Cardiology Flashcards
What should the height of the JVP be?
3cm vertical height above sternal angle
Draw the JVP waves
What is the a wave in jvp
Atrial contraction
What is the x descent of JVP
Atrial relaxation
What is the c wave in the JVP
Closure of the tricuspid, ventricular systole
What is the c wave in JVP
Passing filling of RA against closed tricuspid
What is y descent of JVP
Opening of tricuspid with passive movement of blood from RA to RV
Causes of absent a wave on JVP
AF
Causes of large a waves on JVP
Contracting against high pressure– Pulmonary HTN, tricuspid stenosis, right HF, pulmonary stenosis
Cause of cannon a waves in JVP
Av dissociation:
Complete HB , ventricular arrhythmias/ectopics , AF, atrial tachy
Causes of steep x descent in JVP
Cardiac constriction, tamponade
Causes of giant v waves in JVP
Tricuspid regurg
Causes of slow y descent in JVP
Tricuspid stenosis
Causes of slow y descent in JVP
Cardiac constriction
What is kassmauls signs , what does it mean
JVP rises on inspiration and drops on expiration
That R heart is unable to increase in size and accommodated venous return
Pericardial disease- constriction /effusion
What does raised JVP with loss of normal pulses mean
SVCO
Causes of raised jvp
Biventricular or R HF
Severe Brady
Fluid overload
Causes of absent radial pulse
Post catheterisation/arterial line
Blalock-taussig shunt with congenital heart disease eg tetralogy of Fallot
Aortic dissection with subclavian involvement
Trauma
Takayasus arteritis
Peripheral arterial embolus
Causes of collapsing radial pulse
Aortic regurg
AV fistula
PDA
Causes of slow rising oulse
AS
What is the name of a double shudder of radial pulse
Bisferiens
Cause of bisferiens pulse
Mixed aortic valve disease and significant regurg
Cause of jerky radial pulse
Hypertrophic obstructive cardiomyopathy
What is alternans pulse
Alternate between strong and weak pulse
Cause of alternans radial pulse
Severe LV dysfunction
EF reduced meaning end diastolic volume is elevated, stretching myocytes to improve EF on the next heart beat
What is pulsus paradoxus
Reduction in pulse on inspiration
Occurs with LV compression, due to venous return being compromised&- R chambers not accommodating for increased intrathoracic pressure
Cause of pulsus paradoxus
Tamponade , constrictive pericarditis, severe asthma
(venous return comprised)
Causes of absent apex beat
Obesity
Emphysema
r pneumonectomy with displacement
Pericardial effusion ir construction
Dextrocardia
Causes of heaving apex beat
LVH- causes of this
- HTN
- hypertrophic cardiomyopathy
- AS
May be assoc with s4
Causes of thirsting/hyperdynamic apex
High LV volume:
- mitral regurg
- aortic regurg
- PDA
-VSD
Causes of tapping apex beat
Palpable s1, mitral stenosis
Causes of displaced and diffuse/dyskinetic apex
LV impairment and dilatation:
- dilated cardiomyopathy
- MI
Cause of double impulse apex
With dyskineaia- LV aneurysm
Without dyskinesia- HCM
Cause of pericardial knock apex
Constrictive pericarditis
Causes of parasternal heave
RV hypertrophy:
- ASD
- pulm HTN
- COPD
- pulmonary stenosis
Causes of palpable s3 on aoex
HF
Severe mitral regurg
What is S1
Closure of mitral and tricuspid valves before systole
What is s2
Closure of aortic and pulmonary valves at end of systole
Causes of loud S1
Mobile mitral stenosis
Hyperdynamic states- eg exercise, anxiety
Tachycardia
L to R shunts
Short PR interval
Causes of soft S1
Immobile mitral stenosis
Hypodynamic states
Mitral regurg
Poor LV function
Long PR interval
Causes of split S1
R/L BBB
VT
Inspiration
Ebsteins anomalt
Causes of variable S1
AF
Completed HB
Causes of loud S2
Systemic HTN
Pulmonary HTN
Tachycardia
ASD
Causes of soft/absent s2
Severe AS
Causes of split s2
FIXED– ASD
WIDELY split:
RBB
Pulmonary stenosis
Deep insp
MR
SINGLE:
severe pulm/aortic stenosis
HTN
Large VSD
Tetralogy of Fallot
Eisenmengers
Pulmonary atresia
Elderly
REVERSED:
LBBB
RV pacing
PDA
AS
What is the third heart sound
Passive filling of ventricles in opening of the atrioventricular valves
Causes of S3
Children
Young adults
Rapid ventricular filling:
Mitral regurg
VSD
CHF
Constrictive pericarditis
What is s4
Atrial contraction filling a stiff LV
Causes of S4
LVH-
Amyloid
HCM
Left ventricular ischaemia
Causes of valvular clicks
Aortic ejection- AS, bicuspid
Pulmonary ejection- stenosis
Mid systolic- mitral valve prolapse
When is opening snap? Cause?
After S2 in early diastole
Mitral stenosis
What indicates severity of the pathology causing opening snap?
Closer opening snap is to s2 , but absent in very severe MS (when it becomes completely immobile)
