Continuous Machinery Murmur Early Diastolic Murmur Mid-Late Diastolic Murmur • Also known as Austin-Flint murmur Pansystolic Murmur Ejection Systolic Murmur Late Systolic Murmur
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Introduction • A myeloproliferative disorder caused by malignant proliferation of a clone derived from one pluripotent stem cell leading to an excess proliferation of red blood cell, leucocytes and platelets → hyperviscosity of blood & thrombosis• JAK2 mutation is present in >95% cases • Age group: commoner >60s, peak in 60s Presentation (i) Asymptomatic• Detected […]
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Carvedilol
Introduction • Third generation beta-blocker, non-selective Advantages • Effective in hypertension• Improves mortality & morbidity in patients with heart failure• No adverse effect on insulin resistance & lipid metabolism Precaution • Safety in pregnancy not established Dosage Notes: different dosage for patients with heart failure / angina Hypertension • Starting dose: 12.5 mg OD• Recommended […]
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ORBIT Score
• Used to assess bleeding risk in a patient with atrial fibrillation started with anticoagulant Components Haemoglobin <13 g/dL (male) or <12 g/dL (female) OR Haematocrit <40% (male) or <36% (female) — 2 points Abnormal renal function (eGFR < 60 mL/min/1.73m2)) — 1 point Age >74 years — 1 point Bleeding history (GI bleeding / […]
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HAS-BLED Score
• Used to assess bleeding risk in a patient with atrial fibrillation started with anticoagulant Components Hypertension (SBP >160 mmHg) — 1 point Abnormal renal and or liver function — 1 or 2 points (1 point for each abnormality) Renal: ESRF, requiring dialysis /renal transplant Liver: cirrhosis / serum bilirubin 2×normal / AST or ALT […]
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Sotalol
Introduction • A non-selective beta-blocker• A class III anti-arrhythmic drug Mechanism of Action • It prolongs cardiac action potential and QT interval by delaying slow outward potassium ion current Adverse Effects • Long QT syndrome• Torsades de pointes Cautions • Requires close monitoring of renal profile (potassium level) Related Posts Beta-blockers
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Synchronized Cardioversion
Steps Doses of Synchronized Cardioversion Initial recommended doses:• Narrow regular: 50 – 100 J• : 120 – 200 J biphasic OR 200 J monophasic • Wide regular: 100 J • : defibrillation dose (not for synchronized cardioversion) Aim Risks / Complications[1] Defibrillation VS Synchronized Cardioversion Related Post References
Introduction • A multi-system disease• Female to male ratio 3:1• Peak incidence: 30 – 50 years old • 2 types: (i) , (ii) diffuse cutaneous systemic sclerosis Pathogenesis • Widespread vascular damage involving small arteries, arterioles, and capillaries, leading to arterial lesions & chronic ischaemia • Vasoconstriction / vasospasm occurs • Fibroblasts stimulated to cause […]
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Biliary Colic
Introduction When gallbladder neck is impacted by gallstones or when gallstones passing through the common bile duct, the gallstones may cause pain Features No fever No jaundice, no pape stool, no tea-colored urine White cell count not raised Differential Diagnosis Acute coronary syndrome (ACS) Acute cholecystitis / Ascending cholangitis Peptic ulcer disease Acute pancreatitis Urinary […]
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CHA2DS2VASc Score
If patient has atrial fibrillation, this CHA2DS2VASc Score should be done to assess the 1-year risk of thromboembolic event in non-anticoagulated patient with non-valvular atrial fibrillation Components • Congestive heart failure history – 1 point• Hypertension – 1 point• Age >75 years old – 2 points• Diabetes mellitus – 1 point• Stroke / TIA previously […]