Cardiovascular System

During episodes of AF, the atria beat rapidly but in an uncoordinated and ineffective manner. The ventricles are activated irregularly at a rate determined by conduction through the AV node. This produces the characteristic ‘irregularly irregular’ pulse. The ECG shows normal but irregular QRS complexes; there are no P waves.

Reference: Davidson 23rd; P-518

Explanation: Four chamber. Right & left atrium. Right & left ventricle

The diagnosis can often be made on the basis of clinical features and the ECG; the latter shows ST elevation with upward concavity over the affected area, which may be widespread. PR interval depression is a very specific indicator of acute pericarditis.

Explanation: ACE inhibitors & ARB are contraindicated in pregnancy

Reference: Davidson 23rd; P-544
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd , Page : 543
Explanation : chronic constrictive pericarditis is sometimes overlooked but should be suspected in any patient with unexplained right heart failure and a small heart.
Differential diagnosis of small heart : Chronic constrictive pericarditis,Addison’s disease, Starvation.

Pulsus paradoxus, a decrease in systolic blood pressure of more than 10 mmHg during inspiration, is a classic finding in cardiac tamponade. Davidson explains that in tamponade, fluid accumulation in the pericardium compresses the heart, reducing ventricular filling during inspiration and leading to a drop in blood pressure. Harrison adds that pulsus paradoxus can be detected by palpating the pulse or measuring blood pressure during the respiratory cycle.

Reference: Davidson 23rd; P-514
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: Ticagrelor is an antiplatelet drug. Warfarin, Rivaroxaban, Heparin are anticoagulants

Reference: Davidson 23rd , Page : 473 , Box : 16.24

HOCM is the most common cause of sudden cardiac death in the young. 
Always consider HOCM in sudden death & unusual collapse in young person

For acute dissection, parenteral beta-adrenergic blockers (IV propranolol, metoprolol, labetalol or esmolol) should be administered to achieve a heart rate of ~60 beats/min. Sodium nitroprusside infusion is used to lower SBP to <120 mmHg. Verapamil, diltiazem or enalaprilat may be used parenterally. Isolated use of direct vasodilators like diazoxide and hydralazine is contraindicated because these agents can increase hydraulic shear and may propagate dissection.

Explanation: 12-lead ECG is the initial investigation for acute onset chest pain.

Chest pain on exertion suggests angina pectoris. The reproducibility, predictability and relationship to physical exertion (and occasionally emotion) of the chest pain are the most important features.

Reference: Davidson 23rd; P-530

In PDA, severe pulmonary vascular disease results in reversal of flow through ductus thereby unoxygenated blood is shunted to descending aorta leading to cyanosis and clubbing of the toes, but not fingers. This is called differential cyanosis.

Explanation: smoking is probably the most important modifiable risk factor.

Reference: Davidson 23rd; P-543
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: Acute coronary syndrome almost always occurs in patients who have atherosclerosis, The culprit lesion.

Refractory hypertension refers to the situation where multiple drug treatments do not give adequate control of BP. Although this may be due to genuine resistance to therapy in some cases, a more common cause of treatment failure is non-adherence to drug therapy.

Explanation: see question no: 7

Reference: Davidson 23rd, Box-16.72

Explanation: Chest pain on effort is the hallmark of angina pectoris

Labetalol, a combined alpha- and beta-blocker, is commonly used in hypertensive emergencies to rapidly lower blood pressure. Davidson explains that hypertensive emergencies require immediate reduction of blood pressure to prevent organ damage, and labetalol is effective due to its rapid onset and short half-life. Harrison emphasizes that intravenous administration is preferred in emergencies, and care must be taken to avoid an excessive drop in blood pressure.

ACE inhibitor and ARB are contraindicated 

Davidson Box: 16.72

Reference: Davidson 23rd; P-514

Reference: Davidson 23rd; P-482

Explanation: Echocardiography is a pivotal investigation for vulvular heat disease

Reference: Davidson 23rd; P-133

Explanation: Night sweats is common in TB & infective endocarditis

Reference: Davidson 23rd; P-482

Explanation: Tricuspid regurgitation produces giant v waves that coincide with ventricular systole. Davidson 23rd, P-443

Reference: Davidson 23rd , Page : 443, Box : 5

Reference: Davidson 23rd , Page : 482
Explanation : Adenosine effects are greatly potentiated by dipyridamole and inhibited by theophylline.

JVP reflects phasic pressure changes in right atrium and consists of a, c and v positive waves and x and y negative waves.

Most common symptom attributable to pulmonary hypertension is exertional dyspnea. Other symptoms are fatigue, angina pectoris (RV ischemia), syncope, near syncope & peripheral edema.

Reference: Davidson 23rd; P-533

Explanation: Blood pressure is higher during the daytime

Pansystolic murmur heard best at apex and left sternal edge (diaphragm), radiates to axilla

Reference: Davidson 23rd , Page : 486
Explanation : Age is the most powerful independent risk factor for atherosclerosis.

Reference: Davidson 23rd , Page : 481
Explanation : Amiodarone is probably the most effective drug currently available for controlling paroxysmal AF.

Explanation: Absent a wave in JVP is found in Atrial fibrillation, Tricuspid regurgitation produces giant v waves

Explanation: ECG is the initial investigation for a patient with sudden severe chest pain

The ‘a’ wave corresponds to right atrial contraction and occurs just before the first heart sound.
In atrial fibrillation the ‘a’ wave is absent.

Macleod 14th/52

Reference: Davidson 23rd , Page : 516
Explanation : The most common major manifestation of rheumatic fever is arthritis.

Reference: Davidson 23rd; P-542

Explanation: Acute coronary syndrome is a term that encompasses both unstable angina and myocardial infarction