Cardiac Flashcards
Cardiac causes of clubbing
Infective endocarditis
Cyanotic congenital heart disease
Causes of aortic stenosis:
Degenerative senile calcific
Rheumatic (rarely isolated)
Calcified bicuspid valve
Signs of aortic stenosis:
Narrow pulse pressure
Small volume, slow rising pulse
Non-displaced apex beat
Ejection systolic murmur with radiation to carotids - loudest at 2nd ICS right sternal edge
Severity of aortic stenosis:
Plateau pulse Aortic thrill Length, harshness, lateness of peak of the murmur 4th heart sound Paradoxical splitting of 2nd heart sound Left ventricular failure
Causes of mitral regurg:
CHRONIC:
Degenerative disease
MV prolapse
Rheumatic
Papillary muscle dysfunction – LVF, Ischaemia
Connective tissue disease – RA, Ank Spond
Congenital
ACUTE: IE MI (chordae rupture or papillary muscle dysfunction) Surgery Trauma
Signs of mitral regurg:
Heart failure Splinters AF Displaced apex beat Pansystolic murmur loudest at apex, radiates to the axilla, louder on expiration and laying in left lateral position
Severity of mitral regurg:
Enlarged LV and LVF Pulmonary hypertension 3rd heart sound Early diastolic rumble Soft first heart sound Earlier aortic component of 2nd HS Small volume pulse
Causes of tricuspid regurg:
Functional – RVF Rheumatic (rarely alone) IE Congenital – Ebstein’s anomaly TV prolapse (rare) RV papillary muscle infarction Trauma (steering wheel injury to sternum)
Signs of tricuspid regurg:
Oedema JVP - Large v waves AF Right ventricular heave Pansystolic murmur – maximal at lower end of the sternum, louder on inspiration Pulsatile large and tender liver Ascites
Causes of aortic regurgitation
CHRONIC Valvular: Rheumatic Congenital (bicuspid, VSD) Seronegative arthropathy
Aortic root: Marfan’s Aortitis (seronegative arthopathies, RA, tertiary syphilis) Dissecting aneurysm Old age
ACUTE IE Marfan’s Hypertension Dissecting aneurysm
Signs of aortic regurgitation:
De Musset’s: rhymic bobbing of the head
Stigmata of IE
Collapsing pulse
Wide pulse pressure
Decrescendo early diastolic blowing murmur – louder sitting forward. Best heard at left lower sternal border
Austin Flint murmur – low pitched rumbling at cardiac apex
Severity of aortic regurgitation:
Collapsing pulse Wide pulse pressure Length of the murmur 3rd heart sound Austin Flint Left ventricular failure
Causes of mitral stenosis:
Rheumatic
Severe annular calcification
Post mitral valve repair (rare)
Congenital (very rare)
Signs of mitral stenosis:
Malar flush
AF
Narrow pulse pressure
Mid-diastolic rumbling murmur - loudest at apex with the bell
Severity of mitral stenosis:
Narrow pulse pressure Early opening snap (Increased LA pressure) Length of diastolic murmur Diastolic thrill at the apex (rare) Presence of pulmonary hypertension - right ventricular heave - loud P2 and palpable P2 - pulmonary and tricuspid regurgitation
