Alfred short tutorial (non neurology) Flashcards
What is a wide pulse pressure
>60
Apex beat in mitral regurg
Displaced
How to describe the character of the apex beat
- Pressure loaded - suggests hypertrophied
- Volume loaded/dyskinetic
- Tapping apex beat - mitral stenosis (indicating a palpable first heart sound)
What does a palpable heave suggest
Right ventricular hypertrophy
Where do you hear the first heart sound
Apex
Mitral regurg = soft
Mitral stenosis = loud
Where is best to auscultate for tricuspid regurg
Left lower sternal edge
Where do you best hear aortic regurg
Left sternal edge
When does the first heart sound occur
End of diastole
What does a loud S1 indicate
Reduced diastolic filling
What happens to the first heart sound in severe MR?
Soft S1 (a sign of severity)
What condition causes a variable first heart sound
Atrial fibrillation - due to variatoini in duration of diastole
What causes a fixed split of the 2nd heart sound
ASD
What causes of wide split in the 2nd heart sound that varies with inspiration
Pulmon stenosis/RBBB
Most common cause of a variable wide split of 2nd heart sound
Right bundle branch block
How do u differentiation reversed splitting with normal splitting
In expiration not inspiration
When does the S3 occur
During diastole (S2 is the end of systole)
When is S3 pathological
Pt >40
When does the 4th heart sound occur?
IN diastole
What does the 4th heart sound indicate
Stiff ventricle - generated from atrial contraction (so cannot hear during atrial fibrillation)
Where is diastolic is the AR murmur
Early decrescendo diastolic
Where is the AS murmur heart
Trick question - can be heard all over precordium - characterise it based on harsh/musical
What does valsalva do in differntiating murmurs
Differentiate AS and HOCM - HOCM will get louder
What dynamic maneuvour increases the volume of mitral stenosis
Hand grip
Aetiology of primary mitral regurgitation
Degenerative (myxomatous degeneration, mitral valve prolapse, partial flail, flail leaflet
IE
Rheumatic disease
What is the normal mitral valve size
4-6cm
What mitral valve size would indicate severe MS
<1cm
What is the most common aetiology of AS
Degenerative bicuspid aortic valve
Why do you get chest pain in AS? (4 reasons)
Coexistent coronary artery disease
Turbulant flow in the coornary arteries that come off the aortic root
Raise ventricular end diastolic pressure to get blood out of valve which impedes coronary flow in diastole
Cardiac muscle becomes thick which may suffer from hypoxia
Most common cause of AR
Rheumatic heart disease
When might you hear both a decrescendo diastolic murmur and also an ejection systolic murmur
In severe AR due to high blood flow and does not necessarily mean AS
What is an austin flint murmur
Mid-diastolic murmur which is an indication of severity in aortic stenosis
What is the most common cause of TR
Functional dilataion of the RV
What is a common cause of TR in patients with heart transplants
Frequent trans-jugular cardiac biopsies
What are the peripheral signs of TR
JVP w prominent V wave and rapid Y descent
Pulsatile liver
Often RV heave
PHT, loud P2
Pansystolic murmur, Left LSE, louder on inspiration
What is the most common non genetic cause of HOCM
Long term hypertension
When do you get an apex double impulse
HOCM
Causes of large R wave in V1
R) ventricular hypertrophy
Posterior infarct
RBBB
WPW w RBB configuration
what causes a S3 heart sound
turbulent flow
what does a S4 mean
stiff ventricle (elderly)
