Thursday, October 21, 2021

LV aneurysm: Difference between true LV aneurysm and LV pseudoaneurysm

LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?

Thursday, October 14, 2021

Types of pulmonary hypertension mnemonic

Here are my notes and a video on types of pulmonary hypertension - WHO classification! It comes with a mnemonic :)

Tuesday, October 12, 2021

RV pressure and volume overload notes


RV volume overload and pressure overload

RV pressure overload, most commonly secondary to PH, leads to predominantly end-systolic and early-diastolic flattening of the interventricular septum.

By contrast, RV volume overload leads to predominantly diastolic flattening of the interventricular septum. 

-IkaN (Nakeya Dewaswala) 

Monday, September 27, 2021

HVPG = Hepatic Venous Pressure Gradient

 HVPG = WHVP - Free Hepatic venous pressures 

  • WHVP = Wedged hepatic venous pressure
  • gradient between pressures in the portal vein and the intra-abdominal portion of IVC 
  • When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure.
  • In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant.

➡️ While in Cirrhosis , Sinusoidal interconnection are lost. Therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis !!!


Normal HVPG = 1-5 mm hg 

HVPG >5 = Portal HTN 

HVPG > 10 = Clinically Significant portal HTN 

HVPG > 12 = Threshold for Variceal Rupture = So use Beta Blocker to ⬇️ it.

Measurement of the Hepatic Venous Pressure Gradient (HVPG)


Thank you ! 🩺




Saturday, September 25, 2021

Cardiovascular drugs that can cause digoxin toxicity

A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.

Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine

Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.

Mnemonic by Huzefa Bhopalwala

References:

Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.

Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.

Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.

Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367

Saturday, September 18, 2021

SYNTAX score mnemonic

In the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, patients with 3-vessel and left main coronary artery disease (LMCAD) treated with coronary artery bypass graft surgery (CABG) compared with percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) had lower 5-year rates of death, myocardial infarction (MI), stroke, or unplanned revascularization.

Tuesday, August 24, 2021

Glimpse into my plan for "Last 18 Days to NEET PG"

 Hello believers at other end,


If You have a plan and it is working well for you then no need to read it further.
All the best and Happy studying.


18 days= 14 days(2 weeks) + 4 days( I would never count in last days )
 

 I) 1st week = divide each day in three major slot and 2 minor slots

By the end of 1st week I want to complete major and minor notes 6 minor + 4 major subject + PYQ +MCQ  of important topics + review images and volatile stuff.

Seems daunting and impossible !?
Say it to yourself "not daunting for me" Just 7 days and see the progress in the end.

morning hours = 

1 hour [ half hour pharma ( General,ANS,CVS,GIT ,RS+HORMONES,NEURO,Antimicrobial) 7 days)

other half an hour ( Carb,lipid ,proteins,molecular,vitamins) *5days + last 2days when bio is completed I added PSM formulas for half an hour)

9am-12pm  =

PYQ in form of GT on desktop like an exam ( And do it within 1 and half hour superficially) Review wrong ones .( Aim is to go through papers in stipulated time and when you do the same for consecutive 7 days you can analyze a pattern of your mistakes and type of questions being repeated)

12 pm lunch 


Afternoon 12:30- 4pm ( further divide into 2 slots ) 

2 hour fast reading. I complete minor subjects (Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry)

Next 2 hours I divide for major subject (Surgery+med+obsgynae) 2days and 2 hours each. +pedia 1 day only

4-5 I take nap of 15 min and then do volatile stuff
5-6 I go for walk with earphones and revised imp scores criterias  oR TEACH A FRIEND ON PHONE

6-8 I practice MCQ as much as possible.(I do mcq of selective topics sometime mixed bags )

8-9 [half an hour micro ( gram positive,gram negative,viro rna,viro dna,mycobacterium+immuno,parasito,lifecycles) +half an hour Patho ( systemwise with images) ]

9-10 long break with dinner + telegram or updating yourself with any new thing or some series (depend on mood)

10-11 Images +graphs+formulas

11- 12 Previous day video at 2X until I fall asleep



By the end of 1 week = (SURG+MED+PEDIA+OBS) +(Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry) +IMAGES +PYQ +WEAK TOPIC MCQ+PHARMA +MICRO+PATHO+BIOCHEM= 15 SUBJECTS with images.

II) 2nd week =Remaining 4 subjects

Morning hours and after 6pm slot is same .

9-12 pm I give mock after 2 days and aim is time management only . Assess wrong only if not much time is left . (I would advise you to give mock rather than GT )

afternoon = 2 hours ( physio,PSM) + 2 hours (Anat) (Radio I followed what Zainab mam has told us to do )

+COVID notes
+Revision revision and revision

III) 4 days(NO GT) = Revise volatile stuff + pyq incorrect ones+images+ mcq (I plan it accordingly whatever I feel right and confident with )

In free time or breaks I take printout of admit card and keep the necessary documents ready 2 day before.

Plan 2 days before what topics you feel can come and you are not confident with and want to go through it once. write it down .It is your gut feeling :D

NOTE- You need not to follow it like what I have said .I respect your journey as much as I respect mine. So do what makes you confident.

In the end, it is just an exam. You will get another chance. Just stay calm.

All the best.