Brainscape's Knowledge GenomeTM

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


See full index

yr6 paces - icsm final year Alistair Scott - Medicine COPY (shannon mckay) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ECG leads and relevant blood supply

A

II, III, aVF - Right coronary artery

I, aVL, V5 + V6 - Left circumflex artery

V2-V4 - Left anterior descending artery

V2-V6 - Left main stem

V1, V2, V3 (posterior view) - RCA

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

How to calculate rate on an ecg

A

300 / number of large squares between two equivalent adjacent points

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

Rhythm in AF

A

No discernible P waves

Irregularly Irregular

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

Rhythm in Atrial flutter

A

Saw-toothed baseline

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

Rhythm in nodal/junctional rhythm

A

Regular QRS but no P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal axis deviation

A

Leads I and II +ve

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

Left axis deviation

A

Lead I +ve and lead II -ve (leaving)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Right axis deviation

A

Lead I -ve and lead II +ve (reaching)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of right axis deviation

A
  • Anterolateral MI
  • RVH
  • PE
  • Left posterior hemiblock WPW
  • Atrial Septal Defect secundum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of left axis deviation

A
  • Inferior MI
  • LVH
  • Left anterior hemiblock WPW
  • Atrial septal defect primum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of absent P waves

A

AF
Sinoatrial node block
Nodal rhythm

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

Cause of dissociated P waves

A

Complete heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

P mitrale

A

bifid P waves = Left Atrial hypertrophy

HTN, AS, MR, MS

https://ecgwaves.com/the-ecg-in-left-and-right-atrial-enlargement-abnormality-p-pulmonale-p-mitrale/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

P pulmonale

A

peaked p waves = Right Atrial hypertrophy

Pulmonary HTN, COPD

https://ecgwaves.com/the-ecg-in-left-and-right-atrial-enlargement-abnormality-p-pulmonale-p-mitrale/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Definition and causes of wide QRS

A

> 120ms (3 small squares)

Ventricular initiation
Conduction defect
WPW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Definition and cause of pathological Q wave

A

> 1mm wide and >2mm deep

Full thickness MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Signs of RVH in the QRS complexes

A

Dominant r wave in V1 + deep S wave in V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Signs of LVH in the QRS complexes

A

R wave in V6 >25mm

R wave in V5/V6 + S wave in V1 >35mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Length of normal PR interval

A

120-200ms (3-5 small square)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cause of long PR interval

A

Heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of short PR interval

A
  • Accessory conduction eg WPW
  • Nodal rhythm
  • Hypertrophic Cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cause of depressed PR segment

A

Pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Normal corrected QT interval (QTc)

A

380-420ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bazett’s formula

A

Used to calculate corrected QT interval

QTc = actual QT/√R-R

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Causes of long QT interval (>420ms)

A

TIIMME

Toxins

  • macrolides
  • anti-arrhythmics: quinidine, amiodorone
  • TCAs
  • Histamine antagonists

Inherited eg Romano-Ward, Jervell Lange-Neilson syndrome

Ischaemia

Myocarditis

Mitral valve prolapse

Electrolytes
- ↓Mg, ↓K, ↓Ca, ↓ temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of short QT interval (<380ms)

A

Digoxin

Betablockers

Phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of raised ST segment (>1mm in limbs; >2mm in chest)

A

Acute MI
Prinzmetal’s variant angina
Pericarditis - saddle-shaped
Aneurysm - ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of depressed ST segments (>0.5mm)

A

Ischaemia - flat

Digoxin - down-sloping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

T waves are normally inverted in which leads

A

aVR and V1

Also V2-V3 less so and more commonly in Afro-Caribbeans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Leads in which inverted T waves is abnormal and causes

A

I, II and V4-6

  • Strain
  • Ischaemia
  • Ventricular hypertrophy
  • BBB
  • Digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Effect of hyperkalaemia and hypokalaemia on T waves

A

Hyperkalaemia - tented T waves

Hypokalaemia - flattened T waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

U waves on ECG

A

Occur after T waves

Seen in hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

J waves / Osbourne waves on ECG

A

Occur between QRS and ST segment

Causes

  • Hypothermia < 32
  • Subarachnoid haemorrhage
  • Hypercalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Causes of bradycardia

A

DIVISIONS

  • Drugs
  • Ischaemia/infarction
  • Vagal hypertonia
  • Infection
  • Sick sinus syndrome
  • Infiltration
  • HypO-thyroidism / kalaemia / thermia
  • Neuro: ↑ ICP
  • Septal defect: primum ASD
  • Surgery or catherisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Drugs which cause bradycardia

A

Antiarrythmics (type 1a, amiodarone)

Beta-blockers

Calcium channel blockers

Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Infections which cause bradycardia

A

Viral myocarditis
Rheumatic fever
Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Infiltrative causes of bradycardia

A 
Autoimmune
Sarcoid
Haemochromatosis
Amyloid
Muscular dystrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Definition of Narrow Complex Tachycardia

A

Rate >100bmp

QRS width <120ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of SVT

A

see AS medicine notes, page 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Definition of Broad Complex Tachycardias (VT)

A

Rate >100bmp

QRS width >120ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Causes of VT

A

IM QVICK

  • Infarction
  • Myocarditis
  • QT interval increase
  • Valve abnormality - mitral prolapse, AS
  • Iatrogenic - digoxin, antiarrythmics, catheter
  • Cardiomegaly (esp. dilated)
  • K↓, Mg↓, O2↓, acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Management of VT

A

see AS medicine notes, page 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Common causes of AF

A

IHD
Rheumatic heart disease
Thyrotoxicosis
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Symptoms of AF

A 
Asymptomatic
Chest pain
Palpitations
Dyspnoea
Faintness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Signs of AF

A

Irregualrly irregular pulse

Pulse deficit: difference between pulse and HS

Fast AF -> loss of diastolic filling -> no palpable pulse

Signs of LVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

CHA2-DS2-VAS Score components

A
  • Congestive Heart Failure
  • Hypertension
  • Age≥75 (2 points)
  • Diabetes
  • Stroke or TIA (2 points)
  • Vascular disease
  • Age: 65-74yrs
  • Sex: female

->Determines necessity of anticoagulation in AF
Score
0: aspirin 300mg
≥1: Warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management of Acute AF (≤48h)

A

Haemo unstable → emergency cardioversion
- electrical or pharmaceutical - 1st: Flecainide (if no structural heart disease) 2nd: Amiodarone

Control ventricular rate

  • 1st line: diltiazem or verapamil or metoprolol
  • 2nd line: digoxin or amiodarone

Start LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Paroxysmal AF

A
  • Self-limiting, <7d, recurs
  • Anticoagulate: use CHADSVAS
  • Rx “pill-in-pocket” : flecainide, propafenone
  • Prevention: β-B, sotalol or amiodarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Reasons to use rhythm control in persistent AF

A
  • Symptomatic or CCF
  • Younger (<65)
  • Presenting first time with lone AF
  • Secondary to treated precipitant
50
Q

Rhythm control management in persistent AF

A

Echo first: structural abnormalities

  • Anticoagulate with warfarin for ≥3wks or use echo to exclude intracardiac thrombus.
  • Pre-Rx ≥4wks with sotalol or amiodarone if ↑ risk of failure
  • Electrical or pharmacological cardioversion
  • ≥ 4 wks anticoagulation afterwards (target INR 2.5)

Maintenance antiarrhythmic

  • Not needed if successfully treated precipitant
  • 1st: β-B (e.g. bisoprolol, metoprolol).
  • 2nd: amiodarone
51
Q

Rate control management in persistent AF

A

Target <90bpm at rest

  • 1st line: β-B or rate-limiting CCB (NOT both!)
  • 2nd line: add digoxin (don’t use as monotherapy)
  • 3rd line: consider amiodarone
52
Q

Management of permanent AF

A

RATE CONTROL

Possible reasons:

  • Failed cardioversion / unlikely to succeed
  • AF >1yr, valve disease, poor LV function
  • Pt. doesn’t want cardioversion
53
Q

Management of Atrial Flutter

A

Similar to AF, although normal drugs may not work

Try amiodarone to restore sinus and amiodarone or sotalol to maintain it

Cavotricuspid isthmus ablation (RA) is Rx of choice.

54
Q

Acute coronary syndrome definition

A

ACS = unstable angina + evolving MI

Divided into:

  • ST elevation or new onset LBBB
  • NSTEMI
55
Q

Modifiable risk factors for ACS

A
  • Hypertension
  • Diabetes
  • Smoking
  • ↑cholesterol
  • Obesity
56
Q

Non-modifiable risk factors for ACS

A
  • Age
  • Male
  • Family history of MI < 55yrs
57
Q

Typical ACS symptoms

A 
Acute central/left chest pain >20min
Radiates to left jaw or arm
Nausea
Sweating
Dyspnoea
Palpitations
58
Q

Symptoms of silent MI

A

Syncope
Delirium
Post-op oliguria / hypotension

More common in elderly and diabetics

59
Q

Clinical signs of ACS

A

Anxiety
Pallor Sweating
Pulse ↑/↓
BP ↑/↓
4th heart sound
Signs of LVF (basal creps, ↑ JVP, 3rd HS)
PSM: papillary muscle dysfunction / rupture

60
Q

ECG changes in STEMI

A
  • Normal
  • ST elevation + hyperacute (tall) T waves
  • Q waves: full-thickness infarct
  • Normalisation of ST segments
  • T wave inversion
  • (New onset LBBB also = STEMI)
61
Q

ECG changes in NSTEMI

A
  • ST depression
  • T wave inversion

No Q waves = subendocardial infarct

62
Q

Diagnosis of NSTEMI, STEMI and UA

A

STEMI / LBBB: Typical symptoms + ST elevation (/LBBB)

NSTEMI: Typical symptoms + no ST elevation + +ve trop

UA: Typical symptoms + no ST elevation + -ve trop

63
Q

MI complications

A

Death Passing PRAAED st

Death
Pump failure

Pericarditis
Rupture - myomalacia cordis
Arrhythmias
Aneurysms - ventricular 
Embolism
Dressler’s Syndrome - pleuro-pericarditis
64
Q

Presentation of pericarditis post MI

A

Occurs early after MI

  • Mild fever
  • Central chest pain / change in pain
  • Relieved by sitting forward
  • Pericardial friction rub

Saddle-shaped ST elevation ± PR depression on ECG

65
Q

Presentation of Dressler’s syndrome post MI

A

2-6 weeks after

  • Recurrent pericarditis
  • Pleural effusions
  • Fever
  • Anaemia
  • ↑ESR

Due to auto-antibodies vs. myocyte sarcolemma

66
Q

STEMI management

10 steps

A

1) 12 lead ECG
2) 2-4L oxygen (aim sats 92-98)
3) Iv access, FBC, U+E, glucose, lipids
4) Brief Hx and Exam (CV risk factors, Thrombolysis Contraindications)
5) Antiplatelets - Aspirin/Clopidogrel both 300mg PO (then 75mg/d; asp = indefinite, clop = 1month)
6) Analgesia - Morphine 5-10mg IV; Metoclopramide 10mg IV
7) Anti-ischaemia - GTN 2 puffs or 1 tablet; β-B atenolol 5mg IV (CI: asthma, LVF)
8) LMWH: e.g. enoxaparin IV then SC
9) Admit to CCU for monitoring - Arrhythmias, Continue meds except CCBs
10) Primary PCI or Thrombolysis

67
Q

ECG criteria for thrombolysis treatment of MI

A
  • ST elevation > 1mm in 2+ limbs or > 2mm in 2+ chest leads.
  • New LBBB
  • Posterior: Deep ST “depression” and tall “R” waves in V1-V3
68
Q

Contraindications to thrombolysis after MI

A

AGAINST

Aortic dissection
GI bleeding
Allergic reaction previously
Iatrogenic - recent surgery
Neuro - cerebral neoplasm or CVA history
Severe HTN >200/120
Trauma - including CPR

Also contraindicated beyond 24hrs from onset of pain

69
Q

Everyday drug regime post MI

A
  • ACEi: start w/i 24hrs of MI (e.g. lisinopril 2.5mg)
  • β-blocker: e.g. bisoprolol 10mg OD (or, CCB)
  • Cardiac rehabilitation (group exercise and info) / Heart Manual
  • DVT prophylaxis until fully mobile -> Continue for 3mo if large anterior MI
  • Statin: regardless of basal lipids (e.g. atorvastatin 80mg)
70
Q

Lifestyle advice after MI

A 
Stop smoking
Diet: oily fish, fruit, veg, ↓ sat fats
Exercise: 30min OD
Work: return in 2 months
Sex: avoid for 1 month
Driving :avoid for 1 month
71
Q

CV risk scoring systems

A

GRACE or TIMI

72
Q

Angina classification

A

-Stable: induced by effort
-Unstable: occurs at rest / minimal exertion
-Decubitus: induced by lying down
-Prinzmetal’s / variant: occurs during rest -> Due to coronary spasm; ST elevation during attack: resolves as pain
subsides.
-Syndrome X: angina pain + ST elevation on exercise
test but no evidence of coronary atherosclerosis -> Probably represents small vessel disease

73
Q

Treatment of angina

A

1) Lifestyle changes
2) CV prophylaxis - low dose Aspirin, ACEi. Statins, Antihypertensives
3) GTN + either B-blocker or CCB
4) PCI
5) CABG

74
Q

Definition of heart failure

A

CO is inadequate for the body’s requirements despite adequate filling pressures

75
Q

Steps in compensatory phase of Heart failure

A

Reduced CO initially → compensation

  • Starling effect dilates heart to enhance contractility
  • Remodelling → hypertrophy
  • RAS and ANP/BNP release
  • Sympathetic activation
76
Q

Steps in the decompensatory phase of heart failure

A

-Progressive dilatation → impaired contractility +
functional valve regurgitation
- Hypertrophy → relative myocardial ischaemia
- RAS activation → Na+
and fluid retention → ↑ venous pressure → oedema
- Sympathetic excess → ↑ afterload → ↓ CO

77
Q

Causes of pump failure leading to low output HF

A

1) systolic failure (impaired contraction)
- Ischaemia/MI
- Dilated cardiomyopathy
- HTN
- Myocarditis

2) Diastolic failure (impaired filling)
- Pericardial effusion/tamponade/constriction
- Restrictive/hypertrophic cardiomyopathy

3) Arrhythmias
- Bradycaria/ Heart Block
- Tachycardias
- Anti-arrythmics (eg B-b, verapamil)

78
Q

Causes of low output HF other than pump failure

A

Excessive pre-load

  • AR, MR
  • Fluid overload

Excessive afterload

  • AS
  • HTN
  • HOCM
79
Q

Causes of high output HF

A

Due to increased needs

  • Anaemia, AVM
  • Thyrotoxicosis, Thiamine deficiency (beri beri)
  • Pregnancy, Paget’s
80
Q

Causes of RVF

A
  • Secondary to LVF
  • Cor pulmonale
  • Tricuspid and pulmonary valve disease
81
Q

Symptoms of RVF

A

Anorexia and nausea

82
Q

Signs of RVF

A

Raised JVP
Tender smooth hepatomegaly
Pitting oedema
Ascites

83
Q

Causes of LVF

A

1) IHD
2) idiopathic dilated cardiomyopathy
3) systemic HTN
4) Mitral and aortic valve disease

can also be caused by specific cardiomyopathies

84
Q

Symptoms of LVF

A 
Fatigue
Exertional dyspnoea
Orthopnoea and PND
Nocturnal cough (+/- pink frothy sputum)
S3 + tachycardia (gallop)
Wheeze
Bibasal creps
85
Q

Acute vs Chronic HF

A

Acute

  • New onset or decompensation of chronic
  • peripheral / pulmonary oedema
  • +/- peripheral hypoperfusion

Chronic

  • Develops / progresses slowly
  • Venous congestion common
  • Arterial pressure maintained until very late
86
Q

Criteria for defining Chronic heart failure

A

Framingham Criteria

2 major criteria or 1 major and two minor

87
Q

Major criteria of the Framingham Criteria for CCF

A
  • PND
  • +ve abdominojugular reflux
  • Neck vein distension
  • S3
  • Basal creps
  • Cardiomegaly
  • Acute pulmonary oedema
  • ↑ CVP (>16cmH2O)
  • Wt. loss >4.5kg in 5d secondary to Rx
88
Q

Minor criteria of the Framingham Criteria for CCF

A
  • Bilateral ankle oedema
  • SOBOE
  • ↑HR >120
  • Nocturnal cough
  • Hepatomegaly
  • Pleural effusion
  • 30% ↓ vital capacity
89
Q

Signs of CCF on CXR

A

ABCDE

  • Alveolar shadowing
  • Kerley B lines
  • Cardiomegaly
    (cardiothoracic ratio >50%)
  • Upper lobe Diversion
  • Effusions
  • Fluid in the fissures
90
Q

Signs of CCF on Echo

A

key investigation

  • Global systolic and diastolic function -> Ejection fraction normally ~60%
  • Focal / global hypokinesia
  • Hypertrophy
  • Valve lesions
  • Intracardiac shunts
91
Q

BNP is secreted from ventricles in response to…

A
  • Increased pressure -> stretch
  • Tachycardia
  • Glucocorticoids
  • Thyroid hormones
92
Q

Actions of BNP

A
  • ↑ GFR and ↓ renal Na reabsorption

- ↓ preload by relaxing smooth muscle

93
Q

Level of BNP to diagnose heart failure

A

> 100

  • BNP correlates c¯ LV dysfunction -> i.e. ↑ most in decompensated heart failure
  • ↑ BNP = ↑ mortality
  • BNP also ↑ in RHF: cor pulmonale, PE
94
Q

New York Hear Association Classification

A
  1. No limitation of activity
  2. Comfortable @ rest, dyspnoea on ordinary activity
  3. Marked limitation of ordinary activity
  4. Dyspnoea @ rest, all activity → discomfort
95
Q

Treatable precipitants / causes of chronic heart disease

A

Underlying cause

  • Valve disease
  • Arrhythmias
  • Ischaemia

Exacerbating factors

  • Anaemia
  • Infection
  • ↑BP
96
Q

1st line treatment for chronic heart failure

A

ACEi/ARB + β-B + loop diuretic

eg lisinopril or candesartan ; carvedilol or bisprolol ; frusemide or butmetanide

for β-B’s, ‘start low and go slow’
E.g. carvedilol 3.125mg/12h → 25-50mg/24h
- Wait ≥2wks between increments

97
Q

Treatment of severe pulmonary oedema - 10 steps

A

1 - sit patient up
2 - 15L O2, target 94-98
3 - Iv access + monitor ECG (treat arrhythmias)
4 - Diamorphine 2.5-5mg IV + Metoclopramide 10 mg IV
5 - Frusemide 40-80 mg IV
6 - GTN 2 puffs
7 - CXR, ECG, ?echo
8 - if SBP >100, start nitrate IV
9 - if worsening, consider CPAP, more frusemide or ↑ nitrate infusion
10 - if SBP <100, treat as cardiogenic shock ie consider inotropes

98
Q

Causes of severe pulmonary oedema

A

Cardiogenic

  • MI
  • Arrythmia
  • Fluid overload: renal, iatrogenic

Non-cardiogenic

  • ARDS: sepsis, post-op, trauma
  • upper airway obstruction
  • Neurogenic: head injury
99
Q

signs of left sided or congestive heart failure

A
  • narrow pulse pressure
  • raised jvp
  • displaced thrusting apex with systolic thrill
  • left parasternal heave
  • S3 present
  • Mid-diastolic flow murmur
  • Bibasal crackles
  • Peripheral oedema
100
Q

Causes of mitral regurgitation

A 
Rheumatic heart disease
Ischaemic Heart disease
Endocarditis
Mitral valve disease
Papillary muscle dysfunction (due to IHD or endocarditis)
Connective tissue diseases
Congenital (ASD etc)
Collagen disorders
Hypertrophic cardiomyopathy
101
Q

Signs of mitral stenosis

A

Malar flush
Opening snap
Giant V waves
Graham Steel murmur (high pitched brief early diastolic murmur due to secondary pulmonary regurgitation)

102
Q

Symptoms of mitral stenosis

A

Dyspnoea, reduced exercise tolerance
Orthopnoea and PND
Palpitations
Dysphagia (oesophagus compressed by left atrium)
Haemoptysis secondary to pulmonary hypertension)

103
Q

Causes of mitral stenosis

A

SYMPTOMS MAY BE PRECIPITATED BY CHANGES SUCH AS AF OR PREGNANCY

Rheumatic heart disease
Congenital
Carcinoid syndrome (increased serotonin causes increased collagen production in heart)
SLE
Mucopolysccharidoses
104
Q

Causes of aortic regurgitation

A

Rheumatic heart disease
Bicuspid aortic valve
Infective endocarditis
Aortic root dilatation (eg in collagen disorders)
Inflammatory (eg RA, Reiter’s syndrome, ank spond, syphilis)

105
Q

Quincke’s sign

A

capillary nail bed pulsations

106
Q

Corrigan’s sign

A

visible carotid pulsations

107
Q

De Musset’s sign

A

head nodding with each heartbeat

108
Q

Muller’s sign

A

pulsation of the uvula

109
Q

Duroziez’s sign

A

diastolic femoral bruit when compressed distally

110
Q

Traube’s sign

A

pistol shot femorals

111
Q

Austin Flint murmur

A

mid-diastolic murmur heart at the apex.

thought to be caused by a regurgitant jet interfering with the opening of the anterior mitral valve leaflet ie mimics mitral stenosis

112
Q

Rosenburg’s sign

A

pulsatile liver

113
Q

Gerhadt’s sign

A

enlarged spleen

114
Q

Symptoms of aortic stenosis

A

Chest pain
SOB
Syncope

In absence of other disease, onset of symptoms in AS is a sign of severity and requires consideration of surgery

115
Q

Causes of aortic stenosis

A

Bicuspid valve
Rheumatic heart disease
Calcific
Congenital

116
Q

Symptoms of tricuspid regurgitation

A

Fatigue
Abdo pain
Ankle swelling
Anorexia

117
Q

Causes of tricuspid regurgitation

A

Secondary (most common):

  • chronic left heart failure
  • Primary pulmonary hyper tension
  • cor pulmonale due to chronic cardiorespiratory disease and hypoxia
  • right venticular infarction
  • Eisenmenger’s syndrome (pulmonary hypertension, resulting in reversal of a congenital shunt eg VSD)

Primary:

  • Congenital eg Ebsten’s anomaly
  • Rheumatic heart disease
  • right-sided endocarditis
  • carcinoid syndrome
  • blunt trauma
118
Q

Long term complications of prosthetic valves

A 
Thromboembolic disease
Infective endocarditis
Valve failure
Valve dehiscence
Haemolysis
Anticoagulation complications: GI haemorrhage
119
Q

Small VSD

A

Haemodynamically insignificant

Harsh pansystolic murmur heard at left lower sternal edge (smaller the hole the larger the murmur)

120
Q

Large VSD

A

Presents with cardiac failure in first few months of life

narrow pulse pressure and mid-diastolic murmur (high flow through mitral valve)

May lead to RHF and Eisenmenger’s syndrome (pulmonary hypertension, resulting in reversal of a congenital shunt eg VSD)

yr6 paces - icsm final year Alistair Scott - Medicine COPY (shannon mckay) (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions