Medicine Hack

The most characteristic finding is increased amplitude of the QRS complex. R waves in leads facing the left ventricle (i.e., leads I, aVL, V 5 , and V 6 ) are taller than normal, whereas S waves in leads overlying the right ventricle (i.e., V 1 and V 2 ) are deeper than normal. In many patients, the ST segment is depressed and followed by an inverted T wave. In most cases, the ST segment slopes downward from a depressed J point and the T wave is asymmetrically inverted (formerly called a “strain” pattern). A widening of the QRS complex may be there i.e. more than 110 ms and also the QRS complex may be notched. Common diagnostic criteria include: 1) Sokolow - Lyon index : SV 1 + (RV 5 or RV 6 ) > 3.5 mV                                        : RaVL > 1.1 mV 2) Cornell voltage criteria : SV 3 + SaVL ≥ 2.8 mV (for men)                                        : SV 3 + SaVL ≥ 2.0 mV (for women)

1) Increase dietary potassium intake 2) Limit dietary sodium intake to < 2.4 gm/day 3) Increase physical activity 4) Weight loss 5) All antihypertensive medications and combinations are effective 6) Multiple drug combinations may be required to achieve control 7) Angiotensin-converting enzyme (ACE) inhibitors and beta blockers as monotherapy may be less effective but should be used when indicated (e.g., renal disease, heart failure, post–myocardial infarction) 8) Thiazide diuretics and calcium channel blockers may have greater blood pressure–lowering efficacy 9) A higher incidence of angioedema occurs when using ACE inhibitors

In this condition there is exaggerated vagal discharge following carotid sinus stimulation when doing simple tasks like shaving or buttoning a tight shirt collar or even head rotation. There is reflex vasodilation and decrease in the pulse. These may combine to reduce blood pressure and cerebral perfusion in some elderly patients, causing loss of consciousness. Carotid sinus hypersensitivity is diagnosed by applying gentle pressure over the carotid pulsation just below the angle of the jaw, where the carotid bifurcation is located. Pressure should be applied for 5 to 10 seconds. It should be done in both supine and upright position. A normal response to carotid sinus massage is a transient decrease in the sinus rate, slowing of atrioventricular (AV) conduction, or both. Carotid sinus hypersensitivity is defined as a sinus pause longer than 3 seconds in duration and a fall in systolic blood pressure of 50 mmHg or more.

This is caused by autonomic overactivity, usually provoked by emotional or painful stimuli, less commonly by coughing or micturition. It is also called as neurocardiogenic syncope. The mechanism is that directly or indirectly, the nucleus tractus solitarius is activated by the triggering stimuli and this leads to increased parasympathetic tone and decreased sympathetic tone. The vagal parasympathetic tone leads to negative chronotropic and negative inotropic effects. This causes a slowing in the heart rate and decreased contractility that leads to a drop in the cardiac output. The decreased sympathetic tone on the other hand leads to vasodilation which leads to a decrease in the total peripheral resistance. Both cause a decrease of blood pressure significant enough to lead to loss of consciousness. 'Malignant' vasovagal syndrome is a rare condition where syncopal attacks so frequent that they are significantly disabling . Recovery is rapid if the patient lies down.

The word 'patient' is derived from the Latin patiens , meaning sufferance or forbearance. The overall purpose of medical practice is to relieve suffering. It is important to make a diagnosis, to know how to approach treatment, and to design an appropriate scheme of management for each patient. It is therefore essential to understand each person as fully as possible, whatever their social class or ethnic and cultural background.

Incubation period a) 1-6 hours Staphylococcus aureus Bacillus cereus . . . mainly fried rice b) 8-16 hours Clostridium perfringens Bacillus cereus c) > 16 hours Vibrio cholerae Enterotoxigenic Escherichia coli Enterohemorrhagic Escherichia coli Salmonella spp. Shigella spp. Campylobacter jejuni Vibrio parahemolyticus

It is a common cause of food poisoning. Cause: It is due to the inoculation of toxin-producing S.aureus into food by colonized food handlers. The enterotoxin is heat stable unlike the bacteria which dies on warming/cooking. The toxin stimulates the vagus nerve and the vomiting center of the brain. It also appears to stimulate intestinal peristaltic activity. Onset: Rapid onset usually within 1-6 hr. Clinical features: Nausea and vomiting, although diarrhea, hypotension, and dehydration may also occur. The rapidity of onset, the absence of fever, and the epidemic nature of the presentation arouse suspicion of food poisoning. Symptoms generally resolve within 8–10 h. Treatment is entirely supportive.