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PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the features of the pulse in a patient with aortic stenosis?

A

Slow rising with narrow pulse pressure

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2
Q

What is the character of the murmur found in a patient with aortic stenosis?

A

Ejection systolic murmur, radiating to the carotids.
Loudest at aortic area and in expiration

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3
Q

What additional chest signs may be found in a patient with aortic stenosis?

A

Heaving apex beat
Palpable thrill over aortic area

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4
Q

What are the most common causes of aortic stenosis?

A

Calcification (more likely in older patient)
Congenital bicuspid valve

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5
Q

What are the indications for valve replacement in a patient with aortic stenosis?

A

Symptomatic patient with a gradient >50
Asymptomatic patient AND:
Mod/severe stenosis for CABG or
Severe AS with LVSD
or
Severe AS with abnormal BP response to exercise
or
VT

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6
Q

What are some differentials for a patient with an ejection systolic murmur?

A

Aortic stenosis
Aortic sclerosis
Pulmonary stenosis
Physiological flow murmur
Hypertrophic cardiomyopathy
Patient-prosthesis mismatch

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7
Q

Describe the murmur heard in aortic regurgitation

A

High-pitched early diastolic decrescendo murmur
Loudest at left sternal edge in fixed expiration

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8
Q

Other than a murmur, what signs may be found in a patient with aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Head nodding
Dancing carotid
Pulsating nail beds
Murmur heard over femoral arteries

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9
Q

What are some causes of aortic regurgitation?

A

Acute - infective endocarditis, aortic dissection, prosthesis failure, rheumatic fever
Chronic - infective endocarditis, bicuspid aortic valve, marfan’s syndrome, syphilis, seronegative arthritides

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10
Q

What are the indications for surgical intervention in aortic regurgitation?

A

Moderate to severe acute regurgitation
Chronic AR with SOB or angina
Asymptomatic with significant root dilatation, LV dilatation and EF <50%

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11
Q

What are some manifestations of marfan’s syndrome?

A

Aortic regurgitation
Upwards lens dislocation
Arm span greater than height
Pectus excavatum
Joint laxity
Scoliosis
Pes planus

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12
Q

How often should aortic valve screening be done for patients with Marfan’s?

A

Echocardiogram annually to measure diameter of aorta

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13
Q

What is eisenmenger’s syndrome?

A

Reversal of a large left to right shunt due to increased pulmonary blood flow and pulmonary hypertension, leading to cyanotic heart disease

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14
Q

What are the causes of eisenmenger’s syndrome?

A

Large VSD
PDA
Atrioventricular septal defects
large systemic to pulmonary shunts for treatment of congenital heart disease

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15
Q

What are the potential complications of eisenmengers syndrome?

A

Secondary polycythaemia and hyperviscosity
Arrhythmias
Heart failure
Stroke
Haemoptysis
CKD
Gout
Hypertrophic osteoarthropathy
Sudden cardiac death

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16
Q

What is hypertrophic obstructive cardiomyopathy?

A

Septal hypertrophy, often causing left ventricular outflow tract obstruction

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17
Q

What heart sounds are present in a patient with HOCM?

A

Dynamic ejection systolic murmur radiating to apex. Murmur increases with valsalva manoeuvre and standing. Decreases with squatting

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18
Q

How can HOCM lead to mitral regurgitation?

A

Rapid blood flow at LV outflow tract causes systolic anterior motion of the mitral valve leaflets

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19
Q

What is the cause of HOCM?

A

Genetically inherited in 50%
Can occur de-novo

20
Q

What may be seen on an ECG in someone with HoCM?

A

LVH
Deep q waves
ST elevation

21
Q

Other than a murmur, what signs may be found in a patient with HOCM?

A

Jerky pulse
Low systolic blood pressure and narrow pulse pressure
Palpable thrill over aortic area
Heaving apex
Features of CCF
May be ICD present
MR murmur may be present

22
Q

What information can be gained from a cardiac MRI in someone with HOCM?

A

Hypertrophic distribution
Wall fibrosis
LV function

23
Q

How should HOCM be investigated?

A

ECG
Echo
Holter monitor for ?VT
Exercise tolerance test. Failure of BP to rise with exercise indicates worse LVOT obstruction
Consider genetic testing if appropriate

24
Q

What are some risk factors for sudden cardiac death in a patient with HOCM?

A

Family history of sudden cardiac death
Episodes of ventricular arrhythmias
Abnormal BP response to exercise
High LV wall thickness
Unexplained syncope

25
Q

Describe the murmur heard in a patient with mitral stenosis

A

Low pitched mid-diastolic murmur at apex, loudest in left lateral postion.
May be opening snap of mitral valve
May be loud P2 due to pulmonary hypertension

26
Q

Other than a murmur, what signs may be found in a patient with mitral stenosis?

A

Malar flush
Irregular pulse
Raised JVP
Tapping apex
Palmar erythema
May be left parasternal heave if pulmonary hypertension

27
Q

What are the causes of mitral stenosis?

A

Most common is previous rheumatic fever
Congenital
Infective endocarditis
Calcification

28
Q

What are some complications of mitral stenosis?

A

Pulmonary hypertension and right sided heart failure
Haemoptysis
Flash pulmonary oedema
Emboli (need warfarin, DOACs not licensed)
AF
Infective endocarditis

29
Q

Describe the murmur heard in a patient with mitral regurgitation

A

High pitched pan systolic murmur, loudest at the apex

30
Q

Other than a murmur, what signs may be found in a patient with mitral regurgitation?

A

Features of marfan’s syndrome
Stigmata of infective endocarditis
Raised JVP
Displaced apex beat with apical thrill
Signs of heart failure

31
Q

What are some causes of mitral regurgitation?

A

Acute: IE
Chordae tendinae rupture secondary to MI, rheumatic fever or IE
Chronic: rheumatic fever, marfans, ehlers danlos, rheumatoid arthritis

32
Q

What changes may be found on an ECG in someone with mitral regurgitation?

A

AF
Left axis deviation

33
Q

When is surgical repair of mitral regurgitation indicated?

A

Asymptomatic with LVEF 30-60%
Chronic MR with new AF and raised pulmonary pressures

34
Q

What conditions are associated with mitral valve prolapse?

A

Congenital heart disease such as ASD, AVSD,PDA
Congenital disorders such as Turner’s, Marfan’s, osteogenesis imperfecta
SLE

35
Q

Describe the murmur heard in mitral valve prolapse

A

Late systolic murmur, loudest at left sternal edge
May be midsystolic click

36
Q

What are some complications associated with prosthetic heart valves?

A

Valve failure
Thrombosis and embolisation
Endocarditis - acute or subacute
Stroke/TIA
Haemolysis
Bleeding secondary to anticoagulation

37
Q

What are the main causes of pulmonary stenosis?

A

Congenital due to maternal rubella
Rheumatic fever
Carcinoid syndrome

38
Q

Describe the murmur heard in pulmonary stenosis?

A

Ejection systolic murmur, loudest during inspiration and over pulmonary area

39
Q

What are the defects seen in tetralogy of fallot?

A

Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hypertrophy

40
Q

What are the main causes of pulmonary regurgitation?

A

Hypertension
Tetralogy of fallot if pulmonary valvotomy done
Congenital

41
Q

What clinical signs may be seen in a patient with pulmonary regurgitation

A

Early diastolic murmur
Signs of right heart failure

42
Q

What are the causes of tricuspid regurgitation?

A

Acute:
Infective endocarditis (esp from IVDU)
Trauma
Chronic:
Pulmonary hypertension
Infective endocarditis
Rheumatic fever

43
Q

What are the differentials for an ejection systolic murmur?

A

Aortic stenosis
Pulmonary stenosis
Aortic sclerosis
HOCM
Atrial septal defect

44
Q

What are the differentials for a pansystolic murmur?

A

Mitral regurgitation
Tricuspid regurgitation
Atrial septal defect
Ventricular septal defect

45
Q

What is the genetic cause of Noonan syndrome?

A

Mutations in the RAS/MAPK pathway
Autosomal dominant inheritance, about 60% de novo mutations

46
Q

What medications are initiated after MI?

A

Dual antiplatelet
Beta blocker
ACE I
Statin
Eplerenone if EF <40% and clinical signs of HF

PACES (6 decks)

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