Cardiology

Question 1

What are the clinical signs of aortic stenosis

Answer 1

slow rising, low volume pulse 
narrow pulse pressure 
apex beat is Sustained in Stenosis 
Thrill in aortic area 
Ausculatation = cresendo decresendo ejection systolic mumur loudest in expiration and radiating to carotids

Question 2

what are the possible complications of aortic stenosis

Answer 2

endocarditis
left ventricular dysfucntion
conduction probelms

Question 3

what are the differential diagnosis of AS

Answer 3

HOCm
VSD
Aortic sclerosis - normal pulse character and no radiation
aortic flow - high output clinical states

Question 4

what are the cuases of AS

Answer 4

congenital - bicuspid

acquired - age or streptococcal (rheumatic fever)

Question 5

what are the associations with AS

Answer 5

coarctation and bicuspid aortic valve

angiodysplasia

Question 6

what are the investigations for AS

Answer 6

ECG
CXR - often normal or calcified valve
echo - mean gradient >40 if severe
catheter - invasive transvavular gradient and coronary angiography

Question 7

what is the management of asymptomatic AS

Answer 7

None - advice good dental health (decrease risk of bacterial infection)
Regular reviews - symptoms and echo to assess gradient and LV function

Question 8

what is the management of symptomatic AS?

Answer 8

surgical - aortic valve replacement +/- CABG
percutaneous - balloon aortic valvuloplasty or Transcutaneous aortic valve implantation
If prosthetic valve may think about endocarditis prophylaxis

Question 9

what are the clinical signs of aortic regurg?

Answer 9

collapsing pulse reflecting a wide pulse pressure
apex beat is hyperkinestic and dispalced laterally
thrill in the aortic area

Question 10

what is the mumur seen in aortic regurg

Answer 10

eary diastolic mumur loudest at the left lower sternal edge with the pt sat forward in expiration

Question 11

what are the signs of aortic regurg severity

Answer 11

collapsing pulse, third heart sound and pulm oedema

Question 12

what are the eponymous signs with aortic regurg

Answer 12

corrigan’s sign - visible vigourous neck pulsation
quinckes sign- nail bed pulsitation
de mussets sign - head nodding
traubes - pistol shot osund over hte femoral arteries

Question 13

what are the other causes of a collapsing pulse?

Answer 13

pregnancy
PDA
pagets disease
anaemia
thyrotoxicosis

Question 14

what investigations do you want to perform in aortic regurg

Answer 14

ECG - lateral T wave inversion
CXR - cardiomegaly, pulm oedema
Echo
cardiac catheterisation - rate severity aortogram and check coronary pacing

Question 15

what is the management of aortic regurg

Answer 15

Medical - ACEi/ARB
regular review of sx and echo - check LVEF, size degree of AR
Surgery - depending on cuase
if chronic - valve replacement when symptomatic or severe ideally before left vetnricular dilatation and dysfunction

Question 16

what are the clinical signs of mitral stenosis

Answer 16

malar flush
irregular pulse if AF
tapping apex
left parasternal heave if pulm hypertension

embolic complications - stroke risk high in MS if pt has AF

Question 17

what will the mumur be in mitral stenosis

Answer 17

loud first heart sound - opening snap
loud S1
mid diastolic mumur

Question 18

what are the differentials for mitral stenosis

Answer 18

left atrial myxoma

austin flint mumur

Question 19

what investigations should you do in a pt with mitral stenosis

Answer 19

ECG - p-mitrale and AF
CXR
Trans-oesophageal echocardiogram

Question 20

what is the medical management of mitral stenosis

Answer 20

medical +AF - rate control and oral anticoag, diuretics
mitral valvuloplasty - if pliable, non-calcified with mitral regurg and no left atrial thrombus
surgery - closed/open mitral valvotomy or valve replacement

Question 21

what are the clinical features of mitral regurg

Answer 21

scars - lateral thoractomy 
pulse - AF small volume 
apex displaced and volume loaded
palpation - thrill at apex 
pulm oedema 
signs of endocarditis

Question 22

what investigations should you perform in mitral regur

Answer 22

ECG
CXR
transoesophageal echo

Question 23

what is the management of mitral regurg

Answer 23

medical - anticoag for AF or embolic complications, diuretic, Bblocker, ACEi
percutaneous - mitral clip for palliation
surgical - valve repair with annuloplasty ring or replacement
aim to operate when symptomatic prior to severe LV dilation and dysfunction

Question 24

what is the mumur like in mitral regurg

Answer 24

pan-systolic mumur with wide splitting of S2

s3 indicates rapid ventricular filling from LA

Question 25

what does a midline sternotomy suggest

Answer 25

CABG, AVR, MVR

Question 26

what does a lateral thoractomy scar suggest

Answer 26

MVR, mitral valvotomy, coarctation repair

Question 27

what does a subclavicular scar suggest

Answer 27

pacemaker, implantable cardioverter defibrillator

Question 28

what does a scar in the anticubital fossa suggest

Answer 28

angiography

Question 29

how may an atrial spetal defect present?

Answer 29

Raised JVP
pulm area thrill
fixed split second heart sound (doesnt alter with respiration)
possible signs of pulm hypertension or congestive heart failure