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Cardio exam Flashcards

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3
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What are the features of the murmur of Aortic Stenosis (AS)?

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Ejection systolic murmur, loudest in aortic area, loudest in expiration, radiates to carotids.

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4
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What are the markers of severity in Aortic Stenosis? (7 + 1 biggest)

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Soft, delayed A2; reverse split S2; delayed and prolonged ESM; S4; low-volume and slow-rising pulse; narrow PP; heaving apex; parasternal heave; aortic thrill; bibasal crackles; quiet or absent 2nd heart sound is the biggest sign.

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5
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What are the differential diagnoses of AS murmur? 6

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HOCM, VSD, aortic sclerosis, aortic flow murmur, PS, supravalvular AS.

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6
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What are the common causes of Aortic Stenosis? (2 commonest, 6 rare)

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Congenital (BAV) and acquired (age, rheumatic heart disease).

Congenital heart disease, infective endocarditis, hyperuricaemia, alkaptonuria, Paget’s disease of bone

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7
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What are the complications of Aortic Stenosis? 3

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Endocarditis, LV dysfunction, conduction problems.

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8
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What are the echo markers of severity in Aortic Stenosis? 2

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Normal = AVA 3-4cm², mild = AVA >1.5cm², moderate = AVA 1-1.5cm², severe = AVA <1cm² or gradient >40mmHg.

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9
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What are the indications for Aortic Valve replacement in Aortic Stenosis? 3

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Severe or symptomatic AS, moderate/severe AS with other cardiac surgery, others (LVSD, abnormal BP response to exercise testing, valve area <0.6cm²).

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10
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What are Duke’s criteria for Infective Endocarditis? (2 major, 6 minor & how many of each needed)

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2 major, 1 major + 2 minor, 5 minor. Major: typical organism in 2 blood cultures, echo shows abscess, large vegetation, dehiscence.

Minor: fever >38°C, echo suggestive, predisposed (e.g. prosthetic valve), embolic phenomena, vasculitic phenomena, atypical organism on blood culture.

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11
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What are the most common organisms in Infective Endocarditis? 4

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S. aureus (most common, 30% mortality), viridans streptococcus (S. mitis, S. sanguinis), coagulase-negative Staphylococci (if prosthetic valve within 2 months), S. gallolyticus (if colon cancer, 15% mortality).

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12
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What are the indications for surgery in Infective Endocarditis? 5

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Severe valvular incompetence, aortic abscess, resistant bacterial infection, fungal infection, heart failure refractory to medical treatment, recurrent emboli after antibiotic treatment.

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13
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What are the features of the murmur of Aortic Regurgitation (AR)?

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Early diastolic murmur, loudest at LLSE, loudest forwards in expiration, mid-diastolic murmur (Austin-Flint) due to regurgitant flow impeding MV opening.

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14
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What are the markers of severity in Aortic Regurgitation? 5

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Collapsing pulse, wide pulse pressure, increased murmur duration, Austin-Flint murmur, S3, displaced apex, pulmonary oedema.

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15
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What are the differential diagnoses of collapsing pulse? 9

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AR, pregnancy, PDA, Paget’s disease of bone, anaemia, thyrotoxicosis, severe MR, fever, AV fistula.

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16
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What are the congenital causes of Aortic Regurgitation? 2

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BAV, peri-membranous VSD.

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17
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What are the acquired acute causes of Aortic Regurgitation? 3

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Endocarditis, aortic dissection, trauma.

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18
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What are the acquired chronic causes of Aortic Regurgitation? 5

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Hypertension, rheumatic heart disease, connective tissue diseases, pergolide, aortitis (syphilis, AS, vasculitis, Reiter’s, Takayasu’s).

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19
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What are the indications for Aortic Valve replacement in Aortic Regurgitation? 5

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Symptomatic (NYHA >2), severe AR with angina, LVEF <50%, LV enlargement >55mm systolic diameter, aortic root diameter >50mm (or 45mm in Marfan’s with family history of aortic dissection, or >3mm increase per year with Marfan’s).

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20
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What are the features of the murmur of Mitral Stenosis (MS)?

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Opening snap followed by mid-diastolic murmur, loudest at the apex, loudest on left side in expiration with the bell.

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21
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What are the markers of severity in Mitral Stenosis? 5

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Opening snap occurs nearer to A2, longer mid-diastolic murmur, pulmonary hypertension, congestive heart failure, narrow pulse pressure.

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22
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What are the causes of Mitral Stenosis? (1 commonest, 5 rare)

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Congenital (rare), acquired (rheumatic heart disease, senile degeneration, endocarditis), rare (SLE, RA, carcinoid syndrome).

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23
Q

What are the differential diagnoses of Mitral Stenosis murmur? 2

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Left atrial myxoma/thrombus, Austin-Flint murmur in severe AR.

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24
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What are the indications for Mitral Valve repair/replacement in Mitral Stenosis? 6

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Symptomatic MS, pulmonary hypertension, pulmonary oedema, haemoptysis, recurrent VTE despite anticoagulation, moderate-severe MS during other cardiac operation.

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25
What are the options for Mitral Valve repair/replacement in Mitral Stenosis? 3
Percutaneous mitral balloon commissurotomy (favorable anatomy, no LA thrombus, no MR), open commissurotomy with valve repair (favorable anatomy, no MR), metallic MV replacement (not suitable for commissurotomy, high mortality).
26
What are the features of the murmur of Mitral Regurgitation (MR)?
Pan systolic murmur, loudest at the apex, radiates to axilla, loudest in expiration.
27
What are the markers of severity in Mitral Regurgitation? 6
Soft S1, widely split S2, S3, S4, displaced apex, thrill over MV, mid-diastolic murmur from increased flow across MV, pulmonary hypertension, congestive heart failure, right heart failure.
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What are the congenital causes of Mitral Regurgitation? 2
Association between cleft MV and primum ASD.
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What are the acquired acute causes of Mitral Regurgitation? 3
Endocarditis, rupture post-MI, trauma.
30
What are the acquired chronic causes of Mitral Regurgitation? 6
Myomatous degeneration leading to prolapse, rheumatic heart disease, fibrosis from fenfluramine/pergolide/MI/trauma, dilated LV leading to functional MR, annular calcification, infiltration (amyloid).
31
What are the options for Mitral Valve repair/replacement in Mitral Regurgitation? 3
MV prolapse: percutaneous mitral clip (palliation), open valve repair with annuloplasty (preferred), open MV replacement.
32
What are the indications for Mitral Valve repair in Mitral Regurgitation? 3
When symptomatic (NYHA >2), asymptomatic + LVEF 30-60% + LV systolic diameter >40mm, asymptomatic + preserved LVEF + pulmonary hypertension or atrial fibrillation. If LVEF <30% may be too late.
33
What are the features of the murmur of Mitral Valve Prolapse?
Mid-systolic ejection click, pan systolic murmur that increases in volume towards A2, loudest in expiration.
34
What are the causes of Mitral Valve Prolapse? 5
Idiopathic (primary), familial (AD with incomplete penetrance), connective tissue diseases (SLE, Marfan’s, EDS, OI, PXE), ischemic heart disease, HOCM.
35
What are the features of the murmur of Tricuspid Regurgitation (TR)?
Pan systolic murmur, loudest in tricuspid area, loudest in inspiration, non-radiating, S3 from rapid RV filling.
36
What are the causes of Tricuspid Regurgitation? (1 congenital, 1 aquired acute, 3 acquired chronic)
Congenital (Ebstein’s anomaly), acquired acute (endocarditis), acquired chronic (functional from L side valve disease, chronic lung disease, congestive heart failure, chronic thromboembolic pulmonary hypertension, rheumatic heart disease, carcinoid syndrome).
37
What are the indications for Tricuspid Valve repair in Tricuspid Regurgitation? 3
Severe TR unresponsive to medical treatment, severe TR and undergoing L side valve operation, TR and undergoing L side valve operation and TV annular dilatation or right-sided heart failure.
38
What are the features of the murmur of Pulmonary Stenosis (PS)?
Ejection systolic murmur, loudest in pulmonary area, loudest in inspiration.
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What are the markers of severity in Pulmonary Stenosis? 2
Inaudible P2, longer murmur duration obscuring A2.
40
What are the causes of Pulmonary Stenosis? 4
Tetralogy of Fallot, Noonan’s syndrome, William’s syndrome, maternal rubella.
41
What is the management of Pulmonary Stenosis?
Mild (gradient <36mmHg): TTE every 5 years. Moderate (gradient 36-64mmHg): surgery if symptomatic. Severe (gradient >64mmHg or RV failure): pulmonary valvotomy, percutaneous pulmonary valve implantation, surgical repair/replacement.
42
What are the types of metallic prosthetic valves? 3
Starr-Edwards (ball and cage), Bjork-Shiley (single-tilting disc), St Jude (double-tilting disc).
43
What are the indications for metallic valve vs bioprosthetic valve?
Metallic: 20-30 years, requires warfarin. Bioprosthetic: 10-15 years, no warfarin. If on anticoagulation already, consider metallic. Avoid metallic if elderly or at risk of hemorrhage.
44
What are the late complications of prosthetic valves? (4 metallic, 2 bioprosthetic, 1 both)
Metallic: thromboembolus, bleeding, haemolysis, endocarditis. Bioprosthetic: dysfunction and LVF (can be treated percutaneously with valve in valve). Atrial fibrillation (especially if MVR).
45
What are the differential diagnoses of chest scar + device? 3
PPM, ICD, vagus nerve stimulator battery pack (with leads in neck).
46
What are the indications for Implantable Cardioverter Defibrillator (ICD)? (2 indications - one is a group for primary prevention, 3 secondary prevention)
Primary prevention: MI > 4 weeks ago + NYHA <3 + LVEF <35% + NSVT + positive EP study, LVEF <30% + QRSd >120ms, familial condition with high-risk SCD (LQTS, ARVD, Brugada, HCM, complex congenital HD). Secondary prevention: cardiac arrest due to VT or VF, haemodynamically compromising VT, VT with LVEF <35% and NYHA <4.
47
What are the indications for Cardiac Resynchronization Therapy (CRT) with BiV? 3
LVEF <35%, NYHA II-IV on optimal medical therapy, sinus rhythm + QRSd >150ms (if LBBB >120ms).
48
What are the causes of constrictive pericarditis? 4
Tuberculosis, trauma, surgery, tumor, radiotherapy, connective tissue diseases (SLE, RA).
49
What are the causes of pericarditis? 9
Viral (e.g. Coxsackie), tuberculosis, uraemia, post-MI (1-3 days fibrinous, weeks-months Dressler’s AI), radiotherapy, connective tissue diseases (SLE, RA), hypothyroidism, lung cancer, breast cancer, trauma.
50
What are the features of the murmur of Atrial Septal Defect (ASD)?
Pulmonary ejection systolic murmur, tricuspid flow murmur, fixed split S2.
51
What are the types of Atrial Septal Defect? 3
Primum (15-20%), secundum (80%), sinus venosus ASD.
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What are the complications of Atrial Septal Defect? 5
Paradoxical embolus, atrial arrhythmias, RV dilatation, pulmonary hypertension, Eisenmenger’s syndrome, endocarditis.
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Indications (2) and contraindications (2) for ASD closure
Symptomatic (paradoxical embolus, shortness of breath, platypnoea-orthodeoxia), significant shunt (Qp:Qs > 1.5:1, RV dilatation without/with reversible pulmonary hypertension). contraindications: Irreversible pulmonary hypertension, Eisenmenger's syndrome.
54
What are the options for ASD closure? 2
Percutaneous closure device (secundum only), surgical patch repair.
55
What are the features of the murmur of Ventricular Septal Defect (VSD)?
Systolic murmur well localized at left sternal edge, no radiation, no audible A2, disappears as gradient diminishes.
56
What are the congenital causes of VSD? 2
Down’s syndrome, tetralogy of Fallot.
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What are the acquired causes of VSD? 3
Traumatic, post-operative, post-MI.
58
What are the indications for VSD closure? 5
Recent endocarditis, AR, LV dilatation/dysfunction, reversible pulmonary hypertension, acute VSD secondary to MI.
59
What are the contraindications for VSD closure? 2
Irreversible pulmonary hypertension, Eisenmenger’s syndrome.
60
What are the options for VSD closure? 2
Percutaneous closure (Amplatzer device), surgical patch repair.
61
What are the causes of absent radial pulse? 3 acute, 3 chronic
Acute: embolism, aortic dissection, trauma. Chronic: atherosclerosis, coarctation, Takayasu’s arteritis.
62
What are the features of the murmur of Coarctation of the Aorta (CoA)?
Continuous murmur radiating to the back, loud A2.
63
What are the associations with Coarctation of the Aorta? (cardiac 3, non-cardiac 2)
Cardiac: VSD, BAV, PDA. Non-cardiac: Turner’s syndrome, berry aneurysms.
64
What are the options for management of Coarctation of the Aorta? 4
Long-term anti-hypertensive, long-term follow-up/surveillance with MRA (late aneurysms and recoarctation), percutaneous EVAR, surgical Dacron patch aortoplasty.
65
What are the features of the murmur of Patent Ductus Arteriosus (PDA)?
Loud continuous machinery murmur, loudest below left clavicle, loudest in systole, may be heard posteriorly.
66
What are the causes of Patent Ductus Arteriosus? (4 maternal drugs, 5 others)
Prematurity, low birth weight, maternal prostaglandins, phenytoin, amphetamine, alcohol, maternal rubella in T1, high altitude, maternal hypoxia.
67
What are the complications of Patent Ductus Arteriosus? 4
LV failure, pulmonary hypertension, Eisenmenger’s syndrome, endocarditis.
68
What are the indications for PDA closure? 3
Symptomatic left to right shunt, left atrial enlargement, left ventricular enlargement, reversible pulmonary hypertension.
69
What are the contraindications for PDA closure? 2
Irreversible pulmonary hypertension, Eisenmenger’s syndrome.
70
What are the options for PDA repair? 2
Percutaneous catheter-occlusion, surgical repair.
71
What are the features of the murmur of Hypertrophic Obstructive Cardiomyopathy (HOCM)?
Ejection systolic murmur, loudest at lower left sternal edge, radiates throughout precordium, loudest on expiration, S4.
72
What are the associated conditions with HOCM? 2
Friedreich’s ataxia, myotonic dystrophy.
73
What are the complications of HOCM? 5
Endocarditis, sudden cardiac death, atrial fibrillation, congestive heart failure, angina.
74
What are the management strategies for HOCM? (3 things to avoid, 6 others)
Asymptomatic: avoid strenuous exercise, dehydration, vasodilators. Symptomatic and LVOT gradient >30mmHg: beta blockers, PPM, alcohol septal ablation, surgical myomectomy. Rhythm disturbance/high-risk SCD: ICD. Refractory: heart transplant.
75
What are the criteria for high-risk sudden cardiac death in HOCM? 6
First-degree relative with SCD, history of SVT, history of syncope, abnormal BP response to exercise, LV failure, LV apical aneurysm.
76
What are the poor prognostic factors in HOCM? 4
Young age at diagnosis, syncope, family history of SCD, septal thickness >3cm.
77
What are the ECG signs of dextrocardia? 3
Inverted P waves and QRS complexes in lead I, reverse R-wave progression, normal with right-sided leads.
78
What are the components of the CHADSVASC Score?
CCF, hypertension, age 65-74 = 1, >74 = 2, diabetes mellitus, stroke/TIA, vascular disease (prior MI, PAD, aortic plaque), sex category.
79
What are the components of the HASBLED Score?
HTN Abnormal liver/renal function (1 or 2) Stroke Bleeding, prior major Labile INR Elderly (>65yo) Drugs (antiplatelet/NSAID) or alcohol use (>8 units/week) (1 or 2)

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