Cardiology

Question 1

Signs of severity of Aortic Stenosis

Answer 1

1. Low volume/slow rising pulse
2. Narrow pulse pressure
3. Systolic thrill or LV heave
4. Reversed splitting of the S2
5. Soft or absent S2
6. S4 (pressure loaded LV)
7. Late peaking murmur
8. Signs of heart failure

Question 2

Classify severe AS on echocardiogram

Answer 2

Aortic valve area <1cm^2
Mean pressure gradient >40mmHg
Peak velocity >4cm/sec

Question 3

What are causes of aortic stenosis?

Answer 3

Common:

1. Degenerative valve disease/calcification
2. Bicuspid aortic valve (most common in young)
3. Rheumatic heart disease (less common as isolated)

Rarer causes: Infective endocarditis, hyperuricaemia, alkaptonuria

Question 4

Signs of severity of mitral regurgitation

Answer 4

1. Soft S1
2. S3 (volume loaded LV) - may signify rapid filling not severity…
3. S4 (if in sinus rhythm)
4. Precordial thrill
5. Mid-diastolic flow murmur
6. Signs of pulmonary hypertension
7. Signs of LV failure

Question 5

What are causes of mitral regurgitation?

Answer 5

A. Functional / Annular dysfunction

• 1. Connective tissue disease
• 2. Ankylosing spondylitis
• 3. Marfan’s syndrome
• 4. Aortitis (incl. syphilis)
• 5. Functional MR (secondary to LV dilatation)

B. Leaflet dysfunction

• 1. Degenerative mitral valve disease (incl. MVP)
• 2. Rheumatic heart disease
• 3. Infective endocarditis

Question 6

Signs of severity of aortic regurgitation

Answer 6

1. Collapsing or waterhammer pulse
2. Wide pulse pressure
3. Displaced apex beat
4. Soft S2
5. Presence of S3 (volume loaded LV)
6. Long duration of decrescendo diastolic murmur
7. Austin-Flint murmur

• Low-frequency mid-diastolic rumbling murmur at the apex caused by AR jet impinging on the anterior MV leaflet