KNOWLEDGE IS EVERYTHING (doctor blog)

 EASY WAY TO REMEMBER AUSCULTATION POINTS: BASIC KEYWORDS:   APT-M (2245) E                                                 [APARTMENT-M,,, NO:2245,,,,E-BLOCK] A ) AORTIC- (2) ND RIGHT INTERCOSTAL SPACE P ) PULMONIC- (2) ND LEFT INTERCOSTAL SPACE T ) TRICUSPID- (4) TH INTERCOSTAL SPACE LOWER LEFT STERNAL BORDER M ) MITRAL- (5) TH LEFT MIDCLAVICULAR LINE (5th intercostal space) E ) ERB'S POINT- LEFT (3)RD INTERCOSTAL SPACE (S1S2)

 1. INITIAL MEASURES:        1. HOSPITALIZATION ( IMMEDIATE )        2. HIGH FLOW OXYGEN         3. I/V ACCESS        4. ECG  MONITORING 2. PHARMACOLOGICAL THERAPY:        1. ANTIPLATELET : ASPIRIN 300MG                                             CLOPIDOGREL 300MG        2. ANALGESICS : I/V MORPHINE WITH ANTIEMITICS        3. ANTIANGINAL : SUBLINGUAL GTN  (OR) B-BLOCKERS  (IF, THERE IS NOT ANY                       CONTRAINDICATIONS )        4. THROMBOLYTICS / ANTICOAGULATION:                IF PATIENT COMES WITHIN 12 HOURS : STEMI : THROMBOLYSIS: STREPTOKINASE              IF PATIENT COMES AFTER 12 HOURS : NSTEMI :ANTICOAGULATION:  LMWH (ENOXAPARIN) 3. REPERFUSION THERAPY:        1. PRIMARY PCI [ PERCUTANEOUS CONONARY INTERVENTION  ]        2 . CABG [ CORONARY ARTERY BYPASS GRAFTING  ]

 MYOCARDIAL INFARCTION (MI) BASICS ECG IN MI :  NOTE:  MIN.AFTERWARD (ST ELEVATION).                                 HOURS AFTERWARD ( ST ELEVATION AND T DEPRESSION). DAYS AFTERWARD ( T DEPRESSION).                   WEEKS AFTERWARD (PATH.Q WAVE).                    THIS IS HOW YOU HAVE TO DIFFERENTIATE THE TIME OF MI IN PATIENT. LOCALIZATION OF MI ON ECG NOTE:   ANT.MI : V1-V6              INF.MI : 2nd,3rd,AVf               LAT.MI : V5,V6,1st,AVL             ANTEROSEPTAL MI : V1-V4     ANTEROLATERAL MI : V1-V6,1st, AVL   IF YOU NOTICED : ST CHANGES IN V1-V6 (IT REFLECTS ANTERIOR ASPECT OF HEART). ST CHANGES IN 2ND,3RD,AVf (IT REFLECTS INFERIOR ASPECT OF HEART). ST CHANGES IN V5,V6,1ST,AVL (IT REFLECTS LATERAL ASPECT OF HEART). ST CHANGES IN V3,V4 (IT REFELCTS SEPTUM).

 ATRIAL FLUTTER (BASICS) When the atrial rate is greater than 250/min, and there is no flat baseline between the P waves, "atrial flutter" is present. This type of  arrhythmia  can be dangerous because complications can easily develop. LET'S MAKE IT SIMPLE:   P WAVE CAN BE SEEN AT A RATE OF 300/MIN, GIVING A " SAWTOOTH " APPEARANCE. THERE ARE FOUR P WAVES PER QRS COMPLEX (ARROWED) NOTE:  there are 4 (P waves) between QRS complex, and it looks like sawtooth  appearance. another ECG sample:

THIRD DEGREE HEART BLOCK (BASICS) ALSO CALLED AS COMPLETE HEART BLOCK .   WHEN ATRIAL CONTRACTION IS NORMAL BUT NO BEATS ARE CONDUCTED TO THE VENTRICLES. THIS MAY OCCUR IN PATIENT WITH MYOCARDICAL INFARCTION OR IT MAY BE CHRONIC (USUALLY DUE TO FIBROSIS AROUND THE BUNDLE OF HIS). LET'S MAKE IT SIMPLE:  1. REGULAR  P-P  INTERVAL.                                                   2. REGULAR  R-R  INTERVAL.                                                  3. MORE P WAVES ARE PRESENT THAN QRS COMPLEXES. NOTE:  NO RELATIONSHIP BETWEEN P WAVES AND QRS COMPLEXES, BUT AS I MENTIONED SAME NUMBER OF BIG BOX IN-BETWEEN  (P-P INTERVAL AND R-R INTERVAL)

SECOND DEGREE HEART BLOCK (BASICS) SOMETIMES EXCITATION COMPLETELY FAILS TO PASS THROUGH THE AV NODE   OR BUNDLE OF HIS.  [WHEN THIS OCCURS INTERMITTENTLY , "SECOND DEGREE HEART BLOCK" IS SAID TO EXIST] THERE ARE TWO VARIATIONS OF THIS: MOBITZ TYPE 1(WENCKEBACH) AND MOBITZ TYPE 2. SIMPLE CONCEPT : MOBITZ TYPE 1 AND MOBITZ TYPE 2  1. SHORTER AND LONGER PR INTERVAL  (MOBITZ TYPE 1) OR WENCKEBACH. 2. CONSTANT PR INTERVAL ( MOBITZ TYPE 2) 3. ONE NONCONDUCTED P WAVE ON BOTH (TYPE 1 AND TYPE 2) MOBITZ TYPE 1 (WENCKEBACH) NOTE:   PROGRESSIVE LENGTHENING OF THE PR INTERVAL   AND ONE NONCONDUCTED   P WAVE. [" IF YOU NOTICED IN EACH PR INTERVAL TIME DIFFERS ( NUMBER OF SMALL BOX  VARIES) AND ONE NONCONDUCTED P WAVE, THAT IS KNOWN AS MOBITZ TYPE 1 OR WENCKEBACH"] MOBITZ TYPE 2 NOTE:  PR INTERVAL OF THE CONDUCTED BEATS IS CONSTANT. ONE P WAVE IS NOT FOLLOWED BY QRS COMPLEX. ["IF YOU NOTICED PR INTERVAL IS CONSTANT (NUMBER OF SMALL BOX SAME) AND ONE NONCONDUCTED P WAVE , TH

 FIRST DEGREE HEART BLOCK (BASICS) IF EACH WAVE OF DEPOLARIZATION THAT ORGINATES IN THE SA NODE IS CONDUCTED TO THE VENTRICAL, BUT THERE IS DELAY SOMEWHERE ALONG THE CONDUCTION PATHWAY, THEN PR INTERVAL IS PROLONGED.(THIS IS CALLED FIRST DEGREE HEART BLOCK) LET'S MAKE IT SIMPLE: FIRST DEGREE HEART BLOCK  " PR INTERVAL PROLONGED" IT MAY BE A SIGN OF CORONARY ARTERY DISEASE, ACUTE RHEUMATIC CARDITIS, DIGOXIN TOXICITY (OR) ELECTROLYTE DISTURBANCES. AS YOU CAN SEE PR INTERVAL 360 MS ( NORMAL PR INTERVAL 180 MS) [180 MS :5 SMALL  BOX] IF YOU NOTICED PR INTERVAL PROLONGED MORE THAN 180 MS IT'S FIRST DEGREE HEART BLOCK (MORE THAN 5 SMALL BOX)  

 ECG:  BUNDLE BRANCH BLOCK (BASICS)  THERE ARE 3 TYPES OF BBB( RIGHT, LEFT AND COMPLETE) EASY WAY TO FIND OUT BUNDLE BRANCH BLOCK : IF YOU NOTICED  (BUNNY EARS FORMATION OR M SHAPE WAVES IN LEADS) THEN WE HAVE TO FIND OUT WHICH LEADS WHETHER IT'S LEFT OR RIGHT FOR EXAMPLE: RIGHT BBB ( BEST SEEN IN LEADS V1,V2,V3)                               LEFT BBB ( BEST SEEN IN LEADS V4,V5,V6) RIGHT BBB INDICATES PROMBLEMS IN THE RIGHT SIDE OF THE HEART AND LEFT BBB INDICATES LEFT SIDE. RIGHT BUNDLE BRANCH BLOCK: WE CAN NOTICE M-SHAPED OR BUNNY EARS FORMATON WAVES IN LEADS :V1,V2,V3 (HERE YOU CAN SEE M-SHAPED WAVES IN V1,V2,V3) SO, IT IS RIGHT BBB LEFT BUNDLE BRANCH BLOCK: WE CAN NOTICE M-SHAPED OR BUNNY EARS FORMATION WAVES IN LEADS: VL,   V4,V5,V6 ( HERE YOU CAN SEE M-SHAPED WAVES IN LEADS:VL,V5,V6) SO, IT IS LEFT BBB COMPLETE BUNDLE BRANCH BLOCK: IF YOU SEE M-SHAPED WAVES IN LEDS V1-V6 ON BOTH RIGHT AS WELL LEFT IT INDICATES COMPLETE BBB