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MRCP PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Indications for AVR
(THREE)

A

Severe symptomatic aortic stenosis
Severe symptomatic aortic regurgitation
Infective endocarditis

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2
Q

Mechanical vs bioprosthetic valve

A

Mechanical long lasting and durable
Mechanical requires life long anticoagulation with warfarin

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3
Q

Signs of severity in aortic stenosis
(FIVE)

A

Quiet second heart sound
Long duration of murmur
Low volume pulse
Forceful apex beat
Fourth heart sound

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4
Q

Differentials for ejection systolic murmur
(FOUR)

A

Aortic stenosis
Aortic sclerosis
HOCM
Mitral regurgitation in pansystolic murmur

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5
Q

Aortic stenosis vs pulmonary stenosis
(THREE)

A

Each loudest over respective areas
Aortic loudest expiration, pulmonary loudest inspiration
RV heave in pulmonary stenosis

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6
Q

Management of symptomatic aortic stenosis
(FIVE)

A

Referral to surgeons for valve replacement
Mechanical valve
Bioprosthetic valve
TAVI - transcatheter aortic valve implantation
Beta blockers
Avoid ACE-i, nitrates (increase gradient over valve)

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7
Q

Long term management of mechanical valves
(TWO)

A

Serial echos to monitor functions
Long term anticoagulation

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8
Q

Indications for MVR
(THREE)

A

Mitral stenosis
Mitral regurgitation
Infective endocarditis

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9
Q

Causes of new systolic murmur in MVR

A

Valve incompetence
New mumurs such as AS and TR

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10
Q

Signs of tricuspid regurgitation
(THREE)

A

Pansystolic murmur
Giant V waves in JVP
Left sternal thrill

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11
Q

Second heart sound in ASD

A

Fixed split second heart sound
All other causes of split second heart sound vary with respiration

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12
Q

Aortic stenosis murmur character

A

Crescendo-decrescendo
Ejection systolic
Loudest in aortic area
Loudest in expiration
Radiates to carotids

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13
Q

Mitral regurgitation murmur character

A

Pansystolic
Loudest at apex
Radiates to axilla
Loudest in expiration

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14
Q

Signs of severe MR
(FIVE)

A

Signs of pulmonary hypertension
Raised JVP
Loud P2
S3
Right ventricular heave
Displaced thrusting apex

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15
Q

Mitral regurgitation differentials
(THREE)

A

Mitral valve prolapse
Tricuspid regurgitation
VSD

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16
Q

Symptoms of MR
(THREE)

A

Dyspnoea
Reduced exercise tolerance
Fluid overload

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17
Q

Indications for mitral valve replacement
(FOUR)

A

Symptomatic mitral disease
Pulmonary hypertension/fluid overload
Declining ejection fraction
Acute MR following MI

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18
Q

Causes of MR
(FIVE)

A

Age related degeneration
Mitral prolapse (connective tissue disease eg Ehler’s Danlos)
Papillary muscle rupture (MI)
Rheumatic fever
Infective endocarditis

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19
Q

Causes of AS
(THREE)

A

Congenital bicuspid valve
Age related calcification and degeneration
Rheumatic heart disease

20
Q

Investigations for MR
(SIX)

A

ECG - AF and p mitrale (bifid p wave)
CXR - cardiomegaly
Urine dip - blood and protein in infective endocarditis
Fundoscopy - roth spots
Temperature - IE
Echo

21
Q

Investigations for AS
(THREE)

A

ECG - LVH, prolonged PR
CXR - often normal
Echo

22
Q

Signs of Marfan’s
(THREE)

A

Arachnodactyly (long thin fingers)
Hypermobile joints
High arched palate

23
Q

Inheritance of Marfan’s

A

Autosomal dominant
Affects fibrillin gene

24
Q

Cardiac complications of Marfan’s
(THREE)

A

Aortic root/aortic dilation
Aortic regurgitation
Mitral valve prolapse

25
Symptoms of pulmonary stenosis (FOUR)
SOBOE Right sided heart failure Pre-syncope Syncope
26
Pulmonary stenosis murmur character
Pansystolic/ejection murmur Loudest in pulmonary area Loudest on inspiration Can have widely split second heart sound
27
Causes of pulmonary stenosis (FIVE)
Congenital Tetralogy of fallot Noonans syndrome Carcinoid syndrome Rheumatic fever
28
Investigations for pulmonary stenosis (TWO)
Echo ECG - RVH, RBBB, p pulmonale (tall p waves)
29
Conditions associated with mitral valve prolapse (FIVE)
Marfans syndrome Ehler-Danlos syndrome Osteogenesis imperfecta PCKD HOCM
30
Mitral regurgitation murmur character
Pansystolic murmur Loudest at apex Radiates to axilla Split second heart sound S3
31
Concerning features in PDA on echo (FOUR)
Raised pulmonary pressures RV dilation Tricuspid regurg Left ventricular dysfunction
32
Clinical findings in keeping with severe PDA (THREE)
Right ventricular heave Collapsing pulse Evidence of left ventricular failure
33
Why are right sided murmurs louder on inspiration?
On inspiration increased venous return Increased venous return increases flow across valves in right side of heart
34
What does the ductus arteriosus connect?
Left pulmonary artery Descending aorta
35
What is eisenmenger's syndrome
Reversal of a left to right shunt
36
Signs of eisenmenger's syndrome
Clubbing Split second heart sound Right ventricular heave
37
Complications of eisenmengers syndrome (FOUR)
Infective endocarditis Hypoxia Right ventricular failure Paradoxical embolism
38
Causes of clubbing (all systems) (EIGHT)
Subacute endocarditis Cyanotic congenital heart disease Lung cancer TB Bronchiectasis ILD Cystic fibrosis IBD
39
What is tetralogy of fallot?
Ventricular septal defect Overriding aorta Right ventricular hypertrophy Pulmonary stenosis
40
Types of cyanotic congenital heart disease (SEVEN)
Tetralogy of fallot Transposition of the great arteries Pulmonary atresia Pulmonary stenosis Tricuspid atresia Eisenmengers Ebsteins
41
Causes of constrictive pericarditis (FIVE)
Viral pericarditis Bacterial pericarditis Post surgical pericarditis Post radiation pericarditis TB
42
Causes of restrictive cardiomyopathy (SEVEN)
Endomyocardial fibrosis Loffler's Sarcoidosis Scleroderma Amyloidosis Haemochromatosis Radiation
43
Causes of diastolic dysfunction (preserved systolic)
Constrictive pericarditis Restrictive cardiomyopathy
44
Diagnosis of infective endocarditis
Dukes criteria - 2 major, 1 major + 3 minor, 5 minor Major: Typical organism in two blood cultures - staph aureus, strep viridans Echo findings - vegetation/abscess/dehiscence Minor: Pyrexia >38 Echo suggestive of IE Embolic phenomena Vasculitic phenomena - roth spots, oslers nodes Blood cultures positive but not typical organism
45
Causes of mitral stenosis (THREE)
Rheumatic fever (most common) Degenerative Congenital (rare)
46
Aortic regurgitation murmur character
Early diastolic murmur Loudest sat forward in expiration Austin flint murmur - rumbling mid diastolic murmur
47
TAVI vs AVR
TAVI in patients with higher pre-operative risk due to comorbidities and frailty AVR remains gold standard MDT and patient decision

MRCP PACES (5 decks)

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