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AS / OS Paces RT > Cardio > Flashcards

Cardio Flashcards

1
Q

metallic click

A

mechanical valve

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2
Q

signs of vein harvest on legs

A

coronary artery bypass

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3
Q

old cardiac scar and young pt

A

congential probelmes

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4
Q

cardiac causes of clubbing

A

infective endocarditis
congential cyanotic heart disease (Fallot, TGV)
rare: atrial myxoma

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5
Q

collapsing pulse

A

atrial regurg
thyrotoxic
pregnant
anaemic

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6
Q

absent radial pulse

A

trauma, clot, coarctation, Takayasu, death

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7
Q

impalpable apex beat

A

COPD, obese, pericardial effusion, wrong sided

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8
Q

pulmonary hypertension

A

raised JVP, parasternal heave, pulsatile HSM, asites, oedema

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9
Q

heart sounds summary

A

s1 mitral valve closing
s2 aortic valve closing
s3 left ventricular filling
s4 atrial contraction

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10
Q

for completion in a cardio station

A

check the obs, the drug chart and perform an ECG

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11
Q

presenting a cardio exam

A 
on peripheral inspection
the pulse was 
on examining the precordium
significant negatives 
differentials 
history
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12
Q

cardiac history key questions

A

sOB, chest pain, palpitations, LOC
paroxysmal nocturnal dyspnoea, orthopnoea
screen FLAWs for IE
screen risk - smoking, diabetes, lipids, HTN, FH
screen rhematic fever as a child
check drugs for indication of probs e.g. antiplatelets, statins

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13
Q

cardiac blood panel

A

FBC, UE, NTproBNP, fasting lipids and glucose

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14
Q

cardiac CXR

A

check cardiomegaly, pulmonary oedema, valve calcification

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15
Q

cardiac echo

A

diagnosis, valve function, left ventiruclar function

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16
Q

cardiac catherisation

A

to evaluate coroanres

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17
Q

general cardiac managment

A

MDT approach - GP, cardio, dietician, specialist nurse

optimise risk - sort lipids, BP, diabetes, clotting

regular monitoring

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18
Q

aortic stenosis exam signs full summary

A 
slow rising pulse
narrow pulse pressure < 30mmHg
aortic thrill 
apex forceful
end systolic murmur with carotid radiation
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19
Q

significant negatives to identify with aortic stenosis

A

rule out infective endocarditis signs
rule out left ventricular failure signs, oedema etc
check indicators of severity

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20
Q

differentials for aortic stenosis

A

if young, consider HOCM (Valsalva increases murmur,, squatting decreases)

if older, consider MR, aortic sclerosis

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21
Q

causes of aortic stenosis

A

old age valve calcification
bicuspid valve
rhematic heart disease

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22
Q

3 symptoms of severe aortic stenosis

A

angina
syncope
dyspnoea

half die in 5 years or less with these alongside

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23
Q

investigations if you identify aortic stenosis

A 
ECG, 
FBC, UE, NT proBNP, lipids, glucose 
CXR
echo
coronary angiogram
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24
Q

management of aortic stensois

A

MDT approach, optimise CVD risk (statins, antiHTN, manage DM, antiplatelet)
regular monitoring

surgical valve replacement

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25
Q

3 surgical options for aortic stenosis

A

symptoms bad = valve replacement +/- CABG

TAVI - transcatheter aortic valve implant

balloon valuloplasty

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26
Q

investigation findings in AS

ECG, CXR, echo

A

ECG
 LVH
 Arrhythmias

CXR
 Calcified AV
 LVH
 Pulmonary oedema

Echo + Doppler
 Severity
 Cause: Bicuspid valve, thick calcified cusps
 LV function
 Other valve function
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27
Q

echo findings severe AS

A

Echo Features of Severe AS (AHA 2006)
 Valve area <1cm2
 Pressure gradient >40mmHg
 Jet velocity >4m/s

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28
Q

mitral regurg on examinaton

A

o/e: left parasternal heave, displaced apex, soft S1, pansystolic murmur loudest in left axilla
severe: LVF, AF present

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29
Q

mitral regurg DDx

A

Aortic stenosis (loudest carotids)

Ventricular septal defect

Tricuspid regurgitation

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30
Q

mitral regurg inv

A

Cardiac bluds
ECG – LVH, p mitrale, arryt

CXR – large L heart, calc, oedema

Echo – assess severity, EF
Cardiac angio - assess coronaries pre surg

31
Q

mitral regurg manage

A

MDT
Specialist nurse
Secondary prevention
Regular echo

Treat AF
Replace valve pre structural changes

Open replace
Annuloplasty

32
Q

causes of mitral regurg

A

Causes - Secondary to HTN – LV dilatation

Calcification

Rheumatic heart disease

MV prolapse

33
Q

severity on echo mitral regurg

A

 Jet width >0.6cm
 Systolic pulmonary flow reversal
 Regurgitant volume >60ml

34
Q

aortic regurg signs and severity

A

Quincke’s sign – visible nailbed pulsation
Corrigan’s sign – visible carotid pulse
Collapsing pulse,wide PP
Displaced apex
High pitched end systolic murmur, louder leaning
Severe: collapsing pulse, LVF, wide pulse P

35
Q

aortic regurg DDx

A

Mitral Stenosis

Pulmonary Regurgitation

Tricuspid Stenosis

36
Q

aortic regurg investigations

A

Cardiac bluds+ inflamm blds

ECG – left strain, lateral T wave invert

CXR – large heart, oedema

Echo – assess severity, EF
Cardiac angio - assess coronaries pre surg

37
Q

aortic regurg management

A

MDT
Specialist nurse
Secondary prevention
Regular echo

Replace valve – TAVI, open

Replace valve pre structural changes

38
Q

aortic regurg causes

A

Causes –
Bicuspid aortic valve

Rheumatic fever

Autoimmune – ankspond, RA

Connective tissue disease

Acutely - infective endocarditis

39
Q

mitral stenosis signs and severity

A

o/e:
AF, left parasternal heave, tapping apex, loud S1, rumbling MDM, radiates to axilla
Severe: malar flush, LVF

40
Q

mitral stenosis DDx

A

Aortic Regurgitation

Pulmonary Regurgitation

Tricuspid Stenosis

41
Q

mitral stenosis inv

A

Cardiac bluds
ECG – LVH, p mitrale,

CXR – LA hypertrophy, splayed carina, calc valve, oedem

Echo – assess severity, EF
Cardiac angio - assess coronaries pre surg

42
Q

mitral stenosis management

A

MDT
Specialist nurse
Secondary prevention
Regular echo

Treat AF
RF prophylaxis Pen V

Valvuloplasty

Replace

43
Q

mitral stenosis causes

A

only really rheumatic fever

44
Q

impalpable apex beat

A

dextrocardia, obese, pericardial effusion, emphysema

45
Q

hyperdynamic circulation

A

– regurgitation, thyrotoxicosis, anaemia

46
Q

clubbing in cardio exam

A

cyanotic congenital heart disease

47
Q

Osler’s node

A

painful purple fingertip papules

48
Q

Janeway lesions

A

red macules on palms

49
Q

irregular rhythm

A

– irregularly = AF, flutter, ectopics regularly = 2nd deg heart block

50
Q

radio radial delay

A

dissection/aneurysm

51
Q

radio femoral delay

A

coarctation, which is an aortic narrowing

52
Q

collapsing pulse

A

AR or high output state

53
Q

pulse pressure changes

A

diff between DBP and SBP

wide=AR, narrow=AS

54
Q

malar flush and eye signs

A

Malar flush – MitralSten Eyes - pallor, arcus, xanthelasma

55
Q

mouth signs cardio exam

A

cyanosis under tongue, poor hygiene, high arched palate = Marfan’s

56
Q

raised JVP cardio

A

PO + pulmHTN, PE, PS, pericardial effusion, SVCO, tamponade, TR

57
Q

sustained JVP rise on hepjug reflex

A

RVF

58
Q

apex nature

A

– thrusting + displaced = regurg + dilatation, heaving and preserved =stenosis + hypertrophy

59
Q

parasternal heave

A

RVH due to pulm HTN

60
Q

thrills on palpation

A

strong murmur, often AS over aortic valve ausc zone

61
Q

s4

A

atrial gallop
atrium working against hypertrophied and stiff ventricle

LVH, HTN, AS

62
Q

soft s1

A

severe heart failure or MR

63
Q

loud s1

A

high atrial pressure

tachycardia or MS/AF

64
Q

soft s2

A

AS, PS

65
Q

loud s2

A

pulm HTN, general HTN

66
Q

s3

A

ventricular gallop

hyperdynamic or LVF

67
Q

aortic stensosis full summary (character, radiation, pathology, symptoms, signs, causes)

A

character - ejection systolic
radiates to carotids (+apex)

LV hypertrophy due to resistance from narrowed valve

exertional dyspnoea
then angina
then syncope (v bad sign)

slow rising pulse
narrow pulse pressure
heaving apex
soft S2
LVF signs possible depending on severity (s3, Pulmonary oedema)

causes - age + calcification, bicuspid arotic valve e.g. Turner’s, congenital, rheumatic heart disease

68
Q

aortic sclerosis full summary (character, radiation, pathology, symptoms, signs, causes)

A

ejection systolic
NO RADIATION

hard and inflexible valve, not narrowed!

no other signs

senile calcification

69
Q

mitral regurgitation full summary

character, radiation, pathology, symptoms, signs, causes

A

pansystolic murmur
radiates to left axilla

LV +LA dilatation due to backflow, also pulmHTN

LVF signs - SOB, orthopnea, PND, fatigue, palpitations

signs incl AF, displaced thrusting apex, soft s1, pulm HTN signs (RV heave, loud S2), LVF signs (PO, s3)

causes:

LEAFLETS Endocarditis, prolapse, RF, conn tissue

ANNULUS Secondary to HTN – LV dilatation
Calcification

CHORDAE/PAPILLAE Pap rupture, fibrosis (postMI), infiltration

70
Q

mitral valve prolapse full summary

character, radiation, pathology, symptoms, signs, causes

A

mid systolic click
atypical chest pain
isolated murmur with no other signs

conn tissue and other diseases

71
Q

ventricular septal defect full summary

character, radiation, pathology, symptoms, signs, causes

A

panstyolic loud machinery like murmur

leakage between ventricles

pulm HTN signs (RV heave, loud s2)

acutely may cause cardiogenic shock in babby

causes: either congenital or post MI acute complication!

72
Q

tricuspid regurgitation full summary (character, radiation, pathology, symptoms, signs, causes)

A

pansystolic (diff to MR because louder on inspiration with massive JVP and apex preserved)

fatigue, hepatic pain, ascites, peripheral oedema (as right sided backflow)

giant v waves JVP
backflow signs
pulm HTN signs

causes: RV dilation from pulmHTN and chronic lung or valve disease

may be IE if drugs or rheumatic HD

73
Q

mitral stenosis full summary (character, radiation, pathology, symptoms, signs, causes)

A

low rumbling mid diastolic murmur with opening snap

heard best with bell in apex on side

get pulm HTN, SOB, cough up blood, chest pain

malar flush, tapping apex, AF, loud s1, RV heave

rheumamtic heart disease only

74
Q

aortic regurgitation full summary(character, radiation, pathology, symptoms, signs, causes)

A

early diastolic

fatigue SOB palps

collapsing pulse
wide PP
very displaced apex
Corrigan's - visible carotid
de Musset - head bobbing
Quinkces' red nail pulse

causes

acute= inf endocarditis, aortic dissection

chronic =
connective tissue disease,
rheumatic HD, long term HTN

AS / OS Paces RT (11 decks)

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