Shifa Med

12/08/2026

د ایګزیټ امتخان لپاره د Cardiology کلیدې نکات!!!

‎فصل ۱: Electrocardiogram — ECG

1. ECG څه شی دی؟
ECG د زړه د برقي فعالیت ثبتول دي. د زړه د حجراتو depolarization او repolarization په وسیله برقي سیګنال جوړېږي او ECG یې ثبتوي.
‎د ECG اساسي برخې
* P wave: Atrial depolarization
* QRS complex: Ventricular depolarization
* T wave: Ventricular repolarization
* U wave: کله ناکله لیدل کېږي، په ځانګړې توګه د hypokalemia په حالت کې.
‎مهمه نکته ⭐
P = Atrium�QRS = Ventricle depolarization�T = Ventricle repolarization
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2. ECG Leads
Limb leads
درې standard bipolar leads:
* Lead I
* Lead II
* Lead III
او درې augmented leads:
* aVR
* aVL
* aVF
Chest/Precordial leads
* V1
* V2
* V3
* V4
* V5
* V6
نو عادي ECG = 12 leads
‎مهمه امتحاني نکته ⭐
* Inferior wall: II, III, aVF
* Lateral wall: I, aVL, V5, V6
* Anterior: V1–V4
* Septal: V1–V2
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3. Precordial leads ځایونه
* V1: Right 4th intercostal space
* V2: Left 4th intercostal space
* V3: د V2 او V4 ترمنځ
* V4: 5th intercostal space, mid-clavicular line
* V5: anterior axillary line
* V6: mid-axillary line
⭐ دا ځایونه حتماً حفظ کړه.
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4. ECG Intervals
PR interval
له P wave څخه تر QRS پورې.
د AV node له لارې د impulse انتقال ښيي.
QRS duration
د ventricular depolarization وخت.
QRS > 0.12 sec → Wide QRS
دا په:
* Bundle branch block
* Ventricular rhythm
* ځینو conduction abnormalities
کې لیدل کېدای شي.
QT interval
Ventricular depolarization + repolarization.
QT د heart rate سره بدلېږي، نو QTc کارول کېږي.
ST segment
د QRS له پای څخه تر T wave پورې.
عموماً isoelectric وي.
⭐ ST elevation/depression د ischemia او MI په تشخیص کې ډېر مهم دي.
Cardiology.pdf
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5. Heart Rate محاسبه
د PDF له مخې څو طریقې ذکر شوي:
300 Rule
که rhythm regular وي:
Heart rate = 300 ÷ د لویو مربعو شمېر
مثلاً:
* 1 مربع → 300/min
* 2 → 150
* 3 → 100
* 4 → 75
* 5 → 60
1500 Rule
1500 ÷ د کوچنیو مربعو شمېر
Six-second method
په 6 ثانیو کې QRS وشمېره × 10.
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6. ECG Axis
د QRS axis د معلومولو لپاره:
* Lead I
* aVF
ته ډېر مهم دي.
‎مهم حالتونه
* Normal axis
* Left axis deviation
* Right axis deviation
* Extreme axis
‎د Quadrant method مهمه قاعده ⭐
که:
* Lead I مثبت
* aVF مثبت → Normal axis
که:
* Lead I مثبت
* aVF منفي → Left axis deviation ته فکر
که:
* Lead I منفي
* aVF مثبت → Right axis deviation
که دواړه منفي → Extreme axis
Cardiology.pdf
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7. ECG کې Hypertrophy
Left Ventricular Hypertrophy — LVH
د PDF مهم ECG criteria:
Sokolow-Lyon
S in V1 + R in V5/V6 > 35 mm
نور criteria هم ذکر شوي، لکه:
* Cornell criteria
* Romhilt-Estes
* Total QRS voltage
ECG نورې نښې
* Left axis deviation
* ST-T changes / strain pattern
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Right Ventricular Hypertrophy — RVH
مهمې نښې:
* Right axis deviation
* په V1 کې نسبتاً لوی R
* R/S ratio په V1 کې زیاتوالی
* د V1–V2 په ساحه کې بدلونونه
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8. Bundle Branch Blocks
RBBB
Right Bundle Branch Block
مهم ECG:
* QRS پراخ
* په V1 کې rsR′ / M-shaped pattern
* په V6 کې د S wave پراخوالی
LBBB
Left Bundle Branch Block
مهم:
* Wide QRS
* په V1 کې غالباً منفي complex
* په lateral leads کې پراخ R
⭐ LBBB + acute ischemic symptoms = مهم emergency finding
Cardiology.pdf
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‎فصل ۲: Radiography of Heart
PDF: مخونه 24–36
Chest X-ray د زړه لپاره څه ښيي؟
په CXR کې:
* Heart size
* Cardiac chambers
* Pulmonary vessels
* Pulmonary edema
* Aortic abnormalities
* Calcification
ارزول کېږي.
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1. PA view
Posterior-Anterior view
دا د زړه د اندازې د ارزونې لپاره مهم view دی.
Cardiothoracic Ratio — CTR
CTR = Maximum transverse cardiac diameter / Maximum transverse thoracic diameter
معمولاً:�CTR > 0.50 → cardiomegaly ته شک
⭐ د امتحان مهم ټکی.
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2. Cardiac silhouette
د زړه د contour مختلفې برخې د مختلفو structures له خوا جوړېږي.
په CXR کې د chamber enlargement په معلومولو کې د silhouette بدلون مهم دی.
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‎3. مهمې Cardiac shapes
Boot-shaped heart
په:�Tetralogy of Fallot
کې لیدل کېږي.
Egg-shaped heart
په:�Transposition of great arteries
کې لیدل کېدای شي.
Globular heart
په:�Ebstein anomaly
کې.
Snowman appearance
په:�Total anomalous pulmonary venous return — TAPVR
کې.
Water-bottle appearance
د pericardial effusion سره کلاسیکاً تړاو لري.
Cardiology.pdf
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4. Pulmonary edema
د pulmonary venous hypertension له امله:
* Pulmonary vascular congestion
* Interstitial edema
* Kerley B lines
* Alveolar edema
رامنځته کېدای شي.
Kerley B lines ⭐
د interstitial pulmonary edema مهمه نښه ده.
Bat-wing appearance
په alveolar pulmonary edema کې لیدل کېدای شي.
Cardiology.pdf
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‎فصل ۳: Dyslipidemia
PDF: مخونه 37–52
Dyslipidemia څه ده؟
د وینې د lipid levels غیرنورمال کېدل.
مهم lipids:
* Total cholesterol
* LDL
* HDL
* Triglycerides
* VLDL
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1. Lipoproteins
Chylomicron
د dietary triglyceride انتقال کوي.
VLDL
په عمده توګه endogenous triglycerides انتقالوي.
LDL ⭐
Atherogenic lipoprotein
LDL cholesterol نسجونو ته انتقالوي او د atherosclerosis له خطر سره تړاو لري.
HDL ⭐
Protective / anti-atherogenic
له نسجونو څخه cholesterol بېرته liver ته انتقالوي.
‎حفظ یې کړه:
LDL = Bad�HDL = Good
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2. Atherosclerotic خطر لوړونکي lipids
* ↑ LDL
* ↓ HDL
* ↑ Triglycerides
* Mixed dyslipidemia
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3. Secondary causes of dyslipidemia
PDF کې مهم علتونه:
* Diabetes mellitus
* Obesity
* Hypothyroidism
* Chronic kidney disease
* Cholestatic liver disease
* ځینې drugs
د درملو له ډلې:
* β-blockers
* Glucocorticoids
* Estrogen
* Cyclosporine
* Thiazides
* ځینې نور
Cardiology.pdf
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4. Familial Hypercholesterolemia
مهمه ځانګړنه:�ډېر لوړ LDL
Clinical clues:
* Tendon xanthoma
* Premature coronary artery disease
* Family history
Homozygous form
ډېر شدید وي او په کم عمر کې atherosclerotic disease رامنځته کولای شي.
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5. Lipid profile
معاینه کې:
* Total cholesterol
* LDL-C
* HDL-C
* TG
کتل کېږي.
PDF کې د LDL د محاسبې formula هم ذکر شوی:
LDL-C = Total cholesterol − HDL-C − TG/5
دا د Friedewald-type calculation دی.
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6. Statins ⭐⭐⭐
Statins د HMG-CoA reductase inhibitors دي.
د LDL د کمولو لپاره مهم درمل دي.
High-intensity statins
PDF کې:
* Atorvastatin
* Rosuvastatin
په لوړ doses کې ذکر شوي.
Medium/Moderate intensity
* Atorvastatin
* Rosuvastatin
* Simvastatin
* Pravastatin
* Lovastatin
⭐ د ایګزیټ لپاره د statin intensity مفهوم ډېر مهم دی.
Cardiology.pdf
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‎7. نور lipid-lowering drugs
Ezetimibe
د intestinal cholesterol absorption کموي.
Bile acid sequestrants
لکه:
* Cholestyramine
* Colesevelam
PCSK9 inhibitors
* Alirocumab
* Evolocumab
ډېر لوړ LDL یا high-risk patients کې مهم دي.
Fibrates
په ځانګړې توګه د triglyceride د کمولو لپاره.
Omega-3 fatty acids
په hypertriglyceridemia کې کارول کېږي.
Cardiology.pdf
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‎فصل ۴: Normal Vessel Structure + Endothelium
PDF: مخونه 53–55
Cardiology.pdf
د artery درې مهم layers:
1. Tunica intima
2. Tunica media
3. Tunica adventitia
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Endothelium مهمې دندې
Endothelium:
* Vascular tone تنظیموي
* Nitric oxide تولیدوي
* Platelet adhesion تنظیموي
* Inflammation کې رول لري
* Leukocyte adhesion تنظیموي
* Coagulation تنظیموي
* Vascular growth کې رول لري
‎مهم mediators
NO → Vasodilation
Endothelin → Vasoconstriction
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‎فصل ۵: Atherosclerosis
PDF: مخونه 56–62
Atherosclerosis څه ده؟
په arterial wall کې د lipid، inflammatory cells او fibrous tissue د plaque جوړېدل.
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1. Risk factors
Major
* Dyslipidemia
* Hypertension
* Diabetes
* Smoking
* Obesity
* Age
* Family history
‎نور:
* Inflammation
* Oxidative stress
* Hypercoagulable state
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‎2. د plaque جوړېدو ساده میکانیزم ⭐⭐⭐
Endothelial injury
⬇️
LDL داخل intima ته ننوځي
⬇️
LDL oxidation
⬇️
Monocyte adhesion
⬇️
Macrophage
⬇️
Foam cell
⬇️
Fatty streak
⬇️
Smooth muscle migration/proliferation
⬇️
Fibrous plaque
⬇️
Plaque rupture
⬇️
Thrombus
⬇️
ACS / MI
⭐ دا sequence حتماً زده کړه.
Cardiology.pdf
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3. Stable vs Unstable plaque
Stable plaque
* غټ fibrous cap
* نسبتاً لږ lipid
* rupture خطر کم
Unstable plaque
* نری fibrous cap
* lipid-rich core
* inflammatory activity زیاته
* rupture خطر زیات
Rupture → thrombosis → ACS
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‎فصل ۶: Ischemic Heart Disease — IHD
PDF: مخونه 63–87
Ischemia څه ده؟
کله چې د myocardium د oxygen demand او supply ترمنځ imbalance پیدا شي.
Supply کمېږي:
* Coronary stenosis
* Thrombosis
* Vasospasm
* Hypotension
Demand زیاتېږي:
* Tachycardia
* Hypertension
* Increased contractility
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1. Angina Pectoris
Angina = myocardial ischemia without myocardial necrosis
Typical symptoms ⭐⭐⭐
* Chest pressure
* Tightness
* Squeezing
* Heaviness
* Burning
درد:
* Retro-sternal وي
* Left arm ته خپرېدای شي
* Shoulder
* Neck
* Jaw
* Epigastric region
Cardiology.pdf
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Stable Angina
‎ځانګړتیا:
د exertion یا stress سره راځي.
د rest یا nitroglycerin سره ښه کېږي.
Concept:
Demand ↑ → ischemia → chest pain
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Unstable Angina
ډېر مهم ⭐⭐⭐
Unstable angina:
* په rest کې درد
* New-onset angina
* Crescendo/increasing angina
* د پخوا په نسبت شدید/زیات درد
خو:�No myocardial necrosis
یعنې Troponin د MI په شان نه لوړېږي.
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Angina triggers
* Exercise
* Emotional stress
* Cold
* Heavy meal
* Tachycardia
* Hypertension
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2. Variant / Prinzmetal Angina
اصلي mechanism:�Coronary vasospasm
کولای شي:�Transient ST elevation
رامنځته کړي.
د vasospasm له امله coronary blood flow کمېږي.
‎مهم درمل:
* Nitrates
* Calcium channel blockers
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3. Microvascular Angina / Cardiac Syndrome X
د coronary microcirculation اختلال سره تړاو لري.
ممکن:
* Angina symptoms
* Normal/near-normal epicardial coronary arteries
ولري.
Cardiology.pdf
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4. Silent Ischemia
Myocardial ischemia چې:�واضح chest pain نه لري.
په ځانګړې توګه په:
* Diabetes
* Autonomic neuropathy
کې لیدل کېدای شي.
‎درې ډولونه په PDF کې ذکر شوي:
* Type I
* Type II
* Type III
⭐ Diabetes + painless ischemia = مهم امتحاني association.
Cardiology.pdf
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‎5. د Angina تشخیص
مهمې لارې:
* History
* ECG
* Exercise ECG / TMT
* Stress imaging
* Coronary angiography
* CT coronary angiography
* Biomarkers د ACS/MI لپاره
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6. Exercise ECG
د treadmill یا exercise پر مهال ECG اخیستل کېږي.
‎مثبت ischemic change
مهمه نښه:�ST depression
خو exercise ECG د هر patient لپاره مناسب نه وي.
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7. Stress imaging
Nuclear imaging
لکه:
* Thallium
* Technetium-99m
Perfusion defect د ischemia ساحه ښيي.
Stress echocardiography
Exercise یا pharmacologic stress سره:
* Wall motion
* Contractility
ارزوي.
Cardiology.pdf
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8. Coronary Angiography
د coronary artery stenosis معلومولو لپاره مهم invasive test دی.
IVUS
Intravascular Ultrasound
د coronary artery د دننه plaque/stenosis په ارزونه کې مرسته کوي.
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9. Chronic Stable Angina Treatment ⭐⭐⭐
Lifestyle
* Smoking cessation
* Weight control
* Exercise
* Diet
* Diabetes control
* BP control
* Lipid control
‎درمل
* Aspirin
* Statin
* β-blocker
* Nitrate
* Calcium channel blocker
* ACE inhibitor په مناسب patients کې
PDF کې anti-anginal او anti-ischemic drugs پراخ تشریح شوي.
Cardiology.pdf
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Anti-anginal drugs
Nitrates
Preload ↓
Venodilation کوي او myocardial oxygen demand کموي.
β-blockers
* Heart rate ↓
* Contractility ↓
* Oxygen demand ↓
⭐ Stable exertional angina کې ډېر مهم.
Calcium channel blockers
په ځانګړې توګه:
* Vasospastic angina
* د β-blocker contraindication
په ځینو حالتونو کې.
Ranolazine
Anti-anginal drug دی؛ د myocardial ischemia نښې کموي.
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‎فصل ۷: Revascularization
PCI
Percutaneous Coronary Intervention
معمولاً:
* Balloon angioplasty
* Stent
شاملوي.
Drug-eluting stent
د restenosis خطر کمولو لپاره drug release کوي.
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CABG
Coronary Artery Bypass Grafting
د شدید multivessel disease، left-main disease او ځینو high-risk lesions کې مهم دی.
SynTax score
د coronary disease anatomical complexity ارزوي.
PDF کې:
* Low grade
* Intermediate
* High grade
یاد شوي دي.
Cardiology.pdf
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‎فصل ۸: Acute Coronary Syndrome — ACS
PDF: مخونه 88–90
Cardiology.pdf
ACS درې مهم حالتونه لري:
1. Unstable Angina
Ischemia + No myocardial necrosis
2. NSTEMI
Myocardial necrosis + No persistent ST elevation
3. STEMI
Myocardial necrosis + ST elevation
⭐⭐⭐
‎حفظ:
UA → Troponin negative
NSTEMI → Troponin positive, no ST elevation
STEMI → Troponin positive + ST elevation
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ACS کې ECG
مهم:
* ST depression
* T-wave inversion
* ST elevation په STEMI کې
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ACS Biomarker
تر ټولو مهم:
Cardiac Troponin ⭐⭐⭐
* Troponin I
* Troponin T
د myocardial necrosis لپاره مهم دي.
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ACS Treatment
Antiplatelet
* Aspirin
* Clopidogrel / P2Y12 inhibitor
Anticoagulation
* Heparin
* LMWH
Anti-ischemic
* Nitrates
* β-blocker په مناسب patient کې
Statin
High-intensity statin.
Revascularization
په مناسب STEMI کې:�PCI preferred when available promptly.
Cardiology.pdf
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‎فصل ۹: Acute Myocardial Infarction — AMI
PDF: مخونه 91–119
MI تعریف
Myocardial necrosis چې د prolonged ischemia له امله رامنځته کېږي.
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‎1. د MI تشخیص
مهم عناصر:
Clinical
Typical ischemic symptoms.
ECG
* New ischemic changes
* ST elevation
* New pathological Q waves
* New LBBB په مناسب clinical context کې
Biomarker
Cardiac Troponin ↑
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2. MI Types
PDF کې د MI مختلف ډولونه تشریح شوي.
مهم امتحاني مفهوم:
Transmural infarction
د myocardium ټول thickness ته نږدې involvement.
Subendocardial infarction
د myocardium داخلي برخه ډېره اغېزمنه وي.
STEMI
Persistent ST elevation سره.
NSTEMI
ST elevation نه وي، خو necrosis موجود وي.
Cardiology.pdf
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3. Plaque rupture → MI ⭐⭐⭐
تر ټولو مهم mechanism:
Atherosclerotic plaque
⬇️
Rupture/erosion
⬇️
Platelet activation
⬇️
Thrombus
⬇️
Coronary occlusion
⬇️
Ischemia
⬇️
Myocardial necrosis
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4. MI complications
ډېر مهم فصل ⭐⭐⭐
Electrical
* Sinus bradycardia
* AV block
* Ventricular tachycardia
* Ventricular fibrillation
Mechanical
* Papillary muscle dysfunction/rupture
* Ventricular septal rupture
* Free-wall rupture
* Ventricular aneurysm
Hemodynamic
* LV dysfunction
* Acute heart failure
* Cardiogenic shock
Cardiology.pdf
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5. Troponin
Troponin د myocardial injury تر ټولو مهم biomarkers څخه دی.
‎مهم concept
Troponin ↑ = myocardial injury
خو یوازې د troponin لوړوالی باید د clinical context سره یوځای تفسیر شي.
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6. CK-MB
CK-MB هم د myocardial injury لپاره کارېږي.
د PDF له مخې د MI وروسته د وخت په جریان کې پورته کېږي او بېرته راټیټېږي.
‎امتحاني concept
CK-MB د reinfarction په ارزونه کې هم ګټور کېدای شي، ځکه نسبتاً ژر normal کېږي.
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7. STEMI ECG
ST elevation
د acute coronary occlusion مهمه نښه.
Reciprocal ST depression
په opposite leads کې لیدل کېدای شي.
⭐ د STEMI د localization لپاره ډېر مهم.
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8. Winter’s Sign
PDF کې د Wellens syndrome او Winter sign یادونه شوې.
‎مهم مفهوم
په anterior leads کې ځانګړي ST/T-wave patterns د مهم LAD disease سره تړاو لرلی شي.
⭐ په ECG-based questions کې ورته متوجه اوسه.
Cardiology.pdf
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9. MI Localization ⭐⭐⭐
دا جدول حفظ کړه:
ECG Leads Wall
II, III, aVF Inferior
I, aVL Lateral
V1–V4 Anterior
V1–V2 Septal
V5–V6 Lateral
Inferior MI
معمولاً:�RCA
Anterior MI
معمولاً:�LAD
Lateral MI
معمولاً:�LCX / diagonal branch
PDF کې د lead localization جدول هم شامل دی.
Cardiology.pdf
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10. Reperfusion Therapy — STEMI ⭐⭐⭐
اصلي هدف:�Coronary blood flow ژر بېرته برقرارول.
1. Primary PCI
Preferred reperfusion strategy کله چې په مناسب وخت کې ترسره کېدای شي.
2. Fibrinolysis
که timely PCI موجود/ممکن نه وي او contraindication نه وي.
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PCI Time Concept
PDF کې:
* Medical contact-to-balloon time
* Door-to-balloon
* Door-to-needle
یاد شوي دي.
⭐ د STEMI په مدیریت کې اصل:�Time is myocardium.
یعنې هر څومره reperfusion ژر وي، هغومره myocardium ژغورل کېږي.
Cardiology.pdf
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11. Fibrinolytic drugs
PDF کې نومونه:
* Streptokinase
* Urokinase
* Tissue plasminogen activator-related agents
یاد شوي.
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12. Fibrinolysis Contraindications ⭐⭐⭐
Absolute contraindication کې مهم:
* Active bleeding
* Previous intracranial hemorrhage
* Recent significant stroke
* ځینې intracranial lesions
* Aortic dissection شک
* د وینې شدید coagulation problem
Relative contraindications
PDF کې uncontrolled severe hypertension او ځینې نور حالتونه ذکر شوي.
Cardiology.pdf
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13. Early Hospital/CCU Care
په CCU کې:
* ECG monitoring
* Vital signs
* Oxygenation
* Pain control
* Antiplatelet therapy
* Anticoagulation
* Reperfusion
* مناسب statin therapy
تر څارنې لاندې وي.
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14. Post-MI Secondary Prevention
وروسته له MI:
* Aspirin
* P2Y12 inhibitor په مناسب حالت کې
* β-blocker
* ACE inhibitor / ARB په مناسب patients کې
* High-intensity statin
* Smoking cessation
* Diet/exercise
* Diabetes/BP control
هدف:�Recurrent MI او mortality کمول.
Cardiology.pdf
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‎فصل ۱۰: MI Mechanical Complications
1. Papillary muscle rupture
→ Acute severe mitral regurgitation
ممکن:
* Acute pulmonary edema
* Shock
راولي.
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2. Ventricular Septal Rupture
→ Left-to-right shunt
ممکن:
* New harsh murmur
* Acute heart failure
* Shock
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3. Free-wall rupture
→ Hemopericardium
→ Cardiac tamponade
او ممکن sudden death رامنځته کړي.
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4. Ventricular aneurysm
وروسته له MI څخه د ventricular wall د remodeling له امله رامنځته کېدای شي.
ممکن:
* Heart failure
* Arrhythmia
* Thrombus
سره تړاو ولري.
Cardiology.pdf
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‎فصل ۱۱: Arrhythmias
Supraventricular tachyarrhythmias
Sinus tachycardia
Heart rate زیات وي، خو rhythm sinus وي.
Atrial fibrillation
* Irregularly irregular rhythm
* P waves نه وي/واضح نه وي
Atrial flutter
* Flutter waves
* غالباً organized atrial activity
Treatment concepts
PDF کې:
* β-blocker
* Amiodarone
* Digoxin
* Verapamil/Diltiazem
* Synchronized cardioversion
ذکر شوي.
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Recurrent SVT
PDF کې:
* Vagal maneuvers
* Adenosine
* β-blocker
* Diltiazem
* Verapamil
یاد شوي.
⭐ Regular narrow-complex SVT → Adenosine یو مهم امتحاني concept دی.
Cardiology.pdf
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Ventricular Tachycardia
Sustained VT
د myocardium لپاره خطرناک rhythm دی.
که patient unstable وي:�Synchronized cardioversion
که pulseless وي:�Defibrillation/ACLS approach
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Ventricular Fibrillation ⭐⭐⭐
د cardiac arrest مهم rhythm دی.
→ Defibrillation
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‎فصل ۱۲: Cardiogenic Shock
Cardiogenic shock = د زړه د pump failure له امله tissue perfusion کموالی.
Causes
* Large MI
* Severe LV dysfunction
* Mechanical complications
‎نښې
* Hypotension
* Cold extremities
* Altered mental status
* Oliguria
* Poor perfusion
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Treatment concepts
PDF کې:
* Revascularization
* Inotropes
* Vasopressors
* Mechanical circulatory support
ذکر شوي.
‎درمل
* Dopamine
* Dobutamine
* Milrinone
* Norepinephrine د vasopressor په توګه
او mechanical support:
* Intra-aortic balloon pump
* نور supportive devices
Cardiology.pdf
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‎🧠 د ایګزیټ لپاره تر ټولو مهم ۳۰ نکات
که وخت دې کم وي، لومړی دا ۳۰ حتماً زده کړه:
1. P wave = atrial depolarization
2. QRS = ventricular depolarization
3. T wave = ventricular repolarization
4. 12-lead ECG = 3 standard + 3 augmented + 6 precordial
5. II, III, aVF = Inferior
6. I, aVL, V5, V6 = Lateral
7. V1–V4 = Anterior
8. V1–V2 = Septal
9. QRS > 0.12 sec = Wide QRS
10. ST elevation = acute myocardial injury/ischemia context کې مهم
11. CTR > 0.50 → cardiomegaly ته شک
12. Boot-shaped heart → TOF
13. Egg-shaped heart → TGA
14. Snowman → TAPVR
15. LDL = atherogenic
16. HDL = protective
17. LDL oxidation → macrophage → foam cell → fatty streak
18. Stable plaque = thick fibrous cap
19. Unstable plaque = thin cap + rupture tendency
20. Stable angina = exertion، rest/nitro سره ښه
21. Unstable angina = rest/new/crescendo، no necrosis
22. Prinzmetal = coronary vasospasm
23. UA = Troponin negative
24. NSTEMI = Troponin positive + no persistent ST elevation
25. STEMI = Troponin positive + ST elevation
26. MI mechanism = plaque rupture → thrombus → coronary occlusion
27. Troponin = مهم cardiac biomarker
28. STEMI → rapid reperfusion
29. Primary PCI د مناسب وخت په صورت کې مهم reperfusion strategy دی.
30. MI complications = Electrical + Mechanical + Hemodynamic
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‎⭐ د MI د complications د حفظ کولو طریقه
MI → 3E
⚡ Electrical
* VT
* VF
* AV block
* Bradycardia
🫀 Mechanical
* Papillary muscle rupture
* VSD rupture
* Free-wall rupture
* Ventricular aneurysm
🩸 Hemodynamic
* LV failure
* Pulmonary edema
* Cardiogenic shock
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‎⭐ د ECG Localization د حفظ کولو تر ټولو اسانه طریقه
Inferior = “Bottom”�→ II, III, aVF
Anterior = “Front”�→ V1–V4
Lateral = “Side”�→ I, aVL, V5–V6
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‎⭐ د ACS د حفظ کولو Formula
UA
Ischemia + ❌ Necrosis
NSTEMI
Ischemia + ✅ Necrosis + ❌ ST elevation
STEMI
Ischemia + ✅ Necrosis + ✅ ST elevation
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فصل ۱۳: Hypertension — فرط فشار خون
1. Hypertension څه شی دی؟
Hypertension هغه حالت دی چې د وینې فشار په دوامدار ډول لوړ وي او د وخت په تېرېدو سره د Target Organ Damage (TOD) سبب کېږي.
مهم Target organs:
* 🧠 Brain
* ❤️ Heart
* 👁 Retina
* 🫘 Kidney
* 🩸 Blood vessels
‎⭐ مهم مفهوم
Hypertension اکثره وخت بې‌اعراضه وي، خو په خاموشه ډول زړه، دماغ، پښتورګي او رګونه خرابوي.
له همدې امله ورته:
Silent Killer
ویل کېږي.
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‎2. د وینې فشار Classification
په کتاب کې دوه مهم Classification systems ذکر شوي:
JNC-8
د کتاب له مخې د 140/90 mmHg یا له دې لوړ فشار د Hypertension لپاره مهم threshold ګڼل شوی.
ACC/AHA
په نوي classification کې:
* 10 mmHg
سره تړاو لري.
علتونه:
* Hypovolemia
* Drugs
* Autonomic dysfunction
* ځینې neurological conditions
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Syncope Investigation ⭐
مهم:
* History
* Physical examination
* BP
* ECG
* CBC
* Glucose
* Echocardiography
* Holter monitoring
* Head-up tilt test
* Electrophysiologic studies په مناسب cases کې
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Syncope Treatment
د علت مطابق.
د کتاب مهم موارد:
* Patient education
* Adequate salt/water
* Avoid prolonged standing
* Compressive stockings
* Normal saline په اړوندو حالاتو کې
* Fludrocortisone په ځینو cases کې
* Paroxetine په ځینو NMS cases کې
* Underlying arrhythmia treatment
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‎فصل ۲۱: Shock — شاک
‎📄 مخونه 91–100
1. Shock څه شی دی؟ ⭐⭐⭐
Shock هغه clinical syndrome دی چې:
Tissue perfusion ناکافي شي
→ Oxygen delivery ↓
→ Cellular dysfunction
→ Organ dysfunction
→ که شدید وي → Multiple Organ Failure
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2. Microcirculation
د shock په جریان کې:
Perfusion ↓
→ Tissue oxygen ↓
→ Cellular metabolism ګډوډېږي
→ Anaerobic metabolism ↑
→ Lactate ↑
→ Cellular injury
→ Organ failure
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3. Cellular response
Hypoperfusion:
* ATP ↓
* Lactate ↑
* Reactive oxygen species ↑
* Na⁺/water داخل حجره ↑
* Cellular swelling
* Calcium ↑
* Apoptosis
په شدید حالت کې:
Immune failure + Organ failure
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4. Neuroendocrine response
Shock کې:
Sympathetic system ↑
→ Catecholamines ↑
→ Vasoconstriction
→ HR ↑
→ Contractility ↑
همدارنګه:
* RAAS
* ADH/Vasopressin
* Cortisol
* ACTH
فعالېږي.
هدف:
د BP او circulating volume ساتل
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5. Cardiovascular response
د shock په وخت کې:
* Preload ↓
* Afterload ممکن ↑
* Cardiac output ↓
خو په distributive/septic shock کې په لومړیو مرحلو کې cardiac output ممکن لوړ هم وي.
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6. Pulmonary response
Shock کې:
* Tachypnea
* Tidal volume بدلون
* Dead space ↑
* Hypoxia
* Respiratory alkalosis
او په شدید حالت کې:
ARDS
رامنځته کېدای شي.
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7. Renal response
Hypoperfusion:
→ Renal blood flow ↓
→ GFR ↓
→ Oliguria
→ Acute tubular injury/necrosis
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8. Metabolic response
Oxygen delivery ↓:
→ Anaerobic metabolism ↑
→ Lactate ↑
→ Lactic acidosis
همدارنګه:
* Lipolysis
* Protein catabolism
* Muscle wasting
رامنځته کېدای شي.
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9. Inflammatory response
Shock کې inflammatory mediators فعالېږي.
مهم:
* Complement
* TNF
* Interleukins
* Leukotrienes
* Thromboxane
* Prostaglandins
د شدید inflammation په نتیجه کې:
Multiple Organ Failure
رامنځته کېدای شي.
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‎10. د Shock څلور مهم ډولونه ⭐⭐⭐
1. Hypovolemic Shock
2. Cardiogenic Shock
3. Obstructive Shock
4. Distributive Shock
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11. Distributive Shock
مهم مثال:
Septic Shock
نور distributive causes کې:
* Anaphylaxis
* Neurogenic shock
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12. SIRS
PDF کې SIRS لپاره مهم criteria:
* Temperature >38°C یا 90/min
* Respiratory rate >20/min یا PaCO₂ 12,000 یا 0.20 sec
14. Mobitz I → Progressive PR prolongation → dropped QRS
15. Mobitz II → Constant PR → sudden dropped QRS
16. Complete heart block → AV dissociation
17. SND → symptomatic cases کې Pacemaker
18. AF → Irregularly irregular
19. AF → Stroke risk
20. Atrial flutter → Saw-tooth
21. PSVT → Regular narrow-complex tachycardia
22. Stable PSVT → Vagal maneuvers → Adenosine
23. WPW → Short PR + Delta wave + Wide QRS
24. VT → Wide-complex tachycardia
25. Pulseless VT/VF → Defibrillation
26. Torsades → Magnesium sulfate
CPR
27. BLS → Circulation, Airway, Breathing
28. CPR → 30:2
29. Compression rate → 100–120/min
30. VF/pVT → Shockable
31. PEA/Asystole → Non-shockable
32. Cardiac arrest → CPR + appropriate ACLS
33. Epinephrine → cardiac arrest algorithm کې مهم
34. Amiodarone/Lidocaine → refractory ventricular rhythms
35. Syncope → transient cerebral hypoperfusion
36. Orthostatic hypotension → SBP ↓ >20 یا DBP ↓ >10
Shock
37. Shock → Tissue perfusion ↓
38. Shock types → Hypovolemic, Cardiogenic, Obstructive, Distributive
39. Septic shock → fluids + vasopressor، Norepinephrine مهم
40. Cardiogenic shock → pump failure؛ revascularization/inotrope/mechanical support د علت او حالت مطابق
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‎⭐ د امتحان لپاره د یادولو تر ټولو مهم جدول
حالت مهمه نښه مهم Management
Sinus Bradycardia HR 100 اصلي علت درملنه
1st AV Block PR >0.20 sec اکثره observation/علت
Mobitz I PR ↑ progressive → drop د حالت مطابق
Mobitz II Constant PR → drop Pacemaker ته جدي توجه
Complete AV Block AV dissociation Pacemaker
AF Irregularly irregular Rate/rhythm + anticoagulation assessment
Flutter Saw-tooth Rate/rhythm + thromboembolism prevention
PSVT Regular narrow QRS Vagal → Adenosine
WPW Short PR + Delta wave د rhythm مطابق
VT Wide QRS tachycardia Unstable → synchronized cardioversion
VF Chaotic ventricular rhythm Defibrillation + CPR
PEA Electrical activity، pulse نشته CPR + Epinephrine؛ no shock
Asystole No meaningful electrical activity CPR + Epinephrine؛ no shock
Torsades Polymorphic VT MgSO₄
Septic Shock Infection + hypoperfusion Crystalloid + Norepinephrine
Hypovolemic Volume ↓ Volume/Blood replacement
Cardiogenic Pump failure Revascularization + inotrope/support
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‎🔥 د دې PDF د مطالعې ترتیب
زه به درته دا ترتیب تر ټولو مناسب وبولم:
1️⃣ Hypertension�⬇️�2️⃣ Rate & Rhythm ⭐⭐⭐�⬇️�3️⃣ Cardiac Arrest + ACLS ⭐⭐⭐�⬇️�4️⃣ Shock ⭐⭐⭐�⬇️�5️⃣ په پای کې MCQs او مرور