Cardio Flashcards
1
Q
Dominant A wave causes
A
tricuspid stenosis
pulmonary stenosis
PHTN
2
Q
Dominant V wave causes
A
TR
3
Q
Cannon A wave causes
A
CHB
paroxysmal nodal tachycardia with retrograde atrial conduction
VT with retrograde atrial conduction or AV dissociation
4
Q
Causes of elevated CVP
A
RVF
TS or TR
pericardial effusion or constrictive pericarditis
SVC obstruction
Fluid overload
Hyperdynamic circulation (fever, anaemia, thyrotoxicosis, pregnancy, fistula, exercise, hypercapnia, hypoxia)
5
Q
Anacrotic arterial pulse
A
Small volume, slow upstroke, plus A wave on the upstroke
Cause: AS
6
Q
Plateau arterial pulse
A
Slow upstroke
Cause: AS
7
Q
Bisferiens arterial pulse
A
Anacrotic pulse collapsing
Cause: AS plus AR
8
Q
Collapsing arterial pulse
A
Cause: AR, hyperdynamic circulation, ateriosclerotic aorta, patent ductus arteriosus, peripheral ateriovenous aneursym
9
Q
Small volume arterial pulse
A
Cause: AS, pericardial effusion
10
Q
Alternans arterial pulse
A
Alternating strong and weak beats
Cause: LVF
11
Q
Pressure loaded apex beat
A
AS
HTN
12
Q
Volume loaded apex beat
A
Hyperkinetic
Diastolic overload
13
Q
Tapping Apex beat
A
MS
14
Q
PArasternal heave
A
RVH
LA enlargement
15
Q
Where can a PDA murmur be heard
A
below the left clavicle
16
Q
Causes of a loud S1
A
MS
TS
Tachycardia
Hyperdynamic circulation
17
Q
Causes of a soft S1
A
MR
Calcified mitral valve
LBBB
First degree heart block
18
Q
Loud A2
A
Congenital AS
Systemic HTN
19
Q
Soft A2
A
Calcified aortic valve
AR
20
Q
Loud P2
A
PHTN
21
Q
Soft P2
A
PS
22
Q
Increased normal splitting (wider on inspiration)
A
RBBB
PS
VSD
MR
23
Q
Fixed splitting
A
ASD
24
Q
Reversed splitting (P2 first)
A
LBBB
AS (severe)
Coarctation of aorta
large PDA
25
LV 3rd HS (louder at the apex and on expiration)
```
Physiological
LVF
AR
MR
VSD
PDA
```
26
RV 3rd HS (louder at the left sternal edge and on inspiration)
RVF
| Constrictive pericarditis
27
LV 4th HS
```
AS
acute MR
systemic HTN
IHD
HOCM
```
28
RV 4th HS
PHTN
| PS
29
Causes of MS
rheumatic heart disease
severe mitral annular calcification (sometimes associated with hypercalcemia/hyperparathyroidism)
Congenital
Post mitral valve repair for MR
30
Signs of severity for MS
```
Small pulse pressure
Early - opening snap
Length of mid diastolic rumbling murmur
Diastolic thrill at apex (rare)
Presence of PHTN
```
31
ECG changes in MS
P mitrale in sinus rhythm
AF (sign of chronicity)
RV systolic overload (severe disease)
Right axis deviation (severe disease)
32
CXR changes in MS
mitral valve calcification
Big left atrium
Signs of PHTN
Signs of cardiac failure
33
Causes of MR (Chronic)
```
Degenerative disease
MV prolapse
Rheumatic disease
Papillary muscle dysfunction: LVF, IHD
CTD - RA, Ank Spond
Congenital
```
34
Causes of MR (acute)
IE
Myocardial infarct (chordae rupture or papillary muscle dysfunction)
Surgery
Trauma
35
Signs of Severity for MR
```
Enlarged left ventricle
PHTN (late sign)
3rd HS
Early diastolic rumble
Soft 1st HS
Aortic component of second HS is earlier
Small volume pulse (usually severe)
LVF
```
36
ECG findings in MR
P mitrale
AF
LV diastolic overload
Right axis deviation
37
CXR changes in MR
Large LA
Increased LV size
Mitral annular calcification
PTN (less common)
38
Mitral valve prolapse and dynamic manoeuvres
Valsalva: murmur longer and click earlier
| Hangrip (increased afterload) - murmur shorter
39
Associations with mitral valve prolapse
Marfan's
| ASD
40
Causes of Chronic AR
Valvular:
Rheumatic heart disease
Congenital (Bicuspid valve, VSD)
Seronegative spondyloarthropathy
```
Aortic root:
Marfan's
Aortitis (Syphilis, Ank spond, SLE)
Dissecting aneurysm
Old age
```
41
Causes of acute AR
IE
Marfan's
HTN
Dissecting aneursym
42
Signs of severity of AR
```
Collapsing pulse
Wide pulse pressure
Length of decrescendo diastolic murmur
3rd HS
Soft A2
Austin Flint murmur (diastolic rumble caused by limitation to mitral inflow by the regurgitation jet)
LVF
```
43
ECG changes for AR
LV hypertrophy
44
CXR changes in AR
LV dilatation
Aortic root dilatation or aneurysm
valve calcification
45
Causes of AS
Degenerative calcification
Rheumatic (rarely isolated)
Calcific bicuspid valve
46
Signs of severity for AS
```
Plateau pulse
Aortic thrill
Length, harshness, and lateness of te peak of the systolic murmur
4th HS
Paradoxical splitting of the second HS
LVF
```
47
ECG changes in AS
LV hypertrophy
48
CXR changes in AS
LVH
| Valve calcification
49
Signs of TR
Large V waves in JVP
RV heave
Pulsatile liver
RVF - ascites, peripheral oedema, pleural effusions
50
Causes of TR
```
Functional (RVF)
Rheumatic
IE
Congenital (Ebstein's anomaly)
Tricuspid valve prolapse
RV papillary muscle infarction
Trauma
```
51
Signs of PS
```
Peripheral cyanosis
REduced or normal pulse (low cardiac output)
Giant A waves
RV heave
Thrill over pulmonary valve
ESM over pulmonary area
S4 may be present
```
52
Signs of severe PS
ESM peaking late in systole
Absence of ejection click
S4
Signs of RVF
53
Causes of PS
Congenital
| Carcinoid Syndrome
54
Signs of chronic constrictive pericarditis
```
Cachectic and ascites
Low BP and pulses paradoxus
Elevated JVP
Impalpable apex beat
Distant heart sounds
May have an early 3rd HS
May have an early pericardial knock (rapid ventricular filling is abruptly halted)
Hepatosplenomegaly, ascites, oedema
```
55
Signs of HOCM
Pulse: Sharp, jerky
JVP: prominent A wave
Apex beat: double or triple impulse
Auscultation: late ESM as left sternal edge, PSM at apex from MR, 4th HS
Dynamic: murmur louder with valsalva, softer with isometric, legs raised, squatting
56
ECG for HOCM
LVH
Lateral ST and T changes
Deep Q waves
Conduction defects
57
CXR for HOCM
LV enlarged with hump along the border
| no valve calcification
58
ASD ostium secondum signs
fixed splitting of second HS
Pulmonary ESM (increasing on inspiration)
PHTN (late)
59
ECG changes for ASD ostium secondum
right axis deviation
RBBB
RV hypertrophy
60
ASD ostium primum signs
fixed splitting of second HS
Pulmonary ESM (increasing on inspiration)
PHTN (late)
Associated with MR, TR, or VSD
61
ECG changes of ASD ostium primum
left axis deviation
RBBB
Somtimes prolonged PR interval
62
Signs of VSD
thrill and harsh PSM at the left sternal edge
| Sometimes MR is also present
63
PDA signs
continuous murmur
| Loudest under left clavicle
64
Signs of coarctation of the aorta
```
Better developed upper body
radiofemoral delay
HTN in arms only
midsystolic murmur over the praecordium and back
Hypertensive fund changes
Can be associated with Turners
```
65
Differentials for cyanotic congenital heart disease
Eisenmenger's
TOF
Complex lesions - univentricular heart, ebstein's anomaly
PHTN differentiates Eisenmengers from TOF
66
4 features of TOF
VSD
RV outflow obstruction (determines severity)
Overriding aorta
RVH
Physical signs: cyanosis, clubbing polycythemia, RV heave, thrill at left sternal edge, NO cardiomegaly
67
Causes of HTN
REnal: renal artery atherosclerosis, fibromuscular disease, vasculitis, diffuse renal disease
Endo: Conn's, cushings, Phaeo, CAH, Acromegaly, myxoedema, the pill
Coarctation of the aorta
Other:
-PRV
Uraemia
Toxemia of pregnancy
Neurogenic(increased intracranial pressure, acute intermittant porphyria)
Hypercalcemia
ETOH
OSA
68
Causes of oedema
```
Drugs - CCBs
Cardiac -CCF, cor pulmonale, constrictive pericarditis
Renal - nephrotic
Hepatic - cirrhosis
Malabsorption or starvation
Protein losing enteropathy
Myxoedema
Cyclical oedema
```
69
Pansystolic murmurs
- Mitral regurgitation (blowing quality, often with AF)
- Tricuspid regurgitation (with peripheral signs)
- VSD
- Aortopulmonary shunts
- Gallavardin’s phenomenon from AS (difficult to distinguish from MR) – increase in musical quality and radiation to praecordium; can track gradient (unlike AS and MR where distinct not gradual change in murmur quality)
70
Ejection systolic murmurs
- Aortic stenosis (radiation to carotids, peripheral signs)
- Aortic sclerosis (no radiation or peripheral signs)
- Pulmonary stenosis
- HOCM (louder on Valsalva, consider in a younger male with syncope)
- Flow murmur (e.g. ASD)
- Sometimes VSD can have harsh quality confused with ESM
- Sometimes extreme MR can have ejection quality
71
Late systolic murmurs
- Mitral valve prolapse
| - Papillary muscle dysfunction (usually ischemia or HCM)
72
Early diastolic murmurs
- Aortic regurgitation
| - Pulmonary regurgitation (Graham Steele murmur if pulmonary HTN)
73
Mid diastolic murmurs
- Mitral stenosis
- Tricuspid stenosis
- Atrial myxoma
- Austin Flint murmur of AR (fluttering anterior MV cusp with regurgitation)
Carey Coombs murmur of rheumatic fever (due to thickened MV leaflets)
74
Presystolic murmurs
- Mitral stenosis
- Tricuspid stenosis
- Atrial myxoma
75
Continuous murmurs
- Patent ductus arteriosus
- AV fistula (coronary artery, pulmonary, systemic)
- Aortopulmonary connection
- Venous hum (right supraclavicular fossa abolish by ipsilateral IJV pressure)
- Rupture of sinus of Valsalva into RV or RA
- Mammary souffle (late pregnancy or early postpartum)
76
MArfan's Syndrome
- Cardiac associations: AR +/- aortic root pathology, MV prolapse
- Arachnodactyly and joint hypermobility
- Thumb sign: distal phalanx protrudes beyond clenched fist
- Wrist sign: thumb and fifth digit overlap when around wrist
- Face: small head, epicanthic folds, short palpebral fissures, short nose/midface and lower nasal bridge, thin upper lip, indistinct philtrum
- Lens dislocation (or replacement) +/- blue sclera
- High arched palate
- Pectus carinatum or excavatum and kyphoscoliosis
- Arm span > height; upper to lower segment ratio <0.85
77
Turner Syndrome
- Cardiac associations: coarctation, bicuspid valve, AS
- Short stature and abnormal proportions
- Nail dysplasia, short 4th-5th metacarpals
- Large carrying angle
- Micrognathia, high palate
- Broad chest, poor breast development and widely spaced nipples
- Webbed neck, low posterior hairline, kyphoscoliosis
- Lymphoedema
- Multiple skin naevi
78
Down Syndrome
- Cardiac associations: VSD, AVSD, PDA, ASD, TOF
- Short neck with excess nucal skin
- Flattened facial profile and nose
- Small head, ears and mouth
- Upward slanting eyes and epicanthal folds
- Single palmar crease
79
Noonan Syndrome
- Cardiac associations: PS, HCM
- Short stature
- Deep philtrum, widely spaced blue/green eyes, low set ears
- High arched palate, poor teeth alignment, micrognathia
- Short neck and webbing
- Pectus excavatum, carinatum or scoliosis
- Bleeding disorders
80
William Syndrome
- Cardiac associations: AS, PS
- Long, gaunt face with short nose, wide mouth with full lips
- Small widely spaced teeth
