A Clinical Flashcards by Sophie Shorten

Signs of severity of AS

Plateau pulse
Aortic Thrill
Late peaking ESM
LVF

rSplit S2
S4

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Findings consistent with aortic stenosis

BP- small pulse pressure
Pulse - small vol, slow up rise, plateau

Apex - pressure loaded
Murmur - ESM, rad to carotids, soft on valsalva

RSplitting S2
S3
S4

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Causes of AS

Bicuspid valve

Degenerative calcification

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Signs of severity of MR

Small vol pulse
LV dilatation / displaced apex
LVF
Pulmonary HTN

Early diastolic rumble

S3s:
Soft S1
Split S2
S3

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Findings consistent with MR

Apex - volume loaded, displaced
Murmur - pansystolic, to axilla

Valsalva - move put ur closer to S1
Isometric- increase intensity by increasing afterload

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Indications for MVR

Acute MR
NYHA III/IV
LV dysfunction with EF >30%

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Findings consistent with HOCM

Pulse- jerky
Apex- double impulse
Murmur- ESM, late, max LSE - PSM of MR at apex
S4

Valsalva- louder
Hand grip - softer

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Signs of severity of HOCM

ECG- AF, LVH, lat ST changes, deep q waves, conduction blocks

TTE - asymmetrical hypertrophy with septal hypertrophy and SAM (systolic anterior motion) mitral valve

LVOT gradient correlated with symptoms and prognosis

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Findings consistent with MVP

Murmur- mid or late diastolic click

Late crescendo-decrecendo at apex

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Findings consistent with VSD

Thrill
Murmur- pansystolic loudest at LSE (loud=small)
S3
S4

Valsalva - softer

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Signs of severity of VSD

Pulmonary HTN - shunt reversal

Cyanosis - shunt reversal

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Indications for closure of VSD

Mid to large shunt
Complications:

CCF
RVOT
AR
IE
Eisenmongers

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Findings consistent with ASD

Murmur- Midsystolic pulmonary ejection murmur
Fixed splitting S2
Mid diastolic rumbling LSE (incr flow through TV)

Inspiration - louder

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Signs of severity of ASD

Pulmonary HTN

significant L:R shunt 2:1 (pulmonary to systemic)

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Signs consistent with TR

JVP- prominent v waves, rapid y decent 
Apex - RV heave 
PHT - loud P2
Murmur - harsh midsystolic murmur, LSE
Abdo - pulsatile liver

Louder on inspiration

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Causes of TR

IE
2’ to RV dilation
(Causes of pulm HTN, ebsteins anomaly, large VSD)

Findings consistent with pulmonary artery stenosis

JVP - prominent a wave
Apex -RVH
Murmur - harsh midsystolic pulm area
S2 widely split with soft P2

Signs consistent with MS

Pulse - small pressure AF
Face - malar flush
JVP -prominent A wave

RVH heave
Apex - tapping, palp S1
Opening snap (S1), mid diastolic rumble

Roll to left

Signs of severity of MS

Small pulse pressure 
OS close to S2
Long diastolic murmur
Pulmonary HTN
Apical diastolic thrill

Indications for surgery
VA <1
CCF
PHTN

LA -> AF
Pulmonary HTN -> TR, RHF

Signs consistent with AR

Water hammer / collapsing pulse 
Femoral arterial pistol shot
Widened PP
Apex - displaced, heave 
Diastolic thrill
S3
S4
Decrecendo diastolic murmur 
Austin flint murmur (mid diastolic against MV)

Causes of AR

Rheumatic
Endocarditis
Congenital (assoc with VSD)
Aortic root - dissection, marfans, ank spond, syphilis

Signs of severity of AR

Wide pulse pressure 
Collapsing pulse 
Long decrecendo diastolic murmur 
S3
Soft A2
Austin flint murmur 
LVF

Signs consistent with pulmonary regurgitation

Decrecendo diastolic
Increases on inspiration

Causes
Pulmonary HTN
Post ToF repair
Absent pulmonary valve

Patent ductus arteriosis

Continuous machinery murmur, radiates to the back

Coarctation of the aorta

Radio-femoral delay Different BP UL/LL Continue murmur, loudest below left scapula Systolic - left intraclavicular Diastolic - over chest wall due to blood flow through collaterals

Differentials of systolic murmur over the aortic region

AS - rad to carotids, soft on valsalva, slow rising pulse, narrow PP, pressure loaded apex, old A sclerosis - does not radiate to carotids HOCM - louder on valsalva, jerky pulse and double apex, young

Differentials for Systolic Mumur in the mitral region

Mitral regurgitation - loud on expiration, volume loaded apex MVP - mid, late systolic click, late crescendo-decrecendo murmur at apex

Differentials for systolic murmur at the LSE

VSD- PSM, thrill, pulm HTN TR - PSM, JVP V waves, RV heave, pulsatile liver, pulm HTN Coarctation of aorta - continuous systolic murmur over the left infraclavicular region, radio/dem delay, differential in BP

Differentials of a systolic murmur in the pulmonary region

``` ASD mid systolic ejection murmur Mid diastolic rumble Fixed splitting S2 Aw pulm HTN ``` ``` PAS Harsh midsystolic 2nd ICS Widely split S 2 with soft P2 JVP a waves RV heave ``` Carcinoid/young

Differentials of Diastolic murmur in mitral region

MS - opening snap - mid diastolic rumble that is not audible Clues: Small PP, malar flush, a wave JVP, tapping apex,pulm HTN AR - Austin flint (low pitched mid diastolic or presystolic murmur) Clues: Wide PP, water hammer, volume loaded apex, diastolic thrill

Differentials of diastolic murmur LSE

AR -water hammer, wide PP, volume loaded apex, diastolic thrill PR - pulm HTN - scar, repair of ToF