Marwah Medicine

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

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.

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