Cardiology Flashcards by John Doherty

When to have surgery in Marfans and there is root dilatation?

> 50mm in diametes
45mm in diameter and 1st degree relative with disseciton
3mm increase /year

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In patients without CTD what aortic root diameter needs operating?

> 55mm

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Signs of severe MR?

3rd heart sound
Signs of pul HTN - Loud 2nd HS, RVH
Displaced apex

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When to replace MR in regurg

Symptomatic
Asymptomatic but EF <60%, pulmonary HTN or atrial/ventricular dilatation

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What heart sound do you get with an ASD?

Fixed and widely split

Think of a fat person being wide and fixed in one position

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causes of pulmonary stenosis

TOF, Noonans, williams

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What are signs of severe PS?

Gradient >64mmHg
Valve area <1cm^2

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What cardiac features occur in noonans?

HOCM, PS, VSD

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Cardiac features in turners?

Biscupid aortic valve, coractation, dissection

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What is ballock tussig shunt

Conenction between subclavian and pulmonary artery

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What is PDA

Connection between descending aorta and pulmonary artery

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How do you close a PDA?

NSAIDs
(Kept open by prostaglandins)

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How to diagnose Pulmonary arterial hypertension?

Right heart catheterisation (Pressures >25)

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What are the JVP waves in TR?

CV waves

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Causes of restrictive cardiomyopathy?

Systemic sclerosis
Haemochromatosis
Amyloidosis
Lofflers

Tx is like HF

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Any surgical procedures to treat AF

LAAO or MAZE

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What other murmur do you get with AR?

Austin flint (dont need to auscultate but just inacse they ask afterwards)

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In terms of investigating a heart murmur, what imaging other than an ECHO should be done?

Angiogram - to see if any CABG needs to be done

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When do you consider cardiac resynchronisation therapy in HF?

If eGFR <35%
If prolonged QRS
At maximum medical therapy

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What happens to apex beat in heart failure?

Displaced

What happens to apex beat in hypertrophy?

Heaving apex beat
H FOR HEAVING, H FOR HYPERTROPHY

When thinking about severity what three things do you think about?

Pulse pressure
Extra heart sounds - S3/4 (regurgitant ,murmurs S3)
Affect on apex beat - displaced or heaving

What ejection fracture is considered for valve replacement in aortic disease (Stenosis or regurg)(

50%

What are causes of aortic regurgitation

Degenerative
Infective endocarditis
Rheumatic heart disease
Connective tissue disease - marfans
Collagen disorders - OI, EDS, Alports
Aortitis - Syphilis, ank spond

How to tell the difference between a venous and arterial pulsation

Venous pulsations will not be palpable and can be obliterated by pressure

What happens to the JVP in Pul stenosis

Giant A waves

How to examine in marfans

Collapsing pulse Fingers around wrist Arachnodactlyl High arched palate Arm span Upward lens dislocation Listen for PTX Check for chest wall deformity Listen for AR AAA

What city in belgium is involved in criteria for Marfans

Ghent

What is the differentials for marfans

Homocystinuria (autosomal recessive and downwards lens dislocation) MEN 2B

Treatment of HOCM

Monitoring and patient education BB, PPM, Ablation, myomectomy

High risk factors in HOCM

History of syncope FHX of sudden cardiac death Septal wall >3cm Poor BP response to exercise testing

What 2 murmurs do you get in HOCM?

ESM from the HOCM itself Pansystolic mumur from the mitral regurg (Secondary to SAM)

What two inherited disorders are associated with HOCM?

Myotonic dystrophy Friedreichs

How do you differentiate HOCM from AS?

HOCM does not radiate to carotids HOCM gets louder on valsalva

What are the causes of MR

Degen IE Rheumatic heart disease CTDs Papillary muscle rupture post MIW

Indications for valve in MR?

Symptomatic EF <60% Evidence of pulmonary htn or heart failure

What are features of severe MR? think of 3 things to indicate severity

1. Pulse pressure? not really - but you do get a collapsing pulse 2. S3 3. Effect on apex - displaced Apex/heavig beat from HF

What values are important in MS in terms of severity

Area of <1cm Pressure >10mmHGW

What happens to S1 in MS? Loud or quiet

LOUD (unlike AS)

What are causes of MV Prolapse?

ACPKD CTD - marfans/EDS/OImperfecta Myotonic dystrophy

What are the complications of a prosthetic valve

infection conduction issues Bleeding if on anticoag Failure and need for reprocedure Haemolysis

A flow murmur across a valve is okay - but what type of murmur is not ok?

Regurgitant

Differential diagnosis for Mitral regurg

Tricuspid regurg Mitral valve prolapse VSD HOCM

In what condition due to get a weak left pulse?

Following BT shunt procedure for TOF

What is the purpose of Right heart cath?

For measuring invasive haemodynamics

What is A primary cause of restrictive cardiomyopathy?

Lofflers (endomyocardial) fibrosis

Why do we need to differentiate between restrictive and constrictive pericarditis?

Treatment is very different - Restrictive - Treat the cause, heart failure management - Constrictive - may need surgical correction

Name some congenitla heart disease syndromes

TOF TOGA Pulmonary atresia Pulmonary stenosis Tricuspid atresia Eisenmenger VSD