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Cardiology Mnemonics

Anti-arrythmics: for AV nodes"Do Block AV":DigoxinB-blockersAdenosineVerapamil

Aortic regurgitation: causesCREAM:CongenitalRheumatic damageEndocarditisAortic dissection/ Aortic root dilatationMarfan’s

Aortic stenosis characteristics SAD:SyncopeAnginaDyspnoea

Apex beat: abnormalities found on palpation, causes of impalpableHILT:HeavingImpalpableLaterally displacedThrusting/ Tapping_ If it is impalpable, causes are COPD:COPDObesityPleural, Pericardial effusionDextrocardia

Apex beat: differential for impalpable apex beatDOPES:DextrocardiaObesityPericarditis/ Pericardial tamponade/ PneumothoraxEmphysemaSinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)

Atrial fibrillation: causes A SHIT:AlcoholStenosis (mitral valve)HypertensionInfarction/ IschaemiaThyrotoxicosis

Atrial fibrillation: causesPIRATES:Pulmonary: PE, COPDIatrogenicRheumatic heart: mirtral regurgitationAtherosclerotic: MI, CADThyroid: hyperthyroidEndocarditisSick sinus syndrome

Atrial fibrillation: managementABCD:Anti-coagulateBeta-block to control rateCardiovertDigoxin

Beck's triad (cardiac tamponade)3 D's:Distant heart soundsDistended jugular veinsDecreased arterial pressure

Betablockers: cardioselective betablockers"Betablockers Acting Exclusively At Myocardium"_ Cardioselective betablockers are:BetaxololAcebutelolEsmololAtenololMetoprolol

CHF: causes of exacerbationFAILURE:Forgot medicationArrhythmia/ AnaemiaIschemia/ Infarction/ InfectionLifestyle: taken too much saltUpregulation of CO: pregnancy, hyperthyroidism

Renal failureEmbolism: pulmonary

CHF: causes of exacerbation A SMITH PEAR:AnemiaSalt/ Stress/ Stopping medsMIInfection/ IschemiaThyroid (high/low)HTNPericarditisEndocarditis (valve disease)ArrhythmiaRx (beta blocker, etc)

Coronary artery bypass graft: indications DUST:Depressed ventricular functionUnstable anginaStenosis of the left main stemTriple vessel disease

Coronary artery bypass graft: indicationsDUST:Depressed ventricular functionUnstable anginaStenosis of the left main stemTriple vessel disease

Depressed ST-segment: causes DEPRESSED ST:Drooping valve (MVP)Enlargement of LV with strainPotassium loss (hypokalemia)Reciprocal ST- depression (in I/W AMI)Embolism in lungs (pulmonary embolism)Subendocardial ischemiaSubendocardial infarctEncephalon haemorrhage (intracranial haemorrhage)Dilated cardiomyopathyShockToxicity of digitalis, quinidine

ECG: left vs. right bundle block"WiLLiaM MaRRoW":W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.M pattern in V1-V2 and W in V3-V6 is Right bundle block.

_ Note: consider bundle branch blocks when QRS complex is wide.

ECG: T wave inversion causesINVERT:IschemiaNormality [esp. young, black]Ventricular hypertrophyEctopic foci [eg calcified plaques]RBBB, LBBBTreatments [digoxin]

Exercise ramp ECG: contraindicationsRAMP:Recent MIAortic stenosisMI in the last 7 daysPulmonary hypertension

Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER":Symphatoadrenal systemAtrial natriuretic factor

VasopressinEndogenous digitalis-like factorRenin-angiotensin-aldosterone system_ In all 5, system is activated/factor is released

Heart failure: signs TAPED TORCH:TachycardiaAscitesPulsus alternansElevated jugular venous pressureDisplaced apex beatThird heart soundOedemaRight ventricular heaveCrepitations or wheezeHepatomegaly (tender)

Heart murmurs "hARD ASS MRS. MSD":hARD: Aortic Regurg = DiastolicASS: Aortic Stenosis = SystolicMRS: Mitral Regurg = SystolicMSD: Mitral Stenosis = Diastolic

Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:Heart failureObstruction of venea cavaLymphatic enlargement - supraclavicularIntra-Thoracic pressure increase

JVP: wave formASK ME:Atrial contractionSystole (ventricular contraction)Klosure (closure) of tricusps, so atrial fillingMaximal atrial fillingEmptying of atrium_ See diagram.

MI: basic management BOOMAR:Bed restOxygenOpiateMonitor

AnticoagulateReduce clot size

MI: signs and symptomsPULSE:Persistent chest painsUpset stomachLightheadednessShortness of breathExcessive sweating

MI: therapeutic treatment ROAMBAL:ReassureOxygenAspirinMorphine (diamorphine)Beta blockerArthroplastyLignocaine

MI: therapeutic treatment"O BATMAN!":OxygenBeta blockerASA

Thrombolytics (eg heparin)MorphineAce prnNitroglycerin

MI: therapeutic treatment MONAH:MorphineOxygenNitrogenAspirinHeparin

MI: treatment of acute MI COAG:CyclomorphOxygenAspirinGlycerol trinitrate

Mitral regurgitationWhen you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".

Mitral stenosis (MS) vs. regurgitation (MR): epidemiologyMS is a female title (Ms.) and it is female predominant.MR is a male title (Mr.) and it is male predominant.

Murmur attributes"IL PQRST" (person has ill PQRST heart waves):IntensityLocationPitchQualityRadiationShapeTimingMurmurs: innocent murmur features8 S's:SoftSystolicShortSounds (S1 & S2) normalSymptomlessSpecial tests normal (X-ray, EKG)Standing/ Sitting (vary with position)Sternal depression

Murmurs: locations and descriptions "MRS A$$":MRS: Mitral Regurgitation--SystolicA$$: Aortic Stenosis--Systolic_ The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.

Murmurs: louder with inspiration vs expirationLEft sided murmurs louder with ExpirationRIght sided murmurs louder with Inspiration.

Murmurs: questions to askSCRIPT:SiteCharacter (eg harsh, soft, blowing)RadiationIntensityPitch

Timing

Murmurs: right vs. left loudness"RILE":Right sided heart murmurs are louder on Inspiration.Left sided heart murmurs are loudest on Expiration.

Murmurs: systolicMR PV TRAPS:MitralRegurgitation andProlaspeVSDTricupsidRegurgitationAortic andPulmonaryStenosisMurmurs: systolic typesSAPS:SystolicAorticPulmonicStenosis

_ Systolic murmurs include aortic and pulmonary stenosis._ Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].

Murmurs: systolic vs. diastolicPASS: Pulmonic & Aortic Stenosis=Systolic.PAID: Pulmonic & Aortic Insufficiency=Diastolic.Knowledge Level 1, System: CardiovascularW. Ciulla, RN, PA-C New Life Medical Clinic

Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".Diastolic murmurs: MS AR: "MS. ARden"._ The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden.

Myocardial infarctions: treatment INFARCTIONS:IV access

Narcotic analgesics (eg morphine, pethidine)Facilities for defibrillation (DF)Aspirin/ Anticoagulant (heparin)RestConverting enzyme inhibitorThrombolysisIV beta blockerOxygen 60%NitratesStool Softeners

Pericarditis: causesCARDIAC RIND:Collagen vascular diseaseAortic aneurysmRadiationDrugs (such as hydralazine)InfectionsAcute renal failureCardiac infarctionRheumatic feverInjuryNeoplasmsDressler's syndrome

Pericarditis: EKG

"PericarditiS":PR depression in precordial leads.ST elevation.

Peripheral vascular insufficiency: inspection criteriaSICVD:Symmetry of leg musculatureIntegrity of skinColor of toenailsVaricose veinsDistribution of hair

Pulseless electrical activity: causesPATCH MED:Pulmonary embolusAcidosisTension pneumothoraxCardiac tamponadeHypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ HypovolemiaMyocardial infarctionElectrolyte derangementsDrugs

Rheumatic fever: Jones 5 major criteria STREP:Sydenhams choreaTransient migratory arthritisRheumatic subcutaneous nodulesErythema marginatumPancarditis (endocarditis, myocarditis, pericarditis)_ STREP, since Rheumatic fever is caused by group A strep.

Rheumatic fever: Jones criteria _ Major criteria: CANCER:CarditisArthritisNodulesChoreaErythemaRheumatic anamnesis_ Minor criteria: CAFE PAL:CRP increasedArthralgiaFeverElevated ESRProlonged PR intervalAnamnesis of rheumatismLeucocytosis

Rheumatic fever: Jones major criteria JONES:Joints (migrating polyarthritis)Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)Nodes (subcutaneous nodules)Erythema marginatumSydenham's chorea

Rheumatic fever: Revised Jones criteria JONES PEACE:_ Major criteria:Joints: migratoryO (heart shaped) Carditis: new onset murmurNodules, subcutaneous: extensor surfacesErythema marginatumSydenham's chorea_ Minor criteria:PR interval, prolongedESR elevatedArthralgiasCRP elevatedElevated temperature (fever)_ Need 2 major or 1 major and 2 minor criteria, plus evidence of recent GAS

infection (throat cx, rapid antigen test, or rising strep antibodytiter).

Rheumatic fever: Revised Jones' criteria JONES crITERIA:_ Major criteria:Joint (arthritis)Obvious (Cardiac)Nodule (Rheumatic)Erythema marginatumSydenham chorea_ Minor criteria:Inflammatory cells (leukocytosis)Temperature (fever)ESR/CRP elevatedRaised PR intervalItself (previous Hx of Rheumatic fever)Arthralgia

Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS).Parasympathetic acts on Potassium channels (PS).

Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):SleepInfections (myocarditis)Neap thyroid (hypothyroid)Unconsciousness (vasovagal syncope)Subnormal temperatures (hypothermia)Biliary obstructionRaised CO2 (hypercapnia)AcidosisDeficient blood sugar (hypoglycemia)Imbalance of electrolytesCushing's reflex (raised ICP)AgingRx (drugs, such as high-dose atropine)Deep anaesthesiaIschemic heart diseaseAthletes

Sinus tachycardia TACH FEVER:Tamponade/ ThyrotoxicosisAnemiaCHFHypotension

FeverExcrutiating painVolume depletionExerciseRx (Theo, Dopa, Epi, etc)

ST elevation causes in ECG]ELEVATION:ElectrolytesLBBBEarly repolarizationVentricular hypertrophyAneurysmTreatment (eg pericardiocentesis)Injury (AMI, contusion)Osborne waves (hypothermia)Non-occlusive vasospasm

Supraventricular tachycardia: treatment ABCDE:AdenosineBeta-blocker

Calcium channel antagonistDigoxinExcitation (vagal stimulation)

Ventricular tachycardia: treatment LAMB:LidocaineAmiodaroneMexiltene/ MagnesiumBeta-blocker

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