Cardio

Question 1

Clubbing cardio causes

Answer 1

IE
cyanotic CHD
atrial myxoma

Question 2

IE signs

Stigmata of IE

Answer 2

Changing heart murmurs - fever + new murmur = IE until proven otherwise
Clubbing
eponymous signs:
- Janeway lesions (palms and soles), Osler nodes (finger pulps)
- Roth spots in eyes
Splinter hemorrhages
Poor dentition
mild splenomegaly
microscopic hematuria

Question 3

Causes of peripheral cyanosis

Answer 3

PVD
Raynauds phenomenon
CCF

Question 4

Malar Flush indication?

Answer 4

Mitral stenosis

Question 5

Causes of central cyanosis

Answer 5

Hypoxic Lung disease
R-L Cardiac shunts - Cyanotic CHD, Eisenmenger syndrome
Abnormal Hb - methemoglobinemia (drugs, toxins)

Question 6

Signs of aortic regurgitation

Answer 6

Collapsing pulse
Corrigans sign of the carotids
Quincke - nailbed pulsation
De musset - head-nodding
Duroziez - diastolic femoral murmur
Traube - pistol shot femoral ausultation

Question 7

Clubbing stages

Answer 7

1 - fluctuants of nail bed
2 - loss of nail bed angle
3 - increase in longitudinal curvature
4 - drumsticking of fingers

Question 8

JVP characteristics

Answer 8

In btwn 2 heads of SCM
Rise with expiration (decrease in intrathoracic pressure drags the blood down into thoracic cavity)
Double pulsation, multi-wave form
Non-palpable
Obliterated when pressure is applied on base of neck (clavicle)
Height changes w/ angle of pt
Rise w/ hepatojugular reflux

Question 9

Radio-radio delay causes

Answer 9

cervical rib
aortic dissection/coarctation
embolism

Question 10

Causes of A fib

Answer 10

ischemic heart disease
Rheumatic heart disease
thyrotoxicosis
pneumonia
PE
alcohol

Question 11

Kussmaul sign?

Answer 11

paradoxical rise in JVP on inspiration
due to:
tamponade
constrictive pericarditis
restrictive cardiomyopathy

Question 12

causes of cardiac failure

Answer 12

1) pump failure
- IHD
- Cardiomyopathy
- constrictive pericarditis
- arrythmia
- drugs (neg inotropes)
2) excessive preload
- regurgitant diseases (AR/MR)
- fluid overload
- VSD
3) excessive afterload
- AS
- HTN
4) high-output failure (rare)
- anemia
- pregnancy
- metabolic (hyperthyroidism, Paget’s)
5) isolated RHF
- cor pulmonale
- primary pulmonary HTN

Question 13

pericariditis causes

Answer 13

viral (coxsackie)
bac/fungal infection
immediately post-MI
Dressler syndrome
SLE/RA/scleroderma
uremia
malignancy

Question 14

Mitral stenosis everything

• etiology
• presentation
• features
• ECG features
• CXR features
• DDx
• medical Rx
• indications for surgery/what surgery?

Answer 14

• etio: rheumatic heart disease (99%)
• prsnt: SOB & fatigue, plm edema/hemoptysis, RHF (late)
• features: mid-diastolic, apex, position: LHS on expiration (bell)
• ECG: A fib, P mitrale
• CXR: enlarged left atrium, plm venous congestion
• DDx: Austin flint, carey coombs, tricuspid stenosis
• Rx: Afib Rx + anticoagulation; diuretics
• indications: mod/severe disease
• surgery: percutaneous ballon valvuloplasty unless CI, then CABG
• –> CI: persistent left atrial thrombus; mod/severe MR; rigid calcified valve; pt requires CABG anyway

Question 15

Mitral regurg everything

• etiology
• presentation
• features
• ECG features
• CXR features
• DDx
• medical Rx
• indications for surgery/what surgery?

Answer 15

etio:
- Primary MR (structural) - Rh heart disease; IE; Valve prolapse; papillary muscle rupture (post-MI); Marfans; SLE
- secondary MR (functional) - LV dilatation
Prsnt: SOB & fatigue; ohter LVF (orthopnea, PND)
Features: Pansystolic; apex, radiate to axilla
DDx: VSD (esp post-MI); Tricuspid regurg (functional); AS
Rx: AFib Rx + anticoagulation; diuretics; ACEi (Rx HTN as HTN worsens MR)
- indications: severe primary disease + symptoms/LV impairment or dilatation
- surg: Valve repair > replacement (open surgery controversial)

Question 16

Aortic stenosis everything

• etiology
• presentation
• features
• ECG features
• CXR features
• DDx
• medical Rx
• indications for surgery/what surgery?

Answer 16

Etio:
- Rh heart disease, mention that Rh heart disease tends to cause mitral stenosis instead
- calcified bicuspid valve
- calcified tricuspid valve
Prsnt: SAD triad - Syncope, angina, dyspnea
Features: Ejection systolic, crescendo-decreascendo, radiates to carotids
DDx:
- Aortic sclerosis (no radiation, normal pulse and pulse pressure and S2 present)
- HOCM
- Plm stenosis
- Mitral regurg
Rx: Rx HTN
indications: severe disease + symptoms/LV impairment; mod/severe disease + undergoing CABG/other valve surgery
surg: TAVI

Question 17

Presentation of aortic stenosis

Answer 17

SAD - syncope, angina dyspnea

Question 18

What is S1 and S2?

Answer 18

S1: systole starts, mitral and tricuspid close
S2: aortic and plm close

Question 19

Aortic regurg everything

• etiology
• presentation
• features
• ECG features
• CXR features
• DDx
• medical Rx
• indications for surgery/what surgery?

Answer 19

etio:
- Rh heart dis; IE; luetic heart disease (syphilis); bicuspid valve; HTN; aortic dissection; marfans; RA; ank spond
Prst: SOB & fatigue; palpitations; often asymptomatic
Features: early diastolic, LLSE, pose: sit up + expiration, breath-like (high-pitched)
DDx: Plm regurg, Graham Steele
Rx: Diuretics, vasodilators (ACEi)
indications: severe disease + symptoms/LV impairment or dilatation

Question 20

prosthetic valve complications

Answer 20

structural valve failure
paravalvular leak 
thrombosis & obstruction
IE
intravascular hemolysis
warfarin-related complications

Question 21

bioprosthetic valve vs mechanical valves? indications?

Answer 21

bio valves - dont require warfarinisation, but only lasts 10-15 yrs
indications: elderly; CI warfarin; pt choice