Marwah Medicine

Facebook Instagram Youtube Whatsapp
Menu
Enquire Now
FMGE, INICET, Medicine, NEET PG, NEETPG2024, NExT, NExT Exam

Contraindications to thrombolysis in Myocardial infarction

/

Fibrinolytic agents should be given with 30 minutes of arrival to non-PCI capable hospital where transport to PCI capable hospital is not possible or has delay beyond 120 minutes Current recommended regimen is tPA 15 mg bolus followed by 50 mg Intravenously over 30 minutes and 35 mg over the next 30 minutes. In contrast tenecteplase can be given as weight based intravenous bolus over 10 seconds. Clear Contraindications are remembered by mnemonic: HAS-BLEED 1.       Hypertension marked elevation of BP > 180/110 mm Hg at any time during presentation 2.       Aortic dissection suspected 3.       Stroke: Hemorrhagic at any time 4.       Stroke: Non-hemorrhagic in last 1 year 5.       Bleeding (active internal bleed excluding menses) Relative contraindications to fibrinolytic therapy Mnemonic: RIP – AB AB implies has allergy or Bleed in eye/GIT or bleed risk due to hypertension Recent invasive surgical procedure in last 2 weeks INR> 2 due to current use of OAC Prolonged CPR (> 10 minutes) Pregnancy Risk of Allergic reaction with received STK within preceding 5 days to 2 years Hemorrhagic diabetic retinopathy Active Peptic ulcer disease Severe Hypertension   Hemorrhage is the most serious and most frequent complication of thrombolysis. Hemorrhagic stroke can occur in 0.5 to 0.9% of patients treated with fibrinolytic agents

FMGE, INICET, NEET PG, NEETPG2024

Air Embolism

/

#NEETPG #INICET #FMGE 2 min read You have a patient on central Line in ICU who deteriorates suddenly with crashing of BP due to large of amount of air entering right side of the heart. The large air bubbles will crowd and occlude the flow of blood into pulmonary artery. This leads to crashing of BP. What is the first step to be taken in its management? Shift the patient using Durant maneuver as shown in the inset below. Durant maneuver consists of placing the patient in left lateral decubitus position followed by Head low position in order to prevent venous air bubbles from lodging in lungs. In patients who may have patent fossa ovalis they may enter into left side of heart and go into brain causing features of stroke. The logic is that air will stay in right heart away from pulmonary conus and will gradually be absorbed. Another rationale for head low position is to prevent arterial air embolism bubbles from travelling to the brain. Transesophageal echocardiography will help in estimating the amount of air that is causing venous air embolism. Interventions in air embolism Direct aspiration of air from central venous catheter into the right atrium can be attempted Consider shifting to Hyperbaric oxygen therapy unit if possible Give CPR if patient is pulseless. Giving CPR will break those air bubbles making it easier for dissolution of air. Bonus point: Venous air embolism can be seen during which surgery? Ans- Neurosurgery during Craniotomy

FMGE, INICET, Medicine, Medicine classes, NEET, NEET PG, NEETPG2024

Tricuspid Regurgitation

/

#CausesofTricuspid #TricuspidRegurgitation #TricuspidPrevent Causes of Tricuspid Regurgitation Mnemonic: Functional REP-C Functional dilatation of tricuspid annulus due to RVF R: Rheumatic heart disease, Radiation E: Endomyocardial fibroelastosis and Ebstein anomaly (Lithium teratogenicity) P: Pulmonary artery hypertension severe causing RVF P: Pacing lead induced damage C: Carcinoid syndrome   Clinical features Effort intolerance due to less pulmonary blood flow Visible neck pulsations Abdominal fullness and reduced appetite Examination findings Lancisi sign / cv wave/ prominent v waves Absent x descent Prominent y descent (Contrast with blunted Y of tricuspid stenosis) Pulsatile liver (Systolic pulsations) Pan-systolic murmur that increases on deep inspiration ( carvallo sign) Work up ECG shows -Right axis deviation -Right atrial enlargement of P pulmonale -WPW syndrome can co-exist in Ebstein anomaly and hence ECG findings of delta  wave with short PR interval can be present CXR shows RV enlargement IOC is trans-esophageal echocardiography Doppler shows reversed systolic flow in liver Management Salt restricted diet Diuretics Tricuspid valve repair (TVRp) Tricuspid valve replacement (TVR)

FMGE, INICET, Medical, Medicine, NEET PG, NEETPG2024

Tricuspid Stenosis

/

Tricuspid stenosis Key pick up points –        Large a waves in JVP –        Blunted Y descent in JVP –        Mid-diastolic murmur –        Pulsations in liver Tricuspid stenosis can coexist with mitral stenosis and usually manifests after the Percutaneous mitral valvotomy has been done. Patient will develop features of right sided heart failure. Symptoms  Ankle edema Abdominal fullness and discomfort Fatigue and effort intolerance Examination findings Large a wave in JVP Blunted y descent Pulsatile liver (Pre-systolic pulsations of liver) Mid diastolic murmur that increases on deep inspiration. It is best heard at Left lower sternal border in tricuspid area Work up ECG shows evidence of left atrial enlargement with P pulmonale and right axis deviation Echo shows thickened tricuspid valve. Severe tricuspid stenosis is size less than 1 cm and transit time across narrowed valve of > 190 msec. CXR show Enlarged Right atria and dilated Superior vena cava along with azygoz vein Treatment Salt restricted diet Diuretics Valve repair or prosthetic valve deployment #NEETPG #FMG #INICET

FMGE, INICET, Medical, NEET PG, NEETPG2024

Congenital Heart Disease

/

#NEETPG #FMGE #INICET Criteria used for diagnosis are NADAS criteria Major Criteria Blue baby with noise in heart is having failure Cyanosis due to R- L shunting. It is central cyanosis non-responsive to oxygen administration Diastolic murmur Systolic murmur grade III or more Congestive heart failure due to L-R to shunting that causes overloading of lung circulation and resultant pulmonary edema     Minor criteria Systolic murmur less than grade III Abnormal S2 like single S2 in TOF Abnormal ECG like Right axis deviation in Ostium Secundum Abnormal CXR like boot shaped heart Abnormal BP like in coarctation of aorta with BP in legs being lower than that in upper limbs     Must know fact Correct answer Leading congenital heart disease Peri-membranous VSD Congenital heart disease that shows spontaneous closure Muscular VSD Leading congenital cyanotic heart disease at day 0 Transposition of great arteries   Ductal dependent pulmonary circulation   TOF Tricuspid atresia TGA Ductal dependent systemic circulation   Aortic atresia Mitral atresia Hypoplastic left heart syndrome Interrupted aortic arch Components of tetralogy of Fallot  Right ventricular outflow tract obstruction Concentric right ventricular hypertrophy VSD Over riding of aorta Triology of Fallot Atrial septal defect Concentric Right ventricular hypertrophy Right ventricular outflow tract obstruction Pentalogy of Fallot Right ventricular outflow tract obstruction Concentric right ventricular hypertrophy VSD Over-riding of aorta ASD Ebstein anomaly Lithium intake by mother Inferior displacement of tricuspid valve Tricuspid regurgitation Associated with WPW syndrome Alprostadil is contraindicated in Truncus arteriosus Total anomalous pulmonary venous connection Central cyanosis on day 0 which worsens on crying Congenital diaphragmatic hernia Central cyanosis on day 0 which improves on crying Choanal atresia

FMGE, Medical, Medicine

Sudden Cardiac Death

/

#NEETPG #FMG #INICET 1 min read Sudden cardiac death is defined as death occurring within 1 hour of the onset of cardiac symptoms or 24 hours of last being seen healthy and alive. Men are at higher risk. Leading cause if Coronary artery disease   Differences in physical finding in Sudden cardiac arrest vs Myocardial ischemia Sudden cardiac arrest Myocardial ischemia Pulse Absent Increased rate and bounding Mental Status Unresponsive Afraid and Anxious with Sweating Lips Cyanosis Pallor Pupils Dilated and Non-reactive to Light Reactive to light Muscle Tone Flaccid Normal Auscultation Absent Heart Sounds S3S4 ECG Asystole PEA Agonal Rhythm ST Elevation ST Depression Cardiac condition associated with SCD Fatal arrythmia Hypertrophic Cardiomyopathy Ventricular Fibrillation / Ventricular Tachycardia Holiday Heart Syndrome Atrial Fibrillation Diabetes Mellitus Silent MI Brugada Syndrome Torsades de Pointes, Ventricular Tachycardia Broken Heart Syndrome Cardiogenic Shock and TDP Long QT Syndrome Torsades de Pointes    

COPD, FMGE, INICET, NEET PG

COPD: Long Term Oxygen Therapy

/

#NEETPG #FMGE #INICET #COPD 1 minute read Long term oxygen therapy is the only pharmacological intervention that is demonstrated to reduce mortality in patients of Chronic obstructive lung disease. So here is a quick look at indications for LTOT @1L/min for 15 hours per day. Resting sp02 of less than 88% or p02< 55 mm Hg sp02 < 89% (p02 56-59 mm Hg) with Pulmonary artery hypertension sp02 < 89% (p02 56-59 mm Hg) with right sided congestive heart failure sp02 < 89% (p02 56-59 mm Hg) with Erythrocytosis The benefit of mortality reduction is directly proportional to number of hours oxygen is used. Mostly oxygen concentrator is used to ensure good quality of life. Next step for a would be to develop inhouse portable systems in India that allow mobility outside the home. The long-term hypoxia caused pulmonary vasoconstriction that leads to pulmonary artery hypertension. Loud P2, Narrow split S2 are auscultatory findings to be looked out for. Mean pressure >20 mmHg is threshold for diagnosis of PAH. Hypoxia leads to increased RBC count and secondary polycythemia.

Scroll to Top