Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Talley list > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Go through the Cardiovascular Short Case

A

Praecordium

  • Palpate: left parasternal impulse = RVH or LAE
  • Auscultation (apex then left sternal edge then base) (below left clavicle for PDA):
    • identify 1st and second heart sounds and decide if they sound normal or are split
    • listen for extra sounds or prosthetic sounds (ball case = sharp opening; tilting disc = soft open, sharp close)
    • repeat palpation and auscultation in left lateral then sitting forward
    • lateral for tapping apex and MS with bell
    • forward at end expiration for thrills or murmurs at left sternal edge and base
  • dynamic always if unsure of diagnosis
  • valsalva always with systolic murmur (louder if HCM; MVP murmur longer, click earlier; softer rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Go through the various descriptions of carotid pulse character

A

Anacrotic, plateau, bisferiens, collapsing, small volume, alternans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes of a continuous murmur?

A
  • PDA
  • AVF (coronary artery, pulmonary, systemic)
  • Venous hum
      • over right supraclavicular fossa
      • abolished by compression of ipsilateral IJV
  • Ruptured sinus of valsalva into RA/RV
  • Aortopulmonary connection
  • Mammary souffle
      • late pregnancy or early postpartum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of a third and fourth heart sound?

A

Third - mechanism: tautening of mitral/tricuspid cusps at the end of rapid diastolic filling

  • *Left Ventricle** (loudest at apex on expiration)
  • Physiological (<40yo, pregnant)
  • LVF
  • AR, MR
  • VSD, PDA
  • *Right Ventricle** (loudest at left sternal edge on inspiration)
  • RVF
  • constrictive pericarditis
  • *Fourth** (always abnormal)
  • mechanism: high atrial pressure wave reflected from poorly compliant ventricle
  • *Left Ventricle**
  • AS
  • acute MR
  • hypertension
  • IHD
  • HCM
  • *Right Ventricle**
  • pulmonary hypertension
  • PS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of altered first heart sound?

A

Loud

    • mitral/tricuspid stenosis
    • tachycardia, hyperdynamic circulation

Soft

    • mitral regurgitation, calcified mitral valve
  • - LBBB
    • 1st degree AVB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of altered second heart sound?

A

Aortic:

  • Loud: congenital AS, hypertension
  • Soft: calcified AV, AR

Pulmonary:

  • Loud: pulmonary hypertension
  • Soft: pulmonary stenosis

Increased normal splitting

    • RBBB (later P2)
    • PS (later P2)
    • VSD
    • MR (earlier A2)

Reversed splitting

    • LBBB
    • AS (severe)
    • coarctation
    • PDA (large)

Fixed splitting

    • ASD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of mixed aortic valve disease?

A

Causes

  • degenerative
  • IE
  • rheumatic
  • CTD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the causes, signs of severity, and results of investigations for aortic regurgitation (AR)?

A

Early diastolic murmur with decrescendo character in aortic region (or left lower sternal edge). Loudest on exp leaning forward

Note:

  • may have a loud systolic murmur without any associated aortic stenosis
  • look for peripheral signs to point to the lesion

Causes

  • Chronic
    • Valvular: Rheumatic; congenital (bicuspid, VSD); seronegative arthropathy
    • Aortic root (may be maximal at right sternal border): Marfan’s, aortitis (seroneg arth, RA, syphilis); dissection; age
  • Acute
    • Valvular: IE
    • Aortic root: Marfan’s, hypertension, dissection

Severity

  • collapsing pulse
  • wide pulse pressure
  • length of decrescendo diastolic murmur
  • S3
  • soft A2
  • Austin Flint murmur (diastolic rumble/mitral stenosis due to limitation to mitral inflow by regurgitant jet)
  • LVF

Investigations

  • ECG: LVH
  • CXR:
    • LV dilatation
    • aortic root dilatation
    • valve calcification

Indications for surgery (symptoms, worsening LV function, progressive dilatation)

  • aortic root >50mm with Marfan’s, bicuspid >50mm with RFs, others >55mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes, signs of severity, and results of investigations for aortic stenosis (AS)?

A

Causes

  • Degenerative (older)
  • Rheumatic (rarely alone)
  • Calcified bicuspid (younger)

Severity

  • plateau pulse
  • aortic thrill (important for severity)
  • length, harshness, and lateness of the systolic murmur
  • S4
  • paradoxical splitting of S2 (delayed LV ejection and valve closure)
  • LVF (RVF is pre-terminal)

Investigations

  • ECG: LVH
  • CXR
  • LVH
  • valve calcification
  • TTE - <1cm; mean grad >40mmHg; vel >4cm; DI <0.25
  • LVH/LVdysfunction

Intervention

  • severe AS with symptoms related to AS (normal or with stress testing)
  • severe AS and having other cardiac/aortic surgery (even if AS asymptomatic)
  • severe asymptmatic AS with LV dysfunction thought due to AS
  • severe asymptomatic AS with abnormal stress test thought due to AS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes, signs of severity, and results of investigations for mitral regurgitation (MR)?

A
  • Causes
  • Chronic
    • Degenerative
    • MVP
    • Rheumatic (M > F; rarely the only murmur present)
    • Papillary dysfunction (LVF; ischaemia)
    • CTD (RA, AS)
    • congenital: endocardial cushion defect, parachute valve, corrected transposition
  • Acute
    • IE (perforation anterior leaflet); rupture of myxomatous cord
    • AMI (chordae rupture; papillary muscle dysfunction)
    • Surgery
    • Trauma

Severity

  • Dilated LV
  • Pulmonary hypertension
  • Soft S1
  • Early A2
  • S3
  • Early diastolic rumble
  • LVF
  • small volume pulse (very severe)

Investigations

  • ECG: mitrale; AF; LV diastolic overload; RAD
  • CXR:
  • large LA
  • increased LV size
  • mitral annular calcification
  • pulmonary hypertension
  • TTE:
  • thickened (rheumatic)
  • prolapsing
  • LA size (chronicity)
  • LV size/function
  • associated: aortic valve (rheumatic), ASD associated with prolapse
  • annulus calcification

Indications for surgery (severe)

  • repair preferable to replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes, signs of severity, and results of investigations for mitral stenosis (MS)?

A

Causes

  • rheumatic
  • severe annular calcification (rare)
  • after repair for MR (rare)
  • congenital (very rare; e.g. parachute valve with all chordae into one papillary)

Severity

  • small pulse pressure
  • early opening snap (raised LA pressure)
  • length of mid diastolic rumbling murmur
  • diastolic thrill at apex (rare)
  • pulmonary hypertension
  • <1cm valve area
  • ECG: RV hypertrophy, RAD

Investigations

  • ECG: mitrale in sinus; AF (chronicity)
  • CXR:
    • MV calcification
    • big left atrium: –> double LA shadow, displaced left bronchus, big LA appendage, carina angle > 90 degrees, convex left atrial appendage
  • pulm htn: large central PAs, pruned peripheral PAs
  • cardiac failure

Associated LV dilatation, think associated:

  • MR
  • AV disease
  • hypertension
  • IHD

Indications for surgery

    • symptomatic and severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the causes, signs of severity, and results of investigations for pulmonary stenosis (PS)?

A

Causes

  • congenital
  • carcinoid

Signs

  • peripheral cyanosis (low CO)
  • normal/reduced pulse (low CO)
  • JVP: giant a waves, may be elevated
  • RV heave; pulmonary area thrill (common)
  • presystolic pulsation of liver
  • harsh ESM loudest in inspiration
  • may have ejection click, may have S4

Severity

  • ESM peaking late
  • absent ejection click (when stenosed below the valve level)
  • S4
  • RVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes, signs of severity, and results of investigations for tricuspid regurgitation (TR)?

A

Causes

  • Functional (RVF)
  • Rheumatic (very rarely alone)
  • IE
  • Congenital (Ebstein’s)
  • Prolapse (rare)
  • RV papillary muscle infarction
  • Trauma

Signs

  • JVP: large v waves; elevated in RVF
  • RV heave
  • pulsatile, large, tender liver
  • ascites/oedema with pleural effusions
  • PSM loudest on inspiration at lower end of sternum

Investigations

  • CXR: RV enlargement (maybe bivent if TR secondary to failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of atrial septal defect (ASD)?

A
  • sinus venosus very uncommon in adults
  • ostium primum associated with MR, TR, VSD commonly
  • and look for Down syndrome or upper limb defects (holt-oram syndrome)

Signs

  • fixed splitting of S2
  • pulmonary ESM increasing on inspiration
  • pulmonary hypertension (late)
  • orthodeoxia-platypnoea (if they have position dependent shunting - caused by increased right-to-left shunting of blood on assuming an upright position, with normal pressure in the right atrium)

Investigations

  • ECG:
    • RAD
    • RBBB
    • RVH
  • CXR:
    • increased pulmonary vasculature
    • enlarged RA/RV
    • dilated main pulmonary artery
    • small aortic knob

Intervention

    • close if the shunt is >=1.5:1 (unless there’s reversal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical features of chronic constrictive pericarditis?

A

Think of in cachectic patient with ascites

Signs

    • low BP with pulsus paradoxus
    • JVP: raised with prominent x and y descents
    • impalpable apex
    • distant heart sounds
    • may have early S3 and early pericardial knock (rapid ventricular filling abruptly halted)
  • - hepatosplenomegaly, ascites, oedema

Aetiology (look for signs of these)

    • radiation
    • tumour
  • Infection - uberculosis
  • CTD - sarcoidosis
  • chronic renal failure
    • trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical features of coarctation of the aorta?

A

Most commonly just distal to the origin of the left subclavian artery

Associations

  • Bicuspid aortic valve + aortopathy
  • Other congenital disease (Turner’s especially)
  • Berry aneurysms in 10%

Signs

    • more developed upper body
    • radiofemoral delay
    • hypertension limited to the arms
    • collateral chest vessels
    • hypertensive fundi changes
    • midsystolic murmur (praecordium and back)

Investigations

  • ECG: LVH
  • CXR:
    • enlarged LV
    • enlarged left subclavian artery
    • dilated ascending aorta
    • aortic indentation
    • aortic prestenotic/poststenotic dilation
    • rib notching (2nd-6th ribs, inferior border)

When to do intervention

    • Hypertension + peak-peak gradient 20mmHg
    • Severe anatomic with significant collaterals
17
Q

What are the clinical features of Eisenmenger’s syndrome?

A

Look for cyanosis, clubbing, polycythaemia

Signs (pulmonary hypertension)

  • JVP: dominant a wave; maybe v wave
  • RV heave; palpable P2
  • loud P2
  • S4; pulmonary ejection click
  • PR, TR

Level of the shunt

  • ASD: wide fixed split
  • VSD: single second sound
  • PDA: normal second sound or reversed split (look for differential cyanosis)

Investigations

  • ECG: RVH; p pulmonale
  • CXR
    • RVE/RAE
    • pulmonary artery prominence
    • increased hilar vasculature with dropped out peripheral vasculature
    • non boot shaped heart
18
Q

What are the clinical features of hypertrophic cardiomyopathy?

A

Signs

  • sharp rising, jerky pulse (rapid ejection -> obstruction)
  • JVP: prominent a wave (non-compliant ventricle)
  • double/triple impulse apex beat (ventricular expansion following atrial contraction)
  • late systolic ejection murmur (left sternal edge)
  • PSM from MR
  • S4

Dynamic

  • louder with: valsalva, standing, isotonic exercise (jogging) as all decrease LV filling (dec preload/inc afterload)
  • softer with: squatting, raising legs, isometric exercise (handgrip) as all increase LV filling (inc preload/dec afterload)

Investigations

  • ECG: LVH with lateral ST/T changes; deep Qs; conduction defects
  • CXR: LV enlarged with hump on the border; no calcification
  • TTE
    • asymmetric hypertrophy of the ventricular septum
    • systolic anterior motion of the anterior mitral valve leaflet
    • midsystolic closure of AV
    • LV outflow tract gradient
    • MR
19
Q

What are the clinical features of ventricular septal defect (VSD)?

A

Signs

  • thrill
  • harsh PSM confined to left sternal edge
  • may have associated MR
  • look for Down syndrome

Investigations

  • ECG: LVH
  • CXR
    • LVH
    • RVH
    • increased pulmonary vasculature

When to consider ntervention

  • shunt of >=1.5:1
  • RV dilatation is a proxy of large shunt size
20
Q

What are the signs of pulmonary hypertension?

A
  • Prominent a wave on JVP
  • RV impulse
  • Loud P2
    • palpable P2 more helpful
  • PR or TR
21
Q

What are the types and causes of diastolic murmurs?

A

Early diastolic

  • AR/PR

Mid diastolic

  • MS/TS
  • atrial myxoma
  • Austin Flint of AR (whenthe AR causes MR)
  • Carey Coombs of acute rheumatic fever (The Carey Coombs murmur or Coombs murmur is a clinical sign which occurs in patients with mitral valvulitis due to acute rheumatic fever. It is described as a short, mid-diastolic rumble best heard at the apex, which disappears as the valvulitis improves)

Presystolic

  • MS/TS
  • atrial myxoma
22
Q

What are the types and causes of systolic murmurs?

A

Pansystolic

  • MR, TR
  • VSD (heard at LSE)
  • aortopulmonary shunts

Midsystolic

  • AS, PS
  • HCM
  • pulmonary flow murmur of ASD

Early systolic

  • VSD (very small or large with pulmonary hypertension)
  • acute MR, TR

Late systolic

  • Mitral valve prolapse
  • papillary muscle dysfunction
23
Q

What should you consider and look for if nothing is obvious on auscultation of the heart?

A
  • MS: position and exercise
  • ASD: carefully for fixed splitting
  • MVP: valsalva
  • Pulmonary hypertension
  • Constrictive pericarditis
    • think if they have bad failure and you can’t find much else
  • If you can’t hear heart sounds
    • think dextrocardia
24
Q

Where is the normal apex beat and what are the descriptions of abnormality?

A

Normally 5th space 1cm medial to midclavicular line

Pressure loaded (hyperdynamic):

  • systolic overloaded
  • forceful and sustained
  • AS, hypertension

Volume loaded (hyperkinetic):

  • diastolic overloaded
  • forceful but unsustained
  • AR/MR

Tapping:

  • palpable first heart sound
  • MS

Dyskinetic:

  • larger area than normal due to uncoordinated contraction
  • LV aneurysm following infarction

Double/Triple:

  • hypertrophic cardiomyopathy

Absent:

  • obesity
  • pericarditis
  • COPD
  • situs inversus
25
Q

With what is mitral valve prolapse associated?

(Barlow’s syndrome)

What occurs to the murmur with dynamic manoeuvres?

A

Associations

    • Marfan’s
    • secundum ASD

Complications

  • MR
  • IE

Valsalva (decreased preload)

  • murmur longer with the click earlier

Handgrip (increased afterload) or squatting (increased preload)

  • murmur shorter

​

26
Q

Causes of elevated CVP

A
  • RHF
  • TS/TR
  • Pericardial effusion or constrictive pericarditis
  • SVC obstruction
  • Fluid overload
  • Hyperdynamic circulation (e.g. fever, anaemia, thyrotoxicosis, AVF, pregnancy, exercise, beriberi, hypoxia, hypercapnia)
27
Q

Mitral Valve Prolapse clinical signs and associations

A

Clinical signs:

  • Late systolic click murmur
  • Valsalva – murmur longer, click earlier
  • Hand grip – murmur shorter

Associations:

  • Marfans
  • ASD
28
Q

PDA clinical signs

A
  • Collapsing pulse
  • Low diastolic BP
  • Hyperkinetic apex beat
  • Reverse split S2
  • Continuous machinery murmur in 1st L) ICS
  • **pulmonary HTN or heart failure =. severe heart disease
  • **Cyanosis = shunt reversal R to L
29
Q

Tetralogy of Fallot

A
  • Pulmonary stenosis
  • VSD
  • overiding aorta
  • RV hypertrophy

Associated with Down’s Syndrome

30
Q

Types of JVP (dominant a, dominant v, cannon a)

A
  • Dominant a wave - TS, PS, Pul HTN
  • Dominant v wave - TR
  • Cannon a waves – CHB, paroxysmal nodal tachycardia with retrograde atrial conduction, VT with retrograde atrial conduction of AV dissociation
31
Q

Causes of second heart sounds

A

Talley list (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions