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SHORT CASES > Cardio Shorts > Flashcards

Cardio Shorts Flashcards

1
Q

Mitral Regurgitation: Signs of Severity (5)

A
  1. Small pulse volume
  2. LVH - Displaced Apex beat (Volume Loaded) [or LAH - AF]
  3. Soft S1, Loud S3
  4. Pulmonary HTN
  5. CCF
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2
Q

Mitral Regurgitation: What is the murmur and its associations?

A

Pan-systolic murmur at the apex

  • Radiates to the axilla
  • Accentuated by Expiration (LS) and LLD position
  • Associated with - 1. LAH (AF), 2. LVH (Displaced apex beat), 3. Pulmonary HTN
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3
Q

Ddx of a suspected MR (Pan-systolic murmur at apex)

A
  1. AS (ESM)
  2. VSD
  3. HOCM (+ ESM)
  4. TR (R sided)
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4
Q

Mitral Regurgitation: Causes

A
  1. Primary - Valvular abnormalities [CRIED - P]
    - Congenital (MVP)
    - Rheumatic HD
    - IE
    - Degenerative [E.g. Weakening - Associated with CTD - Ehlers Danlos, Marfans]
    - Papillary rupture - IHD - Acute MR
  2. Functional (Secondary) - Secondary to LV Dilatation (CM - Ischaemia, Drugs, ETOH, Infiltrative (Sarcoid, Amyloid), Post infective myocarditis)
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5
Q

Mitral Regurgitation: Investigations

A

ECG - Arrhythmia (AF), LAH (Bifid P waves in Lead II, Broad in Lead V1), LVH (Voltage criteria - S Wave V1, + R Wave In V5/6 - >35mm)
CXR - Pulmonary congestion or cardiomegaly –> LAH (Splaying of the tracheal carina, Flattening of the L heart border and Double R heart border sign)
TTE - LV Function, Valve function (Assess the regurgitant jet (>50% = Severe) and any additional valvulopathies

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6
Q

Mitral Regurgitation: Management

A
  1. Management of Congestion or CCF
  2. Rate, Rhythm control and anticoagulation for AF
  3. Valve repair or replacement - Symptoms or Decreased EF
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7
Q

What the main differentiating feature for MVP? Causes of MVP?

A

Mid Systolic click - followed by the murmur - L sternal edge
Causes include;
-CTD: Marfans, Ehlers Danlos, SLE

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8
Q

Aortic Stenosis: What is the murmur and its associations?

A

Ejection Systolic murmur at the base (R Sternal edge)

  • Radiating to the Carotids
  • Accentuated by Expiration (LS)
  • Associations; Anacrotic (Low volume, slow rising pulse), Narrow pulse pressure
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9
Q

Aortic Stenosis: Signs of Severity (5)

A
  1. Low volume pulse
  2. Narrow pulse pressure
  3. Anacrotic carotid pulse - Slow Rising, Low volume
  4. Pressure loaded hyperdynamic Apex beat
  5. Aortic Thrill
  6. Soft S2, S4
  7. Signs of CCF
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10
Q

Aortic Stenosis: Causes

A
  1. Degenerative - calcification
  2. Bicuspid aortic valve (Associated with Aortopathy –> Coarctation, Turners Syndrome)
  3. IE
  4. RHD
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11
Q

Aortic Stenosis: Investigations

A

ECG: LVH, LAH
CXR: Cardiomegaly, Pulmonary congestion, Calcified valve
TTE: Assess LV Function and valve

Severe AS (Underestimated if Low LVF)

  • Valve area <1cm2
  • Velocity >4m/s
  • Mean gradient >40mmHg
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12
Q

Aortic Stenosis: Management

A

Surgical management - TAVI or AVR - Severe and symptomatic or rLVEF

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13
Q

HOCM: Characteristics of Murmur

A

Ejection Systolic murmur @ Left Lower sternal edge

  • Radiates up the sternum (Not to the carotids)
  • Accentuated by Valsalva (Decreases Preload)
  • Associated with MR (Systolic anterior motion of MV) - Pan-systolic murmur at the apex
  • Arrhythmia’s and ICD
  • S4
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14
Q

HOCM: Investigations

A

ECG - LVH, LAH, LAD, Q waves in Lateral or inferior leads (1, AVL, V5/6), Arrhythmia
CXR - Pulmonary congestion, Cardiomegaly
TTE - asymmetrical septal hypertrophy, LVOT obstruction + Systolic Anterior motion of the MV, Diastolic –> Systolic dysfunction

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15
Q

HOCM: Management

A
  1. Avoidance of Sport
  2. Support ventricular function - decreased LVOT - Beta blockers
  3. Avoid decreasing preload (Diuretics) - Maintaining Euvolaemia
  4. ICD if syncope or arrhythmia
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16
Q

HOCM: Poor prognostic features

A
  1. Hx of Syncope
  2. Family Hx of SCD
  3. Arrhythmia
  4. Ventricular wall thickness >40mm
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17
Q

Mitral Stenosis: What is the murmur and its associations?

A

Mid Diastolic murmur - At Apex (With bell)

  • Accentuated by Expiration and LLD position
  • Associated - Narrow pulse pressure, AF, Pulmonary HTN
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18
Q

Mitral Stenosis: Signs of Severity (5)

A
  1. Narrow pulse pressure
  2. Diastolic thrill at the apex
  3. Length of murmur
  4. Pulmonary HTN
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19
Q

Mitral Stenosis: Causes

A
  1. Rheumatic Heart disease
  2. Autoimmune: SLE, RA
  3. Degenerative - Calcification
  4. IE
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20
Q

Mitral Stenosis: Investigations

A

ECG - LA Enlargement, AF
CXR - Pulmonary congestion, Cardiomegaly, LA Enlargement
TTE - LVF, Valve area - <1cm = Severe, Pulmonary HTN

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21
Q

Mitral Stenosis: Management

A

Management of CCF and AF

Surgical correction - Valvuloplasty, repair or replacement - Severe, Symptoms or Pulmonary HTN

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22
Q

Aortic Regurgitation: What is the murmur and its associations?

A

Early Diastolic murmur - most audible at Left sternal edge

  • Accentuated by Expiration, Leaning forward
  • Associated - Collapsing pulse, widened pulse pressure (>50mmHg)
23
Q

Aortic Regurgitation: Signs of Severity (5)

A
  1. Collapsing pulse
  2. Widened pulse pressure
  3. Corrigan’s sign - JVP - Sharp rise and rapid collapse
  4. Soft S2, S3
  5. Earlier onset and Longer duration of murmur
  6. Austin Flint murmur - At Apex (Diastolic rumble) (Jet of AR which prevents opening of the Mitral leaflets - Stenotic )
  7. Signs of CCF
24
Q

Aortic Regurgitation: Causes

A 
CRIED-C, MAD --> Can affect the Valve or the aortic root 
Aortic Valve 
1. Congenital - Bicuspid 
2. Rheumatic Heart disease 
3. IE 
4. Dehiscence of prosthetic valve  
5. CTD - AS

Aortic root [MAD]

  1. Marfans or Ehlers danlos
  2. Aortitis - Ankylosing Spondylitis, RA, Syphilis
  3. D - Dissecting Aortic Aneurysm
25
Q

Aortic Regurgitation: Investigations

A

ECG - LVH or LAH
CXR - Pulmonary congestion, Cardiomegaly
TTE - Regurgitant jet >50% = Severe

26
Q

Aortic Regurgitation: Management

A

Medical management - HF therapy

Valve replacement - Severe + Symptoms (OR rLVEF)(Or Moderate to severe - requiring other cardiac surgery)

27
Q

What are the Three Non-cyanotic congenital heart disease

A

ASD, VSD, PDA

28
Q

VSD: Character of murmur and potential associations

A

Harsh Pansystolic murmur at the LSE - no change with inspiration/expiration

  • Smaller = Louder murmur
  • Can develop Pulmonary HTN –> Eisenmengers syndrome
29
Q

VSD and ASD: Causes

A
  1. Congenital
  2. Associated with Syndromes - Downs syndrome
  3. Post MI - Septal rupture
30
Q

VSD: Ix

A

ECG: LVH

31
Q

VSD and ASD: Mx

A

Surgical repair if Pulmonary to Systemic Blood flow > 1.5 :1

32
Q

ASD: Character of murmur and potential associations

A

Ejection systolic murmur at LSE (Ddx PS) - louder with inspiration
Fixed Split S2
-Can develop Pulmonary HTN –> Eisenmengers syndrome

33
Q

PDA: Character of murmur and potential associations

A

Loud continuous machinery murmur - LSE

    • Thrill
  • Collapsing pulse and Widened pulse pressure
34
Q

DDX of continuous murmur

A

PDA
Pulmonary or coronary arteriovenous fistula
Mixed valve pathology - MR/AR

35
Q

PDA: Causes

A
  1. Prematurity
  2. Maternal hypoxia - birth at high altitude
  3. Maternal Rubella
  4. Maternal Drug use - ETOH, Amphetamines
36
Q

Cyanotic Patient - Ddx

A

Congenital Heart disease
- Tetralogy of Fallot
- Eisenmengers syndrome - VSD, ASD, or PDA
Primary pulmonary pathology

37
Q

Eisenmenger’s Syndrome: Clinical features

A

Clubbing, Cyanosis
Pulmonary HTN: RV Heave, Loud P2, Raised JVP
+/- Murmur (Depending on Cause) - Split S2 if ASD, VSD no murmur, PDA - continuous machinery murmur
-Can have associated TR and R heart failure

38
Q

Eisenmengers Syndrome: Ix

A

ECG: RAD (negative Lead 1), RVH, R heart strain pattern, P Pulmonale

  • RVH: RBBB or Voltage criteria with prominent R wave in V 1 >7mm, Prominent S wave in V5/6 >7mm
  • RV Strain with STD and TWI in R sided precordial leads and inferior leads (V1-V4, II, III, AvF)
  • P Pulmonale (Prominent P wave in Lead II) - RA enlargement

CXR - Prominent Pulmonary vasculature

TTE - Assess underlying cause, Assess degree of pulmonary HTN

39
Q

Eisenmenger’s Syndrome: Management

A

Heart lung transplant

Phlebotomy for polycythaemia

40
Q

Tetralogy of Fallot: Clinical features

A
  1. VSD
  2. Overriding aorta
  3. RVH
  4. RVOT obstruction –> ESM (PS)
41
Q

Tetralogy of Fallot: Ix and Mx

A

Ix
ECG - RVH and RAD
CXR - Boot shaped heart due to RVH
TTE

Mx
Shunt surgery usually <1 YO

42
Q

Coarctation of the Aorta: Clinical sign

A

Weak L radial pulse - prior repair OR if proximal to subclavian
R-F Delay
HTN
Hypoplastic LL
Bicuspid AV - AR or AS
LVH - LV heave, Displaced apex beat, S4, LVF
Thoracotomy scar - previous repair

43
Q

Coarctation of Aorta: Associations

A

Bicuspid aortic valve, PDA and VSD
Turners syndrome: Female, Short stature, high arched palate, Webbed neck
PCKD and Berry aneurysms

44
Q

Coarctation of the Aorta: Ix

A

ECG: LVH , LAD
CXR: pulmonary congestion and LVH
ECHO:Bicuspid AV,LVH
CT/MRI

45
Q

Coarctation of the Aorta: Mx

A

Surgical repair or Balloon angioplasty

46
Q

Pulmonary Stenosis: Characteristic of murmur and associations

A
  1. ESM at LSE - loudest on inspiration (R sided)
    - Preceded by Ejection Click
  2. Widely Split S2
  3. Associated TR
  4. S4
47
Q

Pulmonary Stenosis: Causes

A
  1. Congenital
  2. Associated with Syndromes: Noonan Syndrome
  3. Rheumatic heart disease
  4. Carcinoid syndrome
48
Q

Pulmonary Stenosis: Ix and Mx

A

Ix
ECG - RVH, RAH, RAD, R heart strain

Mx
Balloon Valvuloplasty

49
Q

Pulmonary Regurgitation: Causes

A
  1. Primary
    - RHD
    - IE
    - Carcinoid syndrome
    - Iatrogenic - Post Balloon Valvuloplasty for PS, Post Tetralogy of ballot repair
    - CTD: Marfan syndrome
  2. Secondary - Any cause of Pulmonary HTN
50
Q

Tricuspid Regurgitation: Features on examination and associations

A

Pan-systolic murmur at upper LSE

  • ++ Inspiration (L sided)
  • Raised JVP - prominent V Waves
  • Pulsatile liver
  • May have signs of Pulmonary HTN
51
Q

Tricuspid Regurgitation: Causes

A
  1. Secondary (Functional) - Most common - Secondary to Pulmonary HTN
  2. Primary
    - Congenital - Ebsteins anomaly
    - RHD
    - IE
    - CTD
52
Q

Which heart sound is a prosthetic MV?

A

S1

53
Q

Which Heart sound is a prosthetic AV?

A

S2

SHORT CASES (5 decks)

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