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Diagnosis of Cardiovascular Disorders 246 Physical Examination of the Cardiovascular System.................................................. 1859 Patrick T. O’Gara, Joseph Loscalzo 247 Electrocardiography. ..................................................... 1868 Ary L. Goldberger 248 Noninvasive Cardiac Imaging: Echocardiography, Nuclear Cardiology, and Magnetic Resonance/ Computed Tomography Imaging. .................................. 1876 Marcelo F. DiCarli, Raymond Y. Kwong, Scott D. Solomon 249 Diagnostic Cardiac Catheterization and Coronary Angiography................................................................. 1903 Jane A. Leopold, Ajar Kochar. Make notes on basis of harrison 22 edition in detailed thoroughly , conceptual base, dont skip any even small topic , add drug dosages , images, ecg , Make it like useful for cardiologist and dnb resident

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These are your comprehensive Harrison's 22E notes for Chapters 246-249, directly sourced from the textbook. Here's a summary of what's covered:

What's Included in These Notes

Chapter 246 - Physical Examination

  • General appearance: Genetic syndromes with CV involvement (Marfan, Noonan, Holt-Oram, Loeys-Dietz, Trisomy 21)
  • Skin findings table: 15+ cutaneous signs with associated conditions (differential cyanosis, Osler-Weber-Rendu, xanthomas, endocarditis stigmata)
  • Arterial pulse abnormalities: Complete table with all pulse variants, mechanisms, and conditions
  • JVP waveforms: Full a-c-x-v-y analysis, cannon waves, Kussmaul's sign, differential diagnosis
  • Heart sounds: S1-S4, opening snap, ejection clicks, friction rub - all with timing, pitch, location, and diagnostic significance
  • Murmur grading & classification: Holosystolic, midsystolic, early/late systolic, diastolic, continuous
  • Bedside maneuvers table: Valsalva, squatting, handgrip, amyl nitrite - which murmurs respond and how
  • Tamponade vs constriction differentiation signs

Chapter 247 - ECG

  • Basic waveforms and normal intervals with a reference table
  • Axis determination quick method
  • Atrial abnormalities (P-mitrale vs P-pulmonale) with ECG image
  • LVH criteria (Sokolov-Lyon, Cornell, Romhilt-Estes) + strain pattern
  • RVH + Cor pulmonale (acute S1Q3T3 vs chronic COPD pattern)
  • RBBB and LBBB - morphology, causes, clinical significance
  • Sgarbossa criteria for MI in LBBB
  • MI localization table by leads + artery
  • Pericarditis vs STEMI vs early repolarization differential
  • QTc prolongation: drug table, congenital LQTS subtypes (LQT1/2/3), TdP management with dosages
  • WPW: pathway localization, dangerous drug interactions, treatment
  • AV blocks: complete table with pacemaker indications
  • Wellens syndrome & de Winter pattern - high-yield for CCU

Chapter 248 - Noninvasive Imaging

  • Echo principles: phased array, Doppler physics, modified Bernoulli equation
  • Diastolic dysfunction grading (2016 ASE criteria, Grade I/II/III table)
  • AS severity grading table (peak velocity, mean gradient, AVA) + low-flow low-gradient AS with dobutamine
  • MS assessment: MVA by planimetry, PHT, severity thresholds
  • MR quantification: vena contracta, PISA, EROA criteria
  • RV assessment: TAPSE, FAC, McConnell sign, D-sign
  • PA pressure estimation with IVC assessment table
  • Stress echo and viability (biphasic response)
  • TEE: indications and contraindications
  • Nuclear cardiology: tracers table, stress agents with doses and contraindications, FDG PET viability
  • CMR: LGE patterns by disease (ischemic vs non-ischemic, amyloid, myocarditis, ARVC, HCM), T1 mapping/ECV, viability prediction by transmurality
  • Cardiac CT: CACS interpretation (Agatston score), CCTA, CT-FFR, pre-TAVI planning
  • Radiation dose comparison table

Chapter 249 - Cardiac Catheterization

  • Complete indications table (Table 249-1)
  • Access sites: radial vs femoral with advantages/disadvantages
  • Radial artery cocktail (verapamil + NTG doses)
  • Normal hemodynamic values reference table
  • Hemodynamic patterns in tamponade, constriction, restriction, MR, AS, PAH
  • Constriction vs restriction hemodynamic differentiation
  • Gorlin formula for AVA and MVA calculations
  • PVR/SVR calculation formulas
  • Shunt quantification (Qp:Qs)
  • Coronary anatomy with dominance percentages
  • Angiographic projections table
  • FFR and iFR: cut-offs, adenosine dosing, landmark trials (FAME, DEFER)
  • IVUS and OCT: indications, LM MLA cut-offs
  • AR and MR Sellers grading
  • TIMI flow grading
  • Contrast nephropathy prevention protocol
  • Anticoagulation during cath (heparin, bivalirudin doses)
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