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Arjun Khadilkar, MD Profile picture
@akhadilkarMD
May 15 • 9 tweets • 3 min read Twitter logo Read on Twitter
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In order to become a sub-specialist, it is important to first be a good internist!

Here are some of my notes I used to study for the Internal Medicine Boards.

Part #1: 7 High-yield facts!
#arjuncardiology #medtwitter #MedEd #IMG Image
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More from @akhadilkarMD

Arjun Khadilkar, MD Profile picture
May 12
One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes. Let me know what you think!

Thread #19: Pericarditis

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Acute Pericarditis:
- Inflammation of the pericardium
- May be caused by number of factors: viral/bacterial infection, metastatic tumors, collagen vascular diseases, MI, cardiac surgery, and uremia Image
ECG Changes w/ Acute Pericarditis:
- Early phase is characterized by ST segment elevation, due to inflammation of the epicardium, which accompanies inflammation of the overlying pericardium
- Can have generalized ST-T changes in both anterior and inferior leads Image
Read 9 tweets
Arjun Khadilkar, MD Profile picture
May 3
One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes.

Let me know what you think!

Thread #18: Electrolyte Abnormalities #arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Hyperkalemia:
- Distinctive sequence of ECG changes affecting both depolarization (QRS) and repolarization (ST-T)
- First change: Narrowing and peaking of T-waves ('tented' or 'pinched' shape) and can become tall Image
Hyperkalemia:
- Further elevation: PR intervals become prolonged, P-waves may disappear. Will have intra-ventricular conduction delay, with widening of QRS complexes.
- Can lead to large, undulating (sine wave) pattern with asystole and cardiac death Image
Read 11 tweets
Arjun Khadilkar, MD Profile picture
Mar 21
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #13: Inferior, Posterior, RV Infarction

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Inferior Wall Infarction:
- Diaphragmatic portion of the LV
- Will see changes in leads II, III, and aVF
- May produce abnormal Q-waves in these leads
- Generally caused by occlusion of the RCA; less commonly can occur with a left circumflex coronary obstruction
Posterior Infarction:
- Occurs on the posterior (back) surface of the LV
- May be difficult to diagnose because characteristic abnormal ST elevations may no appear in any of the 12 conventional leads
- Tall R-waves and ST depressions can occur in V1 and V2
Read 7 tweets
Arjun Khadilkar, MD Profile picture
Mar 20
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #12: Q-waves

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Q-wave:
- Can occur in any lead; indicates that the electrical voltages are directed away from that particular lead
- With a transmural infarction, necrosis of heart muscle occurs in a localized area of the ventricle
- New Q-waves usually appear within first day of MI
Anterior Wall MI:
- Can see loss of normal R-wave progression in the chest leads (normally should have a progression of height of R-waves from V1-V6)
- In antero-septal infarct, will lose small r waves in V1-V2 (septal depolarization from left to right) and have QS in V1-V2
Read 7 tweets
Arjun Khadilkar, MD Profile picture
Mar 19
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #11: Myocardial Ischemia

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Myocardial Ischemia:
- One of the most important things to evaluate on EKG
- If severe narrowing/complete blockage of a coronary artery causes blood flow to become adequate, ischemia of the heart muscle develops
- Can be transient (angina pectoris) or more severe (necrosis & MI)
Myocardial Ischemia
- LV consists of an outer layer (epicardium/sub-epicardium) and inner layer (sub-endocardium)
- Can have limit of ischemia to the inner layer or can affect the entire thickness of the ventricular wall (transmural ischemia)
Read 8 tweets
Arjun Khadilkar, MD Profile picture
Mar 17
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #10: Fascicular Blocks

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Fascicular Blocks:
- Left bundle branch system: sub-divided into an anterior & posterior fascicle.

- Hemi-block does not widen the QRS complex markedly (compared to a RBBB or LBBB)
Left Anterior Fascicular Block (LAFB):
- Diagnosed by finding of a left axis deviation (-45 degrees or more negative)
- Delayed activation of more superior & leftward position of the LV
- Isolated finding is non-specific; can be seen w/ HTN, AV disease, CAD, and aging
Read 9 tweets

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