retain judgement~
S4 - S1 -- systolic -- S2 - S3(gallop)
S1 = AV valve = tricuspid + mitral; S2 = artery valve = aorta + pulmonary
S3 (Kentucky) = LV dilate; S4 = cardiac hypertrophy
MR (systolic murmur) -> LA dilate -> LV dilate (S3)
- murmur = blood-flow-vibration heart sound
- stenosis: 沒開 when open, functioning
- regurgitation: 被開 when close, not functioning
light touch - low frequency - diaphragm
AVRT - Kent bundle - delta wave = pre-excitation
- 雙向道 單向道
- conceal manifest
- orthodromic antidromic (在中間是否A->V)
PEA: not ECG-problem-related cardiac arrest (no VT VF) -> other problem cause cardiac arrest
Afib: irregularly irregular, foci around pulmonary veins (LA) (pulmonary vein isolation), clot @ LAappendage
VT, rule out SVT with abberancy (BBB + tachycardia)
AFRVR? WPW? TdP? 👻
warfarin indication (mechanical valve/ bad renal function/ anti-phospholipid syndrome) contraindication (pregnancy)
heparin -- (low molecular weight) enoxaparin
DirectOAC: dabigatran/ epixaban, rivaroxaban, apixaban
DualAPT: Aspirin + clopidogrel, prasugrel, ticagrelor (P2Y12i)
ARNI=neprilysin i + ARB = sacubitril + valsartan > ACEi = captopril > ARB = valsartan; neprilysin decrease natriuretic peptide
dapagliptin better, metformin ==
febuxostat for hyperuricemia
entresto = ARNI; sevikar = amlodipine + olmesartan
atorvastatin (rosuvastatin) for LDL, 10mg -40%
K 3.5-5.1
creatinine 0.6-1.1
RV-PA coupling ~ one measure = TAPSE(RV收縮能力~收縮時位移)/PA pressure (bigger better), for TR->TEER prognosis
jugular vein engorgement -> RV
pleural perfusion, alveolar consolidation, interstitial edema (LHF)
CV lung edema: Left congestive HF, edema @ central (🦋🦇) , peribroncus, pleura, interlobular septum (Kerly's B)
Chest lung edema: PNA, patchy peripheral lobe, GGO, consodilation, air bronchograms
atherosclerosis - LDL - antiplatelet
Afib (AF) (pulmonary vein & LAA) - blood clot - anticoagulation
coronary sinus, opening btw IVC & tricuspid valve
RCA, marginal
LCA - LAD, LCX
Fabry disease: X linked, alpha galactosidase - glycosphingolipid, CNS PNS eyes, CV Nephro Derma
Atrial myxoma: 10% ~ Carney's complex (AD), obstruction - emboli - constitutional symptoms
