Cardio Flashcards
What are the signs of AS?
- Hard to feel pulse AKA low volume (usually slow rising)
- Narrow pulse pressure
- “Obvious” - hyperdynamic apex beat - signally LVH
- Loss of S2 - a sign of severity in AS
What are the signs of AS?
- Hard to feel pulse AKA low volume (usually slow rising)
- Narrow pulse pressure
- “Obvious” - hyperdynamic apex beat - signally LVH
- Loss of S2 - a sign of severity in AS
What examination sign should get you ready for an AS murmur?
Hard to feel / low volume pulse!!!
What examination sign should get you ready for an AS murmur?
Hard to feel / low volume pulse!!!
Ejection systolic murmur + ECG thats crazy could mean what?
HOCM - due to obstruction due to septum
Features of HOCM?
- Jerky pulse
- FHx of sudden death AD inheritance
- Associated w/ WPW
Dx of ESM?
- HOCM - quieter on squatting
- Aortic sclerosis - elderly, w/ no radiation, normal apex and pulse
Signs of AR?
- BIG Pulse + Collapsing
- Wide pulse pressure
- Big apex
- EDM murmur - slurring of the second heart sound
Signs of AR?
- BIG Pulse + Collapsing
- Wide pulse pressure
- Big apex
- EDM murmur - slurring of the second heart sound
Signs of MS? - Unlikely to come up
- Usually Female
- Low BP
- Red mitral facies
- Rumbling Mid-Diastolic Murmur (Burr before S1 (lub))
- Loud S1 ‘lub’ + tapping apex beat
What does an opening snap in MS suggest?
The valve isnt very calcified and may be suitable for mitral valvuloplasty however this needs to be confirmed with echo
Why is S1 loud in MS?
LA pressure is raised hence needs greater pressure before it closes hence snaps shut loudly
DDx for Mid-Diastolic murmur?
- MS
- TS - different location
- ASD
- Atrial myxoma - would also have LA mass, fever, clubbing and may embolise
Cyanotic pt w/ scar under breast - what signs should you look for? what could cause this?
- Clubbing
- AF
- Signs of right heart strain - TR, raised JVP, parasternal heave, loud P2
- Possible scars from congenital heart surgery
Shunt - mixing of blood or pulmonary HTN (primary or accquired due to old shunt eg Eisenmengers)
VSD - important info?
- Most common congenital heart leison
- PSM murmur @ TV site
- LV dilatation
Compications from AS?
Valvular complications:
- Infective endocarditis
- Embolic disease eg stroke
- Haemolytic anaemia
Complications due to impaired outflow:
- Left ventricular failure -> syncope, MI and limb ischaemia
Classical Ix for a pt w aortic stenosis?
Bedside:
- Basic obs - check for haemodynamic stability
- Urine dip - proteinuria for infective endocarditis and glycosuria for diabetes
- ECG - LV strain
Bloods:
- FBC - haemolytic anaemia
- Inflammatory markers - CRP and ESR for infective endocarditis
Imaging:
- CXR (signs of pulmonary oedema - cardiomegaly and possibly calcified valve)
- ECHO = Gold standard (<1cm2 valve size or gradient >40mmHg)
- Coronary angio - measure gradient across valve and assess for coronary artery disease
Ix of pt?
Imaging:
Aortic Stenosis mx?
Conservative:
- Pt education = diabetic control, bp control, dental hygiene and modifying other RFs
Medical:
- BP control
Surgical:
- Aortic valve replacement - Open repair or TAVI (high risk) depending on pt risk which is stratified using EUROSCORE
What grade is the murmur?
What are the indicationsof aortic valve replacement?
Severe aortic stenosis (symptomatic, EF <50%)
Acute aortic regurg (secondary to aortic dissection)
Infective endo carditis (non-responsive to medical therapy)
What factors to consider when deciding on valve replacement?
Severity of valve dysfunction - ECHO to measure this
Any recommendation eg HF
Patient choice
What are the complications of valve replacement
Different types of prosthetic valves and +ves and -ves?
RFs for coronary artery disease?
What is a coronary artery bypass?
Healthy artery / vein from elsewhere (eg saphenous vein) is grafted
The grafted vessel bypasses blocked portion of coronary artery -> creating a new path for oxygenated blood flow to heart muscle
What are the indications for CABG?
Left main stem disease
Triple vessel disease
Angina not responsive to medical therapy
Unsuccessful PCI
Ix for coronary artery disease / CABG?
What are some causes of pulmonary fibrosis?
Methotrexate
Ank Spond
RA
Silicosis
What are the causes of Upper and Lower zone pulmonary fibrosis?
Ddx for fibrosis?
ix for pulmonary fibrosis?
What are some indications for a lobectomy?
Malignancy
COPD
Chronic lung abscess
TB
What are the possible complications of a lung ca?
What is p-mitrale?
Broad notched p-waves that suggests left atrial enlargement
What is a pan-systolic murmur?
Lasts entire duration between S1 and S2 and doesn’t change in intensity
Why does mitral regurg cause an irregularly irregular pulse?
MR = MV doesnt close properly -> When LV starts to contract, blood is regurgitated from LV to LA -> LA dilation -> LA remodelling + fibrosis -> Impaired electrical conduction -> AF
Summary
What are some differentials for MR?
Compications of MR?
Valvular:
- Infective endocarditis
Reduced outflow:
- LVF
- AF
Ix for MR?
Bedside:
- basic obs
- urine dip
- ECG - AF? P-mitrale? (sign of dilated LA)
Bloods:
- Inflammatory markers for infective endocardiits
- BNP - if there is associated HF
Imaging:
- CXR - signs of LA enlargement and signs of HF
- Echo - gold standard to assess severity + diagnosis
Special:
- Coronary angio - measure gradient across valve and assess for coronary artery disease
NYHA HF classification?
Grade 1 - No SOB
Grade 2 - SOB upon moderate activity but none at rest
Grade 3 - SOB upon mild activity but none at rest
Grade 4 - SOB at rest
What is HF and what are the causes of LHF and RHF
Ix of HF patients?
Bedside:
- Basic obs
- ECG - signs of LV strain (LBBB + large amplitude QRS) or RV strain (RBBB and RAD)
Bloods:
- FBC - Anaemia which can cause or exacerbate HF
- BNP / NT-pro BNP
- U+Es - renal function which can be deranged in HF due to cardio renal syndrome
- Screen for RFs such as diabetes and hyperlipidemia
Imaging:
- CXR - signs of HF
- ECHO - diagnosis and severity, measuring LVEF
Mx of CCF?
