, Oral contraceptives, Smoking, COVID-19.

✅ Symptoms of DVT:

• Swollen, painful leg (Usually unilateral).
• Redness, warmth over affected vein.
• Positive Homan’s Sign (Pain in calf on dorsiflexion).

✅ Complications of DVT:

• Pulmonary Embolism (Sudden breathlessness, chest pain, hemoptysis).
• Post-Thrombotic Syndrome (Chronic leg swelling & pain).

✅ Diagnosis of DVT:

Test	Findings
D-Dimer Test	↑ in DVT (But not specific).
Doppler Ultrasound	Best non-invasive test for DVT.
CT Pulmonary Angiography (If PE suspected)	Gold standard for PE diagnosis.

✅ Management of DVT:

Treatment	Purpose
Heparin (IV) → Warfarin (Long-term).	Prevent clot growth.
Direct Oral Anticoagulants (DOACs – Rivaroxaban, Apixaban).	Safer alternative to Warfarin.
Compression Stockings.	Prevents post-thrombotic syndrome.

✅ Prevention of DVT:

• Early mobilization in bedridden patients.
• Leg exercises during long flights.
• Low-dose anticoagulants in high-risk patients.

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2. Venous Insufficiency

✅ Definition:
Chronic venous insufficiency (CVI) occurs when veins fail to return blood efficiently to the heart, leading to pooling of blood in the legs.

✅ Causes:

• DVT (Damages valves).
• Varicose veins.
• Obesity, Pregnancy, Prolonged standing.

✅ Symptoms of Venous Insufficiency:

• Leg swelling (Worsens at end of the day).
• Heaviness, aching in legs.
• Brownish skin discoloration (Hemosiderin deposition).

✅ Complications:

• Venous ulcers (Poor wound healing).
• Skin thickening (Lipodermatosclerosis).

✅ Diagnosis:

Test	Findings
Doppler Ultrasound	Detects venous reflux (Backflow of blood).

✅ Management of Venous Insufficiency:

Treatment	Purpose
Compression stockings.	Improves venous return.
Leg elevation, Exercise.	Reduces swelling.
Sclerotherapy or Vein Surgery (Severe cases).	Closes incompetent veins.

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3. Venous Ulcers

✅ Definition:
Venous ulcers are slow-healing wounds caused by chronic venous insufficiency, usually on the medial malleolus (inner ankle).

✅ Features of Venous Ulcers:

• Shallow, irregular edges.
• Red granulation tissue inside the ulcer.
• Surrounding brownish discoloration.
• Leg swelling, warm skin.

✅ Diagnosis:

Test	Findings
Ankle-Brachial Index (ABI)	Normal (Unlike arterial ulcers).

✅ Management of Venous Ulcers:

Treatment	Purpose
Compression bandages.	Improves circulation.
Wound dressings (Hydrocolloid, Foam).	Promote healing.
Surgery (Skin grafting in large ulcers).	Helps in non-healing cases.

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4. Varicose Veins

✅ Definition:
Varicose veins are enlarged, twisted, and swollen veins, usually in the legs, due to weak or damaged vein valves.

✅ Risk Factors:

• Prolonged standing (Teachers, Nurses).
• Pregnancy, Obesity.
• Family history.

✅ Symptoms of Varicose Veins:

• Bulging, twisted veins.
• Leg pain, heaviness, itching.
• Worsens after prolonged standing.

✅ Complications of Untreated Varicose Veins:

• Ulcers, Skin infections.
• Superficial thrombophlebitis (Clot in superficial veins).

✅ Diagnosis:

Test	Findings
Doppler Ultrasound	Detects valve incompetence.

✅ Management of Varicose Veins:

Treatment	Purpose
Compression stockings.	Reduces swelling.
Endovenous Laser Therapy (EVLT).	Closes varicose veins.
Surgical vein stripping (Severe cases).	Removes diseased veins.

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5. Cellulitis

✅ Definition:
Cellulitis is a bacterial skin infection that spreads through dermis and subcutaneous tissue, commonly in the legs.

✅ Causes:

• Streptococcus pyogenes, Staphylococcus aureus.
• Skin injuries, Insect bites, Poor circulation.

✅ Symptoms of Cellulitis:

• Red, swollen, warm, and painful skin.
• Fever, chills.
• Blisters, skin peeling (Severe cases).

✅ Complications:

• Sepsis (Blood infection).
• Necrotizing fasciitis (Flesh-eating bacteria).

✅ Diagnosis:

Test	Findings
Blood culture.	Identifies bacteria (Severe cases).

✅ Management of Cellulitis:

Treatment	Purpose
Oral Antibiotics (Mild Cases) – Amoxicillin, Cephalexin.	Treats infection.
IV Antibiotics (Severe Cases) – Vancomycin, Ceftriaxone.	Hospitalization required.

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6. Lymphatic Disorders

6.1. Lymphangitis & Lymphadenitis

✅ Definition:

• Lymphangitis: Inflammation of lymphatic vessels.
• Lymphadenitis: Inflammation of lymph nodes.

✅ Causes:

• Bacterial infections (Streptococcus, Staphylococcus).

✅ Symptoms:

• Red streaks along the skin (Lymphangitis).
• Tender, swollen lymph nodes (Lymphadenitis).
• Fever, chills, fatigue.

✅ Management:

• Antibiotics (Amoxicillin, Clindamycin).
• Pain relief (NSAIDs).

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6.2. Lymphedema & Elephantiasis

✅ Definition:

• Lymphedema: Swelling due to lymphatic obstruction.
• Elephantiasis: Severe lymphedema caused by parasitic infection (Wuchereria bancrofti – Filariasis).

✅ Causes:

• Primary (Congenital).
• Secondary (Surgery, Radiation, Filariasis).

✅ Symptoms:

• Painless swelling (Legs, arms).
• Thick, hard skin (Elephantiasis).

✅ Management:

Treatment	Purpose
Compression therapy.	Reduces swelling.
Diethylcarbamazine (DEC) for Filariasis.	Kills parasites.
Surgical Lymphatic Bypass (Severe cases).	Restores drainage.