Cardiology Flashcards
HOCM Clinical signs
- Pulse: Jerky
- Double carotid impulsations
- Prominent a waves
- Apex: Undisplaced, double impulse, pressure loaded
- Systolic thrill
- S2- Reverse split
- S4
- ESM at LLSE- Louder with Valsalva, Softer with isometric hand grip
HOCM Complications
Biventricular failure Arrhythmia; AF, VT SCD Angina Endocarditis
HOCM Poor prognosis
1. Clinical History of syncope Family history of SCD 2. Investigations Holter evidence of Ventricular arrhythmias BP drop with exercise 3. Echo Asymmetrical septal wall thickening >30mm Systolic anterior motion
HOCM Investigations
ECG: LVH, LAD, Q waves anterolaterally, ST changes CXR: Cardiomegaly ECHO: LVH, septal hypertrophy, LVOT Exercise testing/Holter monitor Angiogram- right and left
HOCM treatment
Non-pharmacological
Pharmacological if symptomatic: BB
Alcohol septal ablation
Eisenmenger’s syndrome
Pulmonary hypertension with shunt reversal
Eisenmenger Complications
Haemoptysis RVF Paradoxical emboli IE SCD Polycythemia Thrombosis Bleeding
Tetralogy of fallot
VSD
RVOT
RVH
Overriding aorta
Fallot’s Tetralogy Complications
Cyanosis IE RHF Polycythaemia Thrombosis Paradoxical emboli
Fallot’s Tetralogy Investigations
ECG: RVH, RAD
CXR: Boot shaped heart
ECHO: AR, Pul Htn
Fallot’s Tetralogy signs
Central cyanosis Clubbing Diminished Left radial pulse BP lower in Left arm Absent a waves Thoracotomy scar Normal apex beat/Volume loaded Parasternal heave Palpable A2 Murmur: ESM (RVOT), AR (prolapse of coronary cusp
PDA clinical signs
Clubbing of toes Pulse: large volume, collapsing Wide pulse pressure Parasternal heave Left subclavicular thrill Apex displaced, thrusting Continuous machine murmur
Cause Collapsing pulse
AR PDA Fever Thyrotoxicosis Anaemia Pregnancy AVF Severe bradycardia
Continuous murmurs
PDA
Mixed mitral and aortic disease
VSD
AVF
PDA complications
IE
LVF
Pulmonary hypertension
Eisenmenger’s syndrome
Coarctation of aorta Clinical signs
Upper torso better developed Radial-radial delay Vigorous carotid pulsations Radio-femoral delay Apex pressure loaded Ejection click ESM at LSE and posteriorly
Coarctation associated with
Bicuspid aortic valve
PDA
VSD
Transposition of great vessels
ASD clinical signs
Fixed spilt of S2
ESM at upper LSE
Wide split S2
ASD
VSD
MR
RBBB
VSD clinical signs
Parasternal thrill
PSM at LLSE
Pulmonary hypertension signs
JVP: prominent a and v waves Parasternal heave Palpable P2 Loud P2 PSM at LLSE, Inspiration RVF
PHTN Types
Primary LV disease Lung CTE Other
PHTN Inx
ECG: RAD, RVH, biphid P waves, RBBB CXR: Prominent pulmonary vasculature, ?Cause: cardiomegaly, hyperinflation, reticular nodular opacifications ABG ECHO CT/V/Q PFT HRCT RHC- PAP >25 mmHg, wedge >15mmHg
JVP
A- atrial contraction x: emptying C: Tricuspid closure v: filling RA y: open Tricuspid
AR clinical signs
Large volume, Collapsing pulse Wide pulse pressure Visible carotid pulsations Apex: displaced volume loaded Early diastolic murmur, expiration PH/CCF
Causes AR
Aortic: dissection, aortitis, marfans
Valvular: biscupid, RHD, CTD, IE
Eponymous signs
Corrigans: visible carotid pulsations
Quinke’s: Nailbed pulsations
De Musset: Head nodding
Muller: Uvula pulsations
AR surgical indications
Symptomatic: Serve AR
Asymptomatic: LVF (EF <50%), LVESD >55 mm, Aortic Root > 50 mm
