Lipid Lowering Agents

• LDL -> Statins -> +Ezetimibe
• Cholesterol -> Ezetimibe
• HDL -> Niacine
• TGC -> Fibrates -> +Niacine (UW 166)

Vasculitis

• Spanish Mnemonic Wegener's: "Wegener el Cejon" = Wegener has C-ANCA.

Evolution of MI

Congenital Cardiac Disease

Jugular Venous Pulse

Heart Murmurs (HCM vs MVP)

• The classic murmur associated to HCM/HOCM is a systolic, crescendo-decrescendo murmur most audible at the left sternal border. This murmur decreases with squatting and increases with subsequent standing. The ECG shows a deep S waves.
• Mitral Valve Prolapse (MVP) is the most common valvular disease. Produces a late systolic click associated with a high-pitched, late systolic murmur. The systolic click occurs closer to S1 with standing. The ECG is normal.

* HCM: Hypertrophic Cardio Myopathy, HOCM: Hypertrophic Obstructive Cardio Myopathy. MVP: Mitral Valve Prolapse

Interesting blog to expand the explanation: http://iamjagjit.wordpress.com/tag/hand-grip/

Coronary Artery Anatomy

We used one English and one Spanish word like mnemonics in this mindmap RaMP and LoCA (crazy). Focus in this minmap:

• POSTERIOR DESCENDING (RaMP): 80% Right dominance (origins R coronary), and 20% Left dominance (origins L coronary circumflex). Irrigates half posterior interventricular septum.

Lipid Transport Key Enzymes & Major Apolipoproteins

Focus in the mind map some concepts. For USMLE purposes, the fallowing information about Lipoproteins is consider High Yield:

• HDL: Apo-A1. It's the "cleaner A1", the best. It uses tools: L-CAT and CETP to celan.
• Acquire cholesterol from the vessels walls and transfer cholestero ester to IDL.
• Transfer Apo-E and Apo-CII to nascent chylomicrons and VLDLs.
• Chylomicron: ApoB-48:
• Carries dietary fat from the intestine to the blood.
• VLDL: ApoB-100.
• Carries newly made fat in the blood.
• IDL: ApoB-100. Remnant of VLDL.
• Deliver triglycerides to the adipose cells.
• LDL: ApoB-100.
• When the IDL particle accumulates cholesterol esters from the HDL, it becomes in LDL.

Heart Embryology

Focus in this MindMap the relation between "TBP PS" & "AST TCR" mnemonics:

• Truncus arteriosus origins Ascending aorta and pulmonary trunk.
• Bulbus cordis origins Smooth parts.
• Primitive ventricle origins Trabeculade ventricles.
• Primitive atrium origins Trabeculade atrials. 
• Sinus venosus has 2 horns: left origins Coronary sinus and right Right atrium smooth part.

Cardiac Output and Venous Return

TIPS:

• Right Atrial Contraction or Pressure (RAC) is the same in the follow cases: Normal = Hemorrhage = Exercise.
• If RAC increases by Cardiac Faillure or Blood Transfusion.

Excellent Explanation !!! Thank you!!!

Q1: An 36 years-old athlete has a sudden ventricular fibrillation during the exercise. What occur with the right atrial contraction  (RAC) and the mean systemic filling pressure (MSFP) one minute before and one minute after ventricular fibrillation?. *Note: RAC is the same that RAP (right atria pressure).

A1: Explanation:

• Normal (not exercising): RAC = 2 ; MSFP = 7
• Before 1 minute AF (Exercising): RAC = 1 ; MSFP = 9
• After 1 minute AF (Cardiac faillure) patient exercising: RAC = (MSFPexercising - RACexercising = 9 - 1 = 8; the RAC needs to increase +8 mmHg to achieve the MSFP during the exercise because the ventricle stopped to pump to keep the MSFP = 9. 
• After 1 minute AF (Cardiac faillure) patient not-exercising: RAC = (MSFPnormal - RACnormal = 7 - 2 = 5; the RAC needs to increase +5 mmHg to achieve the MSFP during the exercise because the ventricle stopped to pump to keep the MSFP = 7. In cardiac faillure always the RAC will increase to compensate. *(See Kaplan Qbank Step1, Question OL597 to practice it).

Antiarrhytmics Na+ Channel Blockers (Class I)

The image corresponds the ventricular action potential curve. The academic figure shows a black normal ventricular action potential Na+ (type I) antiarrhytmic effects or "BACman" in comparisson with the normal black curve: B of Before (blue curve), A of After (red curve), and C of Cara (face in Spanish) of our hero BACman (see mindmap below).

Correlating the figure above with our minmap:

• Ventricular potential curve description:
• Four phases starting with 0
• Phase 2 called "Plateau" influx Ca+ and efflux K+, atrial potential curve does not have it.
• The BACman face silhouette is the normal curve. See the phase 3 of the curve to apply the mnemonic:
• IB antiarrhytmics show the line Before the (normal) face.
• IA antiarrhytmics show the line After the (normal) face.
• IC antiarrhytmics show the line Cara (spanish world of face), because is the same as normal in phase 3.
• Antiarrhytmic type I Meds menmonic (3 words each one):
• Before you started eating healthy (salads): Lettuce + Tomatoes + Mayo
• Current you eat so so (fries): More + Fries + Please
• After you will eat so fat: Double + Quarter + Pounder

REMEMBER:  Drug induced lupus causes: quinidine, hydralazine, chlorpromazine, isoniazide, methyldopa, minocycline, terbinafine, phenytoin, and sulfasalazine.

Cardiac Cycle

In this mind map is represented the VENTRICULAR cardiac cycle.

• Focusing in the "ISRR" word that represents the 5 phases of the Ventricular cardiac cycle, the Atrial phase is not included (see Dr. Najeeb video).
1. Isometric contraction (max. O2 consumption)
2. Systolic ejection (rapid and slow phases)
3. Isometric relaxation
4. Rapid filling or rapid passive ventricular filling
5. Reduced filling or slow passive ventricular filling
• See the Aorta & Mitral valves icons and remember Aorta up - Mitral down in the house scheme.
• Only the healthy valve sound are in closing, the opening of valves does not produce sounds.

A beautiful Cardiac Cycle explanation in this video by Dr. Najeeb