Cardio Flashcards
cardiac tamponade pulse abnormality
In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus
Upon cardiovascular examination, it is notable that his radial pulse disappears during inspiration.
Aortic regurgitation is associated with which syndrome?
Aortic regurgitation is associated with Marfan syndrome
Electrical alternans is suggestive of
Electrical alternans is suggestive of cardiac tamponade
Aortic stenosis management
Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
NSTEMI (managed conservatively) antiplatelet choice
NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
Use rhythm control to treat AF if
Use rhythm control to treat AF if there is coexistent heart failure, first onset AF or an obvious reversible cause
Electrical cardioversion is synchronised to which part of the ECG
Electrical cardioversion is synchronised to the R waves
Quincke’s sign (nailbed pulsation) is a clinical sign of
Quincke’s sign (nailbed pulsation) is a clinical sign of aortic regurgitation
All TIA patients should have which procedure
All TIA patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy
In mitral stenosis,…indicates the leaflets still have some mobility
In mitral stenosis, an opening snap indicates the leaflets still have some mobility
passmed typical cardiac tamponade presentation
Consider cardiac tamponade in elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma
On the cardiology ward round, a 56-year-old man is seen three days post-myocardial infarction. He complains of worsening dizziness when mobilising. An ECG is performed, which shows a heart rate of 43 beats per minute, and features consistent with third-degree heart block.
What blood vessel was most likely to have been affected by his myocardial infarction?
Right coronary artery:
AV block can occur following an inferior MI
right coronary artery supplies AV node
angina pectoris drug management
summary: BB or CCB prvention and GTN for symptomatic relief
cause of a third heart sound
young patients- normal–> rapid ventricular filling
older patients: can indicate heart failure
causes of S4
- (S4) is heard directly before S1.
- always abnormal and rare to hear.
- It indicates a stiff or hypertrophic ventricle and is caused by turbulent flow from that atria contracting against a non-compliant ventricle.
Special manoeuvres can be used to emphasise certain murmurs:
Position the patient on their left side for mitral stenosis
Position the patient sat up, leaning forward and holding exhalation for aortic regurgitation
mnemonic for describing features of a murmur
how do mitral and aortic stenosis affect the heart muscle?
When pushing against a stenotic valve, the muscle has to try harder, resulting in hypertrophy:
Mitral stenosis causes left atrial hypertrophy
Aortic stenosis causes left ventricular hypertrophy
how do mitral and aortic regurgitation affect the heart muscle?
When a leaky valve allows blood to flow back into a chamber, it stretches the muscle, resulting in dilatation:
Mitral regurgitation causes left atrial dilatation
Aortic regurgitation causes left ventricular dilatation
Mitral stenosis definition
Mitral stenosis is a narrowed mitral valve restricting blood flow from the left atrium into the left ventricle.
mitral stenosis murmur features and other signs
- mid-diastolic, low-pitched “rumbling” murmur heard best in expiration due to a low blood flow velocity.
- Loud S1 due to thick valves requiring a large systolic force to shut, then shutting suddenly.
- There is an opening snap after S2, which triggers the onset of the murmur.
other signs:
* Tapping apex beat, which is a palpable, prominent S1
* Malar flush
* Atrial fibrillation
Causes of mitral stenosis:
Rheumatic heart disease
Infective endocarditis
mitral regurgitation definition and consequence
Mitral regurgitation refers to an incompetent mitral valve, allowing blood to flow back from the left ventricle to the left atrium during systolic contraction of the left ventricle.
The leaking valve causes a reduced ejection fraction and a backlog of blood waiting to be pumped through the left side of the heart, resulting in congestive cardiac failure .
Mitral regurgitation is the second most common indication for valve replacement.
signs of mitral regurgitation including murmur features
pan-systolic, high-pitched “whistling” murmur due to high-velocity blood flow through the leaky valve.
The murmur radiates to the left axilla.
You may hear a third heart sound.
Other signs of mitral regurgitation:
- Thrill in the mitral area on palpation
- Signs of heart failure and pulmonary oedema
- Atrial fibrillation (irregularly irregular pulse)
Causes of mitral regurgitation:
- Idiopathic weakening of the valve with age
- Ischaemic heart disease
- Infective endocarditis
- Rheumatic heart disease
- Connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome
Aortic stenosis definition
Aortic stenosis is the most common valvular heart disease and the most common indication for valve replacement surgery. It refers to narrowing of the aortic valve, restricting blood flow from the left ventricle to the aorta.
Aortic stenosis signs and murmur features
ejection-systolic, high-pitched murmur due to the high blood flow velocity through the aortic valve. This has a crescendo-decrescendo character due to the speed of blood flow across the value during the different periods of systole. Flow during systole is slowest at the start and end and fastest in the middle.
The murmur radiates to the carotids as the turbulence continues into the neck
Other signs of aortic stenosis:
- Thrill in the aortic area on palpation
- Slow rising pulse
- Narrow pulse pressure (the difference between systolic and diastolic blood pressure)
- Exertional syncope (lightheadedness and fainting when exercising) due to difficulty maintaining a good flow of blood to the brain
causes of aortic stenosis
- Idiopathic age-related calcification (by far the most common cause)
- Bicuspid aortic valve
- Rheumatic heart disease
Aortic regurgitation definition
Aortic regurgitation refers to an incompetent aortic valve, allowing blood to flow back from the aorta into the left ventricle.
aortic regurgitation signs and murmur features
early diastolic, soft murmur
It can also cause an Austin-Flint murmur. This is heard at the apex as a diastolic “rumbling” murmur. This is caused by blood flowing back through the aortic valve and over the mitral valve, causing it to vibrate.
Other signs of aortic regurgitation:
- Thrill in the aortic area on palpation
- Collapsing pulse
- Wide pulse pressure
- Heart failure and pulmonary oedema
- Quincke’s sign (nailbed pulsation)
- De Musset’s sign (head bobbing)
Causes of aortic regurgitation:
- Idiopathic age-related weakness
- Bicuspid aortic valve
- Connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome
Tricuspid regurgitation definition
Tricuspid regurgitation refers to an incompetent tricuspid valve, allowing blood to flow back from the right ventricle to the right atrium during systolic contraction of the right ventricle.
tricuspid regurgitation signs and murmur features
- pan-systolic murmur. There is a split second heart sound due to the pulmonary valve closing earlier than the aortic valve, as the right ventricle empties faster than the left ventricle.
Other signs of tricuspid regurgitation:
- Thrill in the tricuspid area on palpation
- Raised JVP with giant C-V waves (Lancisi’s sign)
- Pulsatile liver (due to regurgitation into the venous system)
- Peripheral oedema
- Ascites
Causes of tricuspid regurgitation
- Pressure due to left-sided heart failure or pulmonary hypertension (“functional”)
- Infective endocarditis
- Rheumatic heart disease
- Carcinoid syndrome
- Ebstein’s anomaly
- Connective tissue disorders, such as Marfan syndrome
Pulmonary stenosis definition
Pulmonary stenosis is a narrowed pulmonary valve, restricting blood flow from the right ventricle into the pulmonary arteries.
Pulmonary stenosis signs and features of the murmur
ejection systolic murmur loudest in the pulmonary area with deep inspiration. There is a widely** split second heart sound**, as the left ventricle empties much faster than the right ventricle.
Other signs of pulmonary stenosis:
- Thrill in the pulmonary area on palpation
- Raised JVP with giant A waves (due to the right atrium contracting against a hypertrophic right ventricle)
- Peripheral oedema
- Ascites
Pulmonary stenosis causes
Pulmonary stenosis is usually congenital and may be associated with:
- Noonan syndrome
- Tetralogy of Fallot
Tetralogy of Fallot is a congenital condition where there are four coexisting pathologies:
- Ventricular septal defect (VSD)
- Overriding aorta
- Pulmonary valve stenosis
- Right ventricular hypertrophy
Aortic regurgitation management
medical management of any associated heart failure
surgery: aortic valve indications include:
* symptomatic patients with severe AR
* asymptomatic patients with severe AR who have LV systolic dysfunction
aortic stenosis management
mitral stenosis management
mitral regugitation investigations and management
most common cause of mitral stenosis
rheumatic fever
Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of
Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit - by far the most common cause is atherosclerotic disease in arteries supplying the GI tract
cardiac tamponade triad
Beck’s triad:
hypotension
raised JVP
muffled heart sounds
AAA diameter diagnosis
Critical limb ischaemia presents as
Critical limb ischaemia presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia
