Winter bronchitis
Paroxysmal nocturnal dyspnoea
Pulmonary oedema
Pulmonary apoplexy
Pulmonary infarction
After anticoagulant therapy.

Chest infections can cause atrial fibrillation in 3 ways:

By inducing a stress response which increases the sympathetic tone

Increased sympathetic tone can precipitate atrial fibrillation (AF)

Hypoxia leading to increased pulmonary resistance

This results in pulmonary hypertension and atrial dilatation
Atrial dilatation can lead to AF

Direct involvement of the atria

Cerebral angiography can be done through various routes

Transfemoral – most common
trans axillary – rarely used
trans carotid – rarely used

Why direct puncture of carotid artery is not used?

Any local complications like hematoma and pseudoaneurysm may be life threatening
Atherosclerotic plaques in the cartoid may dislodge during wall puncture and cause stroke\

Why is the axillary artery not used?

Difficult to approach
Difficult to manouvre the catheter into the carotid artery

Why is transfemoral route preferred?

Easy and fast access
Even if local complication arise, they are not life threatening

First you can review the Mechanism of normal split in second heart sound
In case of small ventricular septal defect, the blood flow through it is not large enough to cause a significant increase in right ventricular ejection time
Hence there is a normal split
But in case of large VSD, both the right ventricle and left ventricle act as a single chamber
The blood flow from both the ventricle occur for the same duration
Also because of the presence of pulmonary hypertension, hangout interval becomes negligible
Hence there is a single second heart sound with absent …

First you can review the Mechanism of normal split in second heart sound
In severe right heart failure, the right ventricle takes a longer time to eject the blood – hence the wide split
Also since it cannot accomodate the increased blood flow during inspiration, there is no increase in the split during inspiration

If you couldn’t grasp the rationale behind it, here’s an example:

Imagine the right ventricle to be a plane with 100 seats (seats referring to the capacity)
Lets first take the case of a normal right ventricle
Imagine that during the weekdays (expiration) …

First you can review the Mechanism of normal split in second heart sound
In case of atrial septal defect, the right atrium receives blood from the left atrium in addition to the normal venous return
Due to the increased amount of blood reaching the right ventricle, it takes a longer time to eject the blood
Hence the pulmonary valve takes longer to close and we appreciate a wide split (In both inspiration and expiration)

So, why does it cause a wide fixed split instead of a wide variable split?

During inspiration, the blood flow through …

During inspiration the aortic component of the second heart sound is heard about 0.02 to 0.08 seconds before the pulmonary component. The reason is as follows:

During inspiration, a negative intrathoracic pressure is created to inhale air into the lungs
This creates a vaccum effect which results in increased venous return to the right side of the heart
Hence the right ventricle takes a longer time to eject the blood into the pulmonary system
Also since pulmonary vasculature expands in capacity, lower amount of blood flows into the left atrium
Hence the left ventricle takes a …

The pulmonary valve remains open for some time even after the right ventricular pressure becomes equal to pulmonary artery pressure at end of systole
This time interval is known as hangout interval

Why does pulmonary valve remain open even after pressure equilisation?

According to Newton’s first law of motion, every body continues to move at constant speed unless acted upon by an external force
In this case, the blood continues to flow from the right ventricle even after the the pressure in the right ventricle and the pulmonary artery becomes equal
Just like a rolling …

Atrial fibrillation has been classified into 4 categories based on duration by the American heart association. They are:

Paroxysmal AF – Lasting upto 7 days. But usually it undergoes spontaneous resolution within 48 hours
Persistent AF – Lasting more than 7 days upto 1 year
Long standing persistent AF – If an AF lasts more than 1 year and we are planning to do rhythm control treatment (chemical cardioversion / electrical cardioversion / ablation of the excitation focus)
Permanent AF – If AF lasts for more than 1 year and we are not planning to do …

Radiological signs seen in mitral stenosis are:

Backward displacement of esophagus by enlarged left atrium (in lateral view X-ray)
Enlarged left atrium in AP view X-ray (Blood pools in the left atrium as it is unable to pass into the left ventricle. This results in progressive dilatation.)
Straightening of left heart border
Double shadow due to enlarged left atrium
Splaying of carina (The left main bronchus is lifted up by the enlarged left atrium)
Prominent upper zone pulmonary veins (Inverted moustache sign /  Antler’s horn sign / Cephalisation pulmonary of blood flow)
Enlarged pulmonary trunk (This occurs …