Cardiology Flashcards
What are the clinical signs of aortic stenosis
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
what are the possible complications of aortic stenosis
endocarditis
left ventricular dysfucntion
conduction probelms
what are the differential diagnosis of AS
HOCm
VSD
Aortic sclerosis - normal pulse character and no radiation
aortic flow - high output clinical states
what are the cuases of AS
congenital - bicuspid
acquired - age or streptococcal (rheumatic fever)
what are the associations with AS
coarctation and bicuspid aortic valve
angiodysplasia
what are the investigations for AS
ECG
CXR - often normal or calcified valve
echo - mean gradient >40 if severe
catheter - invasive transvavular gradient and coronary angiography
what is the management of asymptomatic AS
None - advice good dental health (decrease risk of bacterial infection)
Regular reviews - symptoms and echo to assess gradient and LV function
what is the management of symptomatic AS?
surgical - aortic valve replacement +/- CABG
percutaneous - balloon aortic valvuloplasty or Transcutaneous aortic valve implantation
If prosthetic valve may think about endocarditis prophylaxis
what are the clinical signs of aortic regurg?
collapsing pulse reflecting a wide pulse pressure
apex beat is hyperkinestic and dispalced laterally
thrill in the aortic area
what is the mumur seen in aortic regurg
eary diastolic mumur loudest at the left lower sternal edge with the pt sat forward in expiration
what are the signs of aortic regurg severity
collapsing pulse, third heart sound and pulm oedema
what are the eponymous signs with aortic regurg
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
what are the other causes of a collapsing pulse?
pregnancy PDA pagets disease anaemia thyrotoxicosis
what investigations do you want to perform in aortic regurg
ECG - lateral T wave inversion
CXR - cardiomegaly, pulm oedema
Echo
cardiac catheterisation - rate severity aortogram and check coronary pacing
what is the management of aortic regurg
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
what are the clinical signs of mitral stenosis
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
what will the mumur be in mitral stenosis
loud first heart sound - opening snap
loud S1
mid diastolic mumur
what are the differentials for mitral stenosis
left atrial myxoma
austin flint mumur
what investigations should you do in a pt with mitral stenosis
ECG - p-mitrale and AF
CXR
Trans-oesophageal echocardiogram
what is the medical management of mitral stenosis
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
what are the clinical features of mitral regurg
scars - lateral thoractomy pulse - AF small volume apex displaced and volume loaded palpation - thrill at apex pulm oedema signs of endocarditis
what investigations should you perform in mitral regur
ECG
CXR
transoesophageal echo
what is the management of mitral regurg
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
what is the mumur like in mitral regurg
pan-systolic mumur with wide splitting of S2
s3 indicates rapid ventricular filling from LA
what does a midline sternotomy suggest
CABG, AVR, MVR
what does a lateral thoractomy scar suggest
MVR, mitral valvotomy, coarctation repair
what does a subclavicular scar suggest
pacemaker, implantable cardioverter defibrillator
what does a scar in the anticubital fossa suggest
angiography
how may an atrial spetal defect present?
Raised JVP
pulm area thrill
fixed split second heart sound (doesnt alter with respiration)
possible signs of pulm hypertension or congestive heart failure
