Comprehensive Clinical Medicine: Heart Sounds, Arrhythmias, and Systemic Disorders

Flashcards covering essential vocabulary, pathophysiology, clinical signs, and diagnostic landmarks from a multifaceted lecture on cardiology, nephrology, gastroenterology, and endocrinology.

Atrial Systole

The phase of the cardiac cycle where the atria contract, contributing to $30\%$ of ventricular filling.

Isovolumetric Contraction (IVC)

The phase where both ventricles contract with equivalent power while all valves are closed, meaning no blood enters or leaves the ventricles.

S1 (First Heart Sound)

The sound produced by the closure of the mitral ($M1$) and tricuspid ($T1$) valves at the start of isovolumetric contraction.

S2 (Second Heart Sound)

The sound produced by the closure of the aortic ($A2$) and pulmonary ($P2$) valves at the end of ventricular systole.

Diastasis

The phase in the cardiac cycle where the 'heart stands still' physiologically and there is the least cardiac activity.

Ventricular Gallop Rhythm (S3)

The third heart sound occurring during the rapid ventricular filling phase; heard physiologically in people $< 35$ years and pathologically in conditions like CHF.

Atrial Gallop Rhythm (S4)

The fourth heart sound occurring during atrial systole, which is always pathological and signifies outflow tract obstruction or LVH.

Erb's Point

The location at the left of the sternum at the $3rd$ intercostal space where splitting of $S2$ is best appreciated.

Atrial Myxoma

A pedunculated benign cardiac tumor suspended in the lumen of the left atrium that produces a 'tumor plop' sound heard through the bell of a stethoscope.

Angiosarcoma

The most common primary malignant tumor of the heart.

Pardee Sign

An ECG finding in Myocardial Infarction where the ST elevation has a convex shape in an upward direction with T wave inversion.

Kussmaul's Sign

A paradoxical rise of Jugular Venous Pressure (JVP) on deep inspiration, seen in constrictive pericarditis and restrictive cardiomyopathy.

Pulsus parvus et tardus

A slow-rising pulse with less amplitude, characteristic of Aortic Stenosis.

SAD Triad

The clinical findings of Syncope on exertion, Angina, and Dyspnea on exertion associated with Aortic Stenosis.

Patent Ductus Arteriosus (PDA)

A congenital connection between the pulmonary artery and descending aorta characterized by a machinery-like continuous murmur that peaks at $S2$.

Vena Contracta

The area of maximum velocity and the narrowest part of the regurgitant jet, used as a criterion ($> 0.7\,cm$) for severe mitral regurgitation.

Gallavardin Phenomenon

A clinical sign where the harsh ejection systolic murmur of Aortic Stenosis radiates to the axilla, mimicking mitral regurgitation.

Brugada Syndrome

A genetic disorder involving a $SCN5A$ defect in sodium channels, identified by a cove or saddle-back pattern ST elevation in leads $V1-V3$ and associated with sudden nocturnal death.

Beck's Triad

The combination of muffled heart sounds ($S1, S2$), hypotension, and elevated non-pulsatile JVP, seen in cardiac tamponade.

Bundle of Kent

An accessory pathway in Wolff Parkinson White (WPW) syndrome that bypasses the AV node and causes pre-excitation of the ventricles.

Mobitz Type-I (Wenckebach Phenomenon)

A second-degree heart block characterized by serial prolongation of the PR interval until a QRS complex is dropped (missed beat).

Nadas Criteria

A set of guidelines used to diagnose congenital heart disease, involving major criteria like central cyanosis and CHF, and minor criteria like abnormal $S2$ or ECG.

Tetralogy of Fallot

A cyanotic heart disease comprising four components: subpulmonic stenosis, concentric right ventricular hypertrophy, ventricular septal defect, and overriding aorta.

Metabolic Syndrome (Syndrome X)

A cluster of conditions including centripetal obesity, hypertriglyceridemia ($> 150\,mg/dl$), low HDL, hypertension, and elevated blood sugar levels.

Syndrome Z

A condition combining Metabolic Syndrome with obstructive sleep apnea.

Auscultatory Gap

A temporary silence of Korotkoff sounds during blood pressure measurement that can lead to underestimation of systolic and overestimation of diastolic pressure.

Liddle Syndrome

A Mendelian cause of hypertension characterized by a gain-of-function mutation in Epithelial Sodium Channels ($ENaC$), leading to hypokalemic metabolic alkalosis and low renin/aldosterone.

Dressler Syndrome

An autoimmune pericarditis that occurs $> 6$ weeks post-Myocardial Infarction, presenting with chest pain and global concave ST elevation.

Framingham Criteria

A diagnostic protocol used for Congestive Heart Failure, including major signs like pink frothy sputum, congested neck veins, and tender hepatomegaly.

J point

The isoelectric point at the end of the S wave and the start of the ST segment in an ECG.

Osborn Wave (J-wave)

A specific notch at the end of the QRS complex seen on an ECG in patients with hypothermia ($< 35^{\circ}C$).

Isosthenuria

A fixed urine specific gravity of $1.010$ due to an inability to concentrate or dilute urine, seen in Sickle cell anemia and CKD.

Kimmelstiel Wilson change

The characteristic histological finding of nodular glomerular sclerosis seen in Diabetic Nephropathy.

Schwartz Formula

The specialized equation used for GFR calculation in children, defined as $\frac{K \times \text{Height}}{\text{Serum Creatinine}}$ with $K = 0.41$.

Passaro's Triangle

Also known as the Gastrinoma triangle, an anatomical region where the commonest location of Gastrinoma in Zollinger Ellison Syndrome is found.

Marsh Classification

The grading system used for small intestinal mucosal biopsies in Celiac sprue, ranging from normal (Type 0) to total villous atrophy (Type IIIc).

Tylosis Palmaris

Hyperkeratosis of the palms and soles associated with a high risk of developing esophageal squamous cell carcinoma.

Borchardt's Triad

The clinical sign of stomach volvulus consisting of violent retching without vomiting, acute epigastric pain, and inability to pass a nasogastric tube.

Cag A (Cytotoxin-associated gene A)

A virulence factor of Helicobacter pylori associated with gastric inflammation and increased cancer risk.

Woltman Sign

Also known as 'hung up ankle jerk,' it is the slow or delayed relaxation of the ankle jerk and is the most reliable sign of primary hypothyroidism.

Whipple's Triad

The diagnostic criteria for insulinoma: symptoms of hypoglycemia, low blood sugar ($< 45\,mg/dl$), and immediate relief of symptoms with IV glucose.

ADAMTS13

A disintegrin and metalloproteinase with thrombospondin motif 13; an enzyme that cleaves large vWF multimers, deficiency of which leads to TTP.

Rome IV Diagnostic Criteria

The clinical standard for diagnosing Irritable Bowel Syndrome (IBS), requiring recurrent abdominal pain at least $1$ day/week for $3$ consecutive months associated with changes in defecation.

Montreal Classification

A system used to categorize the extent ($E1-E3$) and severity ($S0-S3$) of Ulcerative Colitis.

Pemberton Sign

Facial plethora or congestion upon elevation of the arms, indicating retrosternal extension of an enlarged thyroid gland pressing on the superior vena cava.