Cardio High Yield Flashcards
peripheral cyanosis
clubbing - IE, chronic heart failure, cyanotic congenital heart disease, atrial myxoma
splinter haemorrhages - IE
osler nodes
janeway lesions
quincke’s sign - AR
pale conjunctiva - anaemia
corneal arcus - hyperlipidaemia
xanthelasma
central cyanosis - hypoxia
raised JVP - causes = STOPT
SVCO
TR
Overload / RVF
Pulmonary HTN
Tamponade
pectus excavatum
pectus carinatum
peripheral oedema
displaced apex beat causes
LV dilation e.g. MR or AR
Cardiomegaly
Displacement due to RV enlargement or mediastinal shift
slow rising low volume pulse
AS
bounding/collapsing pulse
AR, PDA
high-output states - anaemia, thyrotoxicosis, physiological state e.g. pregnancy, fever
irregularly irregular rhythm
AF, ectopics, flutter w/variable block
regularly irregular rhythm
2nd degree heart block
radio-radial / radio-femoral delay
aortic dissection / aneurysm, coarctation
systolic murmurs vs diastolic murmurs examination
systolic murmurs e.g. MR and AS radiate
- MR = to axilla
- AS = to carotids
diastolic murmurs e.g. MS and AR are quiet and need accentuation movements
- MS = lean to left
- AR = lean forward
Causes of AS
✅ Degenerative (Calcific) Aortic Stenosis – Common in elderly due to wear and tear.
✅ Bicuspid Aortic Valve – Congenital cause leading to early calcification (presents <65 years).
Causes of AR
✅ Aortic Root Dilatation – e.g., Marfan syndrome, aortic dissection, syphilitic aortitis.
✅ Valvular Disease – e.g., Rheumatic heart disease, infective endocarditis.
Causes of MR
✅ Primary (Valve Disease):
Mitral valve prolapse (MVP)
Rheumatic heart disease
Infective endocarditis
✅ Secondary (LV Dilatation or Papillary Muscle Dysfunction post-MI):
Ischaemic heart disease
Dilated cardiomyopathy
Causes of MS
✅ Rheumatic Heart Disease (most common).
✅ Congenital Mitral Stenosis (e.g., parachute mitral valve).
✅ Mitral Annular Calcification (elderly patients).
Austin-flint murmur
A low-pitched, mid-diastolic murmur heard at the apex in severe aortic regurgitation.
Caused by regurgitant blood from the aorta hitting the anterior mitral valve leaflet, leading to premature mitral valve closure.
5 eponymous signs of AR
- Corrigan’s Sign – Bounding carotid pulse.
- Quincke’s Sign – Pulsations in nail beds.
- De Musset’s Sign – Head bobbing with each heartbeat.
- Traube’s Sign – Pistol-shot sounds over the femoral arteries.
- Duroziez’s Sign – Diastolic murmur heard over the femoral artery with pressure.
Aortic stenosis vs Aortic sclerosis
✅ Aortic Stenosis (AS):
Harsh ejection systolic murmur loudest at right upper sternal edge, radiates to carotids.
Reduced or delayed carotid upstroke (pulsus parvus et tardus).
S2 may be soft or absent (due to calcification preventing valve closure).
✅ Aortic Sclerosis (ASc):
Also ejection systolic murmur but does NOT radiate to carotids.
Normal pulse & carotid upstroke.
Normal S2 (valve still mobile).
🔹 Key Test: Echocardiogram – AS shows valve narrowing & pressure gradient, ASc does not.
MR vs TR
upper right sternal edge
❤️ Aortic Stenosis ❤️
Character: ejection systolic
Best heard: upper right sternal edge; loudest on expiration
Radiation: carotids and apex
Sx and signs of AS
upper right sternal edge
❤️ Aortic Sclerosis ❤️
Character: ejection systolic
Best heard: upper right sternal edge
Radiation: does not radiate
apex
❤️ Mitral regurg ❤️
Character: pansystolic
Best heard: apex; loudest on expiration
Radiation: left axilla
Sx and signs of MR
apex
❤️ Mitral valve prolapse ❤️
Character: mid-systolic click and/or late systolic murmur
Differentiate from MR by normal S1 then gap before murmur
Best heard: apex; loudest on expiration
Radiation: left axilla and back
mitral valve prolapse associations
Connective tissue diseases
Primary congenital
Polycystic kidney disease
Hypertrophic obstructive cardiomyopathy
SLE
Muscular dystrophy
lower left sternal edge
❤️ Tricuspid regurg ❤️
Character: pansystolic
Differentiate from MR by…
louder on inspiration because it’s on the right
Giant JVP
Non-displaced apex
Best heard: lower left sternal edge; loudest on inspiration
Radiation: nonev
Sx and signs of TR
TR causes
Most commonly due to RV dilation in pulmonary hypertension (e.g. in chronic lung disease)
Rheumatic heart disease
Infective endocarditis (IV drug user)
Ebstein’s anomaly (if split S1 and S2)
How would you clinically assess the severity of aortic stenosis?
✅ Echocardiography (Gold Standard) – Measures valve area and pressure gradient.
✅ ECG – May show left ventricular hypertrophy (LVH).
✅ CXR – May show post-stenotic aortic dilatation.
What are the general indications for a valve replacement?
🔹 Symptomatic severe valve disease – Any symptoms (SOB, syncope, angina).
🔹 Severe stenosis with LV dysfunction – EF <50%.
🔹 Severe stenosis in high-risk situations – e.g., before major surgery or in young patients.
🔹 Severe regurgitation with progressive LV dilatation (LV end-systolic diameter >50mm).
What are the possible risks and complications of a valve replacement?
Early Complications
⚠️ Bleeding & Infection – Post-op risks.
⚠️ Valve Thrombosis & Embolism – More common with mechanical valves.
⚠️ Stroke – Due to embolisation.
⚠️ Arrhythmias – Due to conduction system injury.
Late Complications
⚠️ Structural Valve Degeneration – More common with bioprosthetic valves.
⚠️ Prosthetic Valve Endocarditis – Lifelong risk, requires antibiotics for prevention.
⚠️ Lifelong Anticoagulation (Mechanical Valves) – Warfarin needed to prevent thrombosis.
valve replacement signs
midline sternotomy
abnormal S1 = mitral
abnormal S2 = aortic
HF signs
Tachypnoea/tachycardia
Cool peripheries
Raised JVP
Displaced apex
S3 (ventricular gallop)
Bi-basal fine crepitations
Peripheral oedema
Cor pulmonale signs
Plethoric facial appearance
Central cyanosis
Raised JVP (large ‘a’ waves)
Giant V waves + pansystolic murmur (if secondary TR)
Right ventricular heave
Palpable/loud S2
Pedal oedema
HOCM signs
Pacemaker/implantable cardioverter defibrillator
Jerky pulse/pulsus bisferiens
Double apex beat
Ejection systolic murmur (left lower sternal edge)
S4
What is Eisenmenger syndrome?
Definition: Reversal of a left-to-right shunt (e.g., VSD, ASD, PDA) into a right-to-left shunt due to pulmonary hypertension, causing cyanosis and clubbing.
Signs: Central cyanosis, clubbing, polycythaemia, RV failure.
What are the different types of valves that can be used for a valve replacement?
✅ Mechanical Valves – Durable but require lifelong anticoagulation (warfarin).
✅ Bioprosthetic Valves – Shorter lifespan (~10–15 years) but no anticoagulation needed.
🔹 Choice depends on age, bleeding risk, and patient preference.
LHF vs RHF
Which conditions would cause a crescendo-decrescendo systolic murmur?
✅ Aortic Stenosis – Ejection systolic murmur, radiates to carotids.
✅ Hypertrophic Obstructive Cardiomyopathy (HOCM) – Similar to AS but louder with Valsalva.
✅ Pulmonary Stenosis – Left upper sternal edge, increases with inspiration.
What are the different types of cardiomyopathies?
What is the tetrad of abnormalities in Tetralogy of Fallot?
- Pulmonary Stenosis (RV outflow obstruction).
- Right Ventricular Hypertrophy (RVH) (Boot-shaped heart on CXR).
- Overriding Aorta (Aorta positioned over VSD).
- Ventricular Septal Defect (VSD) (Causes right-to-left shunting → cyanosis).
upper right sternal edge / lower left sternal edge leaning forwards
❤️ Aortic regurg ❤️
Character: Early diastolic (sounds like a breath)
Best heard: upper right sternal edge (or lower left sternal edge sitting forwards); loudest on expiration
Radiation: none
Sx and signs of AR
apex in left lateral position
❤️ Mitral stenosis ❤️
Character: low rumbling mid-diastolic with opening snap
Best heard: apex in left lateral position; loudest on expiration using bell of stethoscope
Radiation: none
Sx and signs of MS
Criteria for IE diagnosis
✅ Diagnosis requires:
Definite IE = 2 Major, or 1 Major + 3 Minor, or 5 Minor
Possible IE = 1 Major + 1 Minor or 3 Minor
🔹 Major Criteria (2)
1️⃣ Positive Blood Cultures (Typical IE organisms in ≥2 separate cultures or persistently positive cultures)
🦠 Strep viridans, Staph aureus, Enterococcus, HACEK group
2️⃣ Evidence of Endocardial Involvement
Vegetation, abscess, or prosthetic valve dehiscence on ECHO (TTE/TOE)
New regurgitant murmur
🔸 Minor Criteria (5)
1️⃣ Predisposing Heart Condition (e.g., prosthetic valve, congenital heart disease, IVDU)
2️⃣ Fever ≥38°C
3️⃣ Vascular Signs (e.g., emboli, Janeway lesions, splenic infarcts, stroke)
4️⃣ Immunological Signs (e.g., Osler’s nodes, Roth spots, GN, RF+)
5️⃣ Positive Blood Culture Not Meeting Major Criteria
✅ Mnemonic: “BE FEVER”
Blood culture (+)
Echo findings
Fever
Embolic signs
Vascular signs
Endocardial involvement
Risk factors
abx for IE
indications for valve replacement / debridement in IE
- Heart failure due to valve destruction.
- Uncontrolled infection despite antibiotics (>7 days, persistent fevers).
- Large vegetation (>10mm) with embolic risk (e.g., stroke).
- Prosthetic valve IE.
during S1
metallic mitral valve
What is TAVI?
