Cardiology Flashcards
Signs of pulmonary HTN
RV heave
Loud P2
Raised JVP
Loud S1
Mitral stenosis
Soft S1
1st deg HB
LBBB
MR
A2
Loud - HTN, AS
Soft - AS, AR
S3
Low pitched mid diastolic sound - hear with bell
Gallop rhythm
Caused by tautening of mitral or tricuspid muscles at the end of rapid diastolic filling
Pathological S3 - reduced ventricular compliance e.g. increased atrial and ventricular end diastolic pressure
LV S3 - loudest at apex and on expiration. Increased cardiac output, LV failure, LV dilatation. AR, MR, VSD, PDA
RV S3 - loudest at left sternal edge and inspiration. RV failure, constructive pericarditis.
S4
Late diastolic low pitched sound “Tennessee” High pressure atrial contraction Stiff, non compliant ventricle Not able if in AF E.g. MI, HCM
Normal split S2
Wider on inspiration Delay in RV emptying Pulm stenosis RBBB VSD MR
Reversed splitting
P2 before A2
Wider on expiration
LBBB, severe AS, large PDA
Signs of severity AS
Low volume pulse Slow rising pulse Soft A2 Reverse splitting of S2 Aortic thrill Long, late peaking murmur Pressure loaded apex beat LVF
Causes of AS
Calcified valve
Bicuspid valve
Rheumatic heart disease
Endocarditis
Echo findings of severe AS
AVA <1cm
Mean gradient >40mmHg
Jet velocity >4m/s
Indications for AS surgery
Symptomatic severe AS
Asymptomatic - undergoing CAGS, systolic dysfunction
Signs of severity MR
Soft S1 Volume loaded displaced apex beat LHF Signs of Pulm HT Loud S3 Early diastolic rumble
Causes of MR
Mitral valve prolapse Degenerative valve Rheumatic heart disease Dilated CM - functional MR Connective tissue disease Endocarditis Ruptured papillary muscles 2' to MI
Signs of severity AR
Widened pulse pressure (>80mmHg) Water hammer pulse Soft A2 S3 Long decrescendo diastolic murmur Signs of LVF Austin Flint murmur (low pitched mid-diastolic rumble heard loudest at apex)
