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PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Differential diagnosis of systolic murmur

A

Aortic stenosis
Aortic sclerosis
HOCM
Mitral regurgitation (pan systolic)

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2
Q

Management of severe symptomatic AS

A

Referral to cardiothoracics for valve replacement

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3
Q

Medical management of AS

A

Beta blockers
Avoid vasodilator eg ACEi, nitrates and sildenafil

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4
Q

Surgical options in AS

A

Mechanical aortic valve
Tissue aortic valve
TAVI - transaortic vale intervention

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5
Q

Severity of AS on examination

A

Slow rising low volume pulse
Narrow pulse pressure
Muted/absent S2
High pitch
Length of murmur
Radiation to carotids
LV heave
Fourth heart side

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6
Q

Findings on Aortic regurgitation

A

Collapsing pulse
Wide pulse pressure
Pan diastolic murmur
Apex beat thrusting and displaced

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7
Q

Indications for AVR

A

Severe symptomatic aortic stenosis/regurgitation
Infective endocarditis

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8
Q

Advantages of mechanical heart valve

A

Longer lasting and more durable although requires life long anticoagulation

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9
Q

Indications for MVR

A

Mitral stenosis
Mitral regurgitation
Infective endocarditis

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10
Q

How does the splitting of the second heart sound vary with an ASD

A

Fixed and widely split, does not vary with respiration

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11
Q

Differentials for MR

A

Mitral valve prolapse
Tricuspid regurgitation
VSD

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12
Q

Severe MR findings

A

Raised JVP
Loud P2
S3 gallop rhythm
Apex displaced and thrusting
RV heave

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13
Q

Indication for MR surgery

A

Symptomatic MR

Asymptomatic but with:
Declining EF
MR with new AF
Increasing LV dilatation
Acute MR following MI

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14
Q

Causes of MR

A

Age related MR
Papillary rupture following MI
IE or rheumatic fever
CTD - Ehlers danlos

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15
Q

What is the cause of S3

A

Caused by filling of ventricles

Can be normal in younger patients

Asssociated with heart failure

Occurs in early diastole

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16
Q

What is the cause of S4

A

Almost always pathological

Caused by pumping blood from atria to ventricles against resistance

Occurs in late diastole

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17
Q

What is Marfan’s

A

Autosomal dominant inherited disorder in fibrillin gene

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18
Q

Indication for aortic surgery

A

Dilatation >50mm at aortic root or >40mm with family history of aortic dissection

Increasing >10mm dilatation per year

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19
Q

Noonan syndrome features

A

Autosomal dominant

Cubitus valgus
Webbed neck
Widely spaced nipples
Pectus excavatum
Short stature
Proptosis
Strabismus
Ptosis
Mild intellectual disability
Difficulties with blood clotting
Motor delay
Congenital heart defects

20
Q

Symptoms of pulmonary stenosis

A

Exercise intolerance
Signs of right sided heart failure
Syncope and pre syncope
Palpitations
SOB

21
Q

Clinical findings in the pulmonary stenosis

A

Large A waves in JVP
Right ventricular heave from right ventricular heave
Pansystolic murmur from TR
Right sided heart valve
Widely split 2nd heart sound
Radiation to infraclavicular area

22
Q

Cardiac complications in Noonans syndrome

A

Pulmonary stenosis
HCM
Septal lesions

23
Q

Features on ECHO of Pulmonary stenosis

A

Peak gradient >64mmHg
Area over valve <1cm2
Velocity >4m2 across valve

24
Q

Features of tetralogy of Fallot

A

Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis
VSD

25
Q

Causes of pulmonary stenosis

A

Congenital
Tetralogy of allot, Noonan, Williams
Rheumatic fever
Endocarditis
Carcinoid

26
Q

Management of pulmonary stenosis

A

Management of underlying cause
Balloon valvuloplasty
Valve replacement surgery

27
Q

Associated conditions with mitral valve prolapse

A

Marfans
Ehlers-Danlos
Osteogenesis imperfecta
Polycystic kidney disease

28
Q

Causes of systolic murmur

A

AS
Mitral regurgitation
Mitral valve prolapse
HOCM
VSD

29
Q

Complications of Ehlers-Danlos

A

Lens dislocation
Mitral valve prolapse
Bicuspid valve
Aortic dissections
Aortic aneurysms
Spontaneous artery dissections
Raynaud’s disease
Arthralgia
Joint dislocation

30
Q

Concerning features on ECHO of PDA

A

Raised pulmonary pressures
Dilated pulmonary arteries
Evidence of right ventricular dilatation
Tricuspid regurgitation
Evidence of LV dysfunction

31
Q

Severity of findings in PDA

A

Collapsing pulse
Right ventricular heave
LV failure

32
Q

Why does inspiration make right sided murmurs louder?

A

In inspiration increased venous return
More flow across right side of the heart
Increases character of the murmur

33
Q

What is the ductus arteriosus

A

Connection between the left pulmonary artery and the descending aorta

Allows blood to bypass the pulmonary circulation in the foetus

Usually closes at birth to become the ligaments arteriosum

Failure to close leads to PDA

34
Q

Management of PDA

A

If severe findings considered for device closure percutaneously

35
Q

Clinical findings in PDA

A

Machine like continuous flow murmur
Louder in expiration
Best heard in 2nd intercostal space left to sternum
Also heard on back

36
Q

Ix in PDA

A

ECHO
Cardiac MR
Cardiac CT

Cardiac catheterisation - pressure within pulmonary circulation

37
Q

What is Eisenmenger’s Syndrome

A

Process in which long standing left to right shunt is caused by congenital heart defects

Leads to pulmonary hypertension and eventually reversal of shunt to right to left and cyanosis

38
Q

Causes of Eisenmengers

A

VSD defect
ASD defect
PDA

39
Q

Indications for closure in VSD

A

Evidence of left to right shunt
Other reasons for cardiac surgery
Aortic regurgitation - prolapse of aortic leaflets through defect
LV dysfunction

40
Q

Complications fo Eisenmengers

A

RV failure
Paradoxysial embolism
IE
Hypoxaemia
Haemoptysis

41
Q

Causes of clubbing

A

Cardiac
- Subacute IE
- Cyanotic congenital heart disease

Respiratory
- Lung malignancy
- Suppurative lung pathology
- TB
- ILD

Gastro
- IBD

Familial causes

42
Q

Indications for lateral thoracotomy scar

A

Lobectomy
Pneumonectomy
Coarctation surgeries

43
Q

Syndromes associated with VSD

A

Down’s
Edwards
Di George

44
Q

Management of pulmonary hypertension

A

Endothelin antagonist eg bosentan
PDE5 inhibitors eg sildenafil
Prostanoid infusions

45
Q

Cyanotic congenital heart defects

A

Tetralogy of Fallot
Transposition of the great arteries
Pulmonary stenosis
Pulmonary Atresia
Eisenmengers
Epsteins

46
Q

Complications following surgery in tetralogy of Fallow

A

Pulmonary regurgitation
Endocarditis
Polycythaemia
Coagulopathy
Paradoxysial embolism
Arrythmias

47
Q

Acyanotic congenital heart defects

A

ASD
PDAs
Coarctation
AS

PACES (6 decks)

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