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BPT Shorts > Cardio > Flashcards

Cardio Flashcards

1
Q

Dominant A wave causes

A

tricuspid stenosis
pulmonary stenosis
PHTN

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2
Q

Dominant V wave causes

A

TR

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3
Q

Cannon A wave causes

A

CHB
paroxysmal nodal tachycardia with retrograde atrial conduction
VT with retrograde atrial conduction or AV dissociation

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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)

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5
Q

Anacrotic arterial pulse

A

Small volume, slow upstroke, plus A wave on the upstroke

Cause: AS

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6
Q

Plateau arterial pulse

A

Slow upstroke

Cause: AS

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7
Q

Bisferiens arterial pulse

A

Anacrotic pulse collapsing

Cause: AS plus AR

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8
Q

Collapsing arterial pulse

A

Cause: AR, hyperdynamic circulation, ateriosclerotic aorta, patent ductus arteriosus, peripheral ateriovenous aneursym

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9
Q

Small volume arterial pulse

A

Cause: AS, pericardial effusion

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10
Q

Alternans arterial pulse

A

Alternating strong and weak beats

Cause: LVF

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11
Q

Pressure loaded apex beat

A

AS

HTN

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12
Q

Volume loaded apex beat

A

Hyperkinetic

Diastolic overload

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13
Q

Tapping Apex beat

A

MS

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14
Q

PArasternal heave

A

RVH

LA enlargement

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15
Q

Where can a PDA murmur be heard

A

below the left clavicle

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16
Q

Causes of a loud S1

A

MS
TS
Tachycardia
Hyperdynamic circulation

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17
Q

Causes of a soft S1

A

MR
Calcified mitral valve
LBBB
First degree heart block

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18
Q

Loud A2

A

Congenital AS

Systemic HTN

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19
Q

Soft A2

A

Calcified aortic valve

AR

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20
Q

Loud P2

A

PHTN

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21
Q

Soft P2

A

PS

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22
Q

Increased normal splitting (wider on inspiration)

A

RBBB
PS
VSD
MR

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23
Q

Fixed splitting

A

ASD

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24
Q

Reversed splitting (P2 first)

A

LBBB
AS (severe)
Coarctation of aorta
large PDA

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25
Q

LV 3rd HS (louder at the apex and on expiration)

A 
Physiological
LVF
AR
MR
VSD
PDA
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26
Q

RV 3rd HS (louder at the left sternal edge and on inspiration)

A

RVF

Constrictive pericarditis

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27
Q

LV 4th HS

A 
AS
acute MR
systemic HTN
IHD
HOCM
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28
Q

RV 4th HS

A

PHTN

PS

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29
Q

Causes of MS

A

rheumatic heart disease
severe mitral annular calcification (sometimes associated with hypercalcemia/hyperparathyroidism)
Congenital
Post mitral valve repair for MR

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30
Q

Signs of severity for MS

A 
Small pulse pressure
Early - opening snap
Length of mid diastolic rumbling murmur
Diastolic thrill at apex (rare)
Presence of PHTN
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31
Q

ECG changes in MS

A

P mitrale in sinus rhythm
AF (sign of chronicity)
RV systolic overload (severe disease)
Right axis deviation (severe disease)

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32
Q

CXR changes in MS

A

mitral valve calcification
Big left atrium
Signs of PHTN
Signs of cardiac failure

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33
Q

Causes of MR (Chronic)

A 
Degenerative disease
MV prolapse
Rheumatic disease
Papillary muscle dysfunction: LVF, IHD
CTD - RA, Ank Spond
Congenital
34
Q

Causes of MR (acute)

A

IE
Myocardial infarct (chordae rupture or papillary muscle dysfunction)
Surgery
Trauma

35
Q

Signs of Severity for MR

A 
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
Q

ECG findings in MR

A

P mitrale
AF
LV diastolic overload
Right axis deviation

37
Q

CXR changes in MR

A

Large LA
Increased LV size
Mitral annular calcification
PTN (less common)

38
Q

Mitral valve prolapse and dynamic manoeuvres

A

Valsalva: murmur longer and click earlier

Hangrip (increased afterload) - murmur shorter

39
Q

Associations with mitral valve prolapse

A

Marfan’s

ASD

40
Q

Causes of Chronic AR

A

Valvular:
Rheumatic heart disease
Congenital (Bicuspid valve, VSD)
Seronegative spondyloarthropathy

Aortic root:
Marfan's
Aortitis (Syphilis, Ank spond, SLE) 
Dissecting aneurysm
Old age
41
Q

Causes of acute AR

A

IE
Marfan’s
HTN
Dissecting aneursym

42
Q

Signs of severity of AR

A 
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
Q

ECG changes for AR

A

LV hypertrophy

44
Q

CXR changes in AR

A

LV dilatation
Aortic root dilatation or aneurysm
valve calcification

45
Q

Causes of AS

A

Degenerative calcification
Rheumatic (rarely isolated)
Calcific bicuspid valve

46
Q

Signs of severity for AS

A 
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
Q

ECG changes in AS

A

LV hypertrophy

48
Q

CXR changes in AS

A

LVH

Valve calcification

49
Q

Signs of TR

A

Large V waves in JVP
RV heave
Pulsatile liver
RVF - ascites, peripheral oedema, pleural effusions

50
Q

Causes of TR

A 
Functional (RVF)
Rheumatic 
IE
Congenital (Ebstein's anomaly)
Tricuspid valve prolapse
RV papillary muscle infarction
Trauma
51
Q

Signs of PS

A 
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
Q

Signs of severe PS

A

ESM peaking late in systole
Absence of ejection click
S4
Signs of RVF

53
Q

Causes of PS

A

Congenital

Carcinoid Syndrome

54
Q

Signs of chronic constrictive pericarditis

A 
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
Q

Signs of HOCM

A

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
Q

ECG for HOCM

A

LVH
Lateral ST and T changes
Deep Q waves
Conduction defects

57
Q

CXR for HOCM

A

LV enlarged with hump along the border

no valve calcification

58
Q

ASD ostium secondum signs

A

fixed splitting of second HS
Pulmonary ESM (increasing on inspiration)
PHTN (late)

59
Q

ECG changes for ASD ostium secondum

A

right axis deviation
RBBB
RV hypertrophy

60
Q

ASD ostium primum signs

A

fixed splitting of second HS
Pulmonary ESM (increasing on inspiration)
PHTN (late)

Associated with MR, TR, or VSD

61
Q

ECG changes of ASD ostium primum

A

left axis deviation
RBBB
Somtimes prolonged PR interval

62
Q

Signs of VSD

A

thrill and harsh PSM at the left sternal edge

Sometimes MR is also present

63
Q

PDA signs

A

continuous murmur

Loudest under left clavicle

64
Q

Signs of coarctation of the aorta

A 
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
Q

Differentials for cyanotic congenital heart disease

A

Eisenmenger’s
TOF
Complex lesions - univentricular heart, ebstein’s anomaly

PHTN differentiates Eisenmengers from TOF

66
Q

4 features of TOF

A

VSD
RV outflow obstruction (determines severity)
Overriding aorta
RVH

Physical signs: cyanosis, clubbing polycythemia, RV heave, thrill at left sternal edge, NO cardiomegaly

67
Q

Causes of HTN

A

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
Q

Causes of oedema

A 
Drugs - CCBs
Cardiac -CCF, cor pulmonale, constrictive pericarditis
Renal - nephrotic
Hepatic - cirrhosis
Malabsorption or starvation
Protein losing enteropathy
Myxoedema
Cyclical oedema
69
Q

Pansystolic murmurs

A
  • 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
Q

Ejection systolic murmurs

A
  • 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
Q

Late systolic murmurs

A
  • Mitral valve prolapse

- Papillary muscle dysfunction (usually ischemia or HCM)

72
Q

Early diastolic murmurs

A
  • Aortic regurgitation

- Pulmonary regurgitation (Graham Steele murmur if pulmonary HTN)

73
Q

Mid diastolic murmurs

A
  • 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
Q

Presystolic murmurs

A
  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma
75
Q

Continuous murmurs

A
  • 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
Q

MArfan’s Syndrome

A
  • 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
Q

Turner Syndrome

A
  • 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
Q

Down Syndrome

A
  • 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
Q

Noonan Syndrome

A
  • 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
Q

William Syndrome

A
  • Cardiac associations: AS, PS
  • Long, gaunt face with short nose, wide mouth with full lips
  • Small widely spaced teeth

BPT Shorts (6 decks)

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