CVS DISORDERS.
✅ 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:
✅ 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. |
✅ Cardiac Cycle (One Complete Heartbeat):
✅ 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:
✅ 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:
✅ 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. |
✅ 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).
✅ Definition:
A detailed history helps in identifying risk factors, symptoms, and potential cardiovascular conditions.
✅ Key Questions to Ask the Patient:
| 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. |
✅ Definition:
A systematic examination of the cardiovascular system detects abnormalities in heart function, blood flow, and vascular integrity.
✅ Steps of Cardiovascular 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:
✅ 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):
✅ Lung Examination (To Detect Heart Failure):
✅ Extremities Examination:
✅ Definition:
Diagnostic tests help confirm cardiac diseases, assess severity, and guide treatment.
✅ Common Cardiovascular Diagnostic Tests:
✅ Purpose:
✅ 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. |
✅ Purpose:
✅ Types of ECHO:
| Type | Use |
|---|---|
| Transthoracic (TTE) | Non-invasive, commonly used. |
| Transesophageal (TEE) | Detailed imaging (Endocarditis, Clots). |
| Doppler ECHO | Checks blood flow abnormalities. |
✅ Purpose:
✅ Procedure:
✅ Purpose:
✅ Procedure:
✅ Findings:
| Finding | Condition |
|---|---|
| >70% Narrowing of artery | Severe CAD (Needs stenting or bypass). |
| Thrombus in artery | Acute Heart Attack (STEMI). |
| 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. |
✅ 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:
✅ 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:
✅ 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:
| 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. |
| 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:
✅ 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:
✅ Diagnosis of Angina:
✅ 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 |
✅ 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:
✅ 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:
✅ 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:
✅ 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:
✅ Complications of Atherosclerosis:
✅ 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:
| 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. |
✅ 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:
✅ Symptoms of Myocardial Infarction:
✅ 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:
| Morphine | Oxygen | Nitroglycerin | Aspirin |
|---|---|---|---|
| Pain relief | Improves oxygenation | Dilates coronary arteries | Prevents clot formation |
| 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:
Valvular heart disease occurs when heart valves become stenotic (narrowed) or regurgitant (leaky), affecting blood flow.
✅ Definition:
Mitral stenosis is narrowing of the mitral valve, obstructing blood flow from the left atrium to the left ventricle.
✅ Causes:
✅ Symptoms of Mitral Stenosis:
✅ Diagnosis:
| Test | Findings |
|---|---|
| Echocardiography (ECHO) | Thickened mitral valve, reduced opening. |
| Auscultation | Loud S1, Opening Snap, Diastolic Murmur. |
✅ Management of Mitral Stenosis:
✅ Definition:
Aortic stenosis is narrowing of the aortic valve, obstructing blood flow from the left ventricle to the aorta.
✅ Causes:
✅ Symptoms of Aortic Stenosis:
✅ Diagnosis:
| Test | Findings |
|---|---|
| Echocardiography (ECHO) | Thickened aortic valve, pressure gradient. |
| Auscultation | Systolic Murmur (Crescendo-Decrescendo). |
✅ Management of Aortic Stenosis:
✅ 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:
✅ Symptoms of Valve 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:
| 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. |
| 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:
✅ Definition:
Tricuspid stenosis is narrowing of the tricuspid valve, impeding blood flow from the right atrium (RA) to the right ventricle (RV).
✅ Causes:
✅ Pathophysiology:
✅ Symptoms of Tricuspid Stenosis:
✅ 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:
| Drug Class | Examples | Purpose |
|---|---|---|
| Diuretics | Furosemide, Spironolactone | Reduces systemic congestion. |
| ACE Inhibitors | Enalapril | Decreases afterload. |
| Anticoagulants | Warfarin (If AF present) | Prevents clot formation. |
| 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:
✅ Definition:
Pulmonary stenosis is narrowing of the pulmonary valve, reducing blood flow from the right ventricle (RV) to the pulmonary artery (PA).
✅ Causes:
✅ Pathophysiology:
✅ Symptoms of Pulmonary Stenosis:
✅ 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:
| Drug Class | Examples | Purpose |
|---|---|---|
| Beta-Blockers | Propranolol | Reduce heart workload. |
| Diuretics | Furosemide | Reduce RV overload. |
| 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:
✅ 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:
✅ Complications of Pericarditis:
✅ 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:
| 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. |
| Procedure | Indication |
|---|---|
| Pericardiocentesis | Pericardial effusion with cardiac tamponade. |
| Pericardiectomy | Chronic constrictive pericarditis. |
✅ 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:
✅ Complications of Myocarditis:
✅ 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:
| 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. |
✅ 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:
✅ Symptoms of Endocarditis:
✅ Complications of Endocarditis:
✅ Diagnosis of Endocarditis:
| Test | Findings |
|---|---|
| Blood Cultures | Detects causative bacteria. |
| Echocardiography (ECHO) | Vegetations on valves (Best seen in Transesophageal ECHO – TEE). |
✅ Management of Endocarditis:
| Drug Class | Examples | Duration |
|---|---|---|
| IV Antibiotics | Vancomycin + Gentamicin | 4-6 weeks |
| Anticoagulants | Not recommended (High embolism risk). | N/A |
✅ 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:
✅ Management of Rheumatic Fever:
✅ 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:
✅ Definition:
Acute heart failure occurs suddenly with rapid fluid accumulation in the lungs (pulmonary edema) due to left ventricular failure.
✅ Symptoms of Pulmonary Edema:
✅ 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:
✅ Definition:
CCF is a long-term condition where the heart gradually weakens, leading to fluid overload in the lungs and body.
✅ Symptoms of CCF:
✅ 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:
| 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:
✅ Definition:
Pericardial effusion is the accumulation of fluid in the pericardial sac around the heart.
✅ Causes of Pericardial Effusion:
✅ Symptoms of Pericardial Effusion:
✅ Diagnosis:
| Test | Findings |
|---|---|
| Echocardiography (ECHO) | Detects fluid accumulation. |
| ECG | Low voltage QRS. |
✅ Management:
✅ 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:
✅ Definition:
Cardiac arrest is a sudden cessation of heart function, leading to loss of consciousness and death if untreated.
✅ Causes of Cardiac Arrest:
✅ Signs of Cardiac Arrest:
✅ 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. |
✅ 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:
✅ Symptoms:
✅ Management:
✅ Definition:
Arterial ulcers occur due to reduced blood supply (ischemia) to the skin, often on toes, feet, and lower legs.
✅ Features:
✅ Management:
✅ 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:
✅ 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:
✅ Symptoms of Aneurysm:
✅ Complications of Aneurysm:
✅ 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:
✅ Definition:
✅ 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:
✅ 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:
✅ 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:
✅ 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. |
✅ 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:
✅ Symptoms of Hypertension:
✅ Complications of Untreated Hypertension:
✅ Management of Hypertension:
| Medication | Example |
|---|---|
| ACE Inhibitors | Ramipril, Enalapril |
| Beta-Blockers | Metoprolol, Atenolol |
| Diuretics | Furosemide, Hydrochlorothiazide |
| Calcium Channel Blockers | Amlodipine, Nifedipine |
✅ Lifestyle Changes:
✅ 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:
✅ Complications of DVT:
✅ 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:
✅ 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:
✅ Symptoms of Venous Insufficiency:
✅ Complications:
✅ 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. |
✅ Definition:
Venous ulcers are slow-healing wounds caused by chronic venous insufficiency, usually on the medial malleolus (inner ankle).
✅ Features of Venous Ulcers:
✅ 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. |
✅ Definition:
Varicose veins are enlarged, twisted, and swollen veins, usually in the legs, due to weak or damaged vein valves.
✅ Risk Factors:
✅ Symptoms of Varicose Veins:
✅ Complications of Untreated Varicose 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. |
✅ Definition:
Cellulitis is a bacterial skin infection that spreads through dermis and subcutaneous tissue, commonly in the legs.
✅ Causes:
✅ Symptoms of Cellulitis:
✅ Complications:
✅ 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. |
✅ Definition:
✅ Causes:
✅ Symptoms:
✅ Management:
✅ Definition:
✅ Causes:
✅ Symptoms:
✅ Management:
| Treatment | Purpose |
|---|---|
| Compression therapy. | Reduces swelling. |
| Diethylcarbamazine (DEC) for Filariasis. | Kills parasites. |
| Surgical Lymphatic Bypass (Severe cases). | Restores drainage. |