Cardiology Flashcards
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
In patients without CTD what aortic root diameter needs operating?
> 55mm
Signs of severe MR?
3rd heart sound
Signs of pul HTN - Loud 2nd HS, RVH
Displaced apex
When to replace MR in regurg
Symptomatic
Asymptomatic but EF <60%, pulmonary HTN or atrial/ventricular dilatation
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
causes of pulmonary stenosis
TOF, Noonans, williams
What are signs of severe PS?
Gradient >64mmHg
Valve area <1cm^2
What cardiac features occur in noonans?
HOCM, PS, VSD
Cardiac features in turners?
Biscupid aortic valve, coractation, dissection
What is ballock tussig shunt
Conenction between subclavian and pulmonary artery
What is PDA
Connection between descending aorta and pulmonary artery
How do you close a PDA?
NSAIDs
(Kept open by prostaglandins)
How to diagnose Pulmonary arterial hypertension?
Right heart catheterisation (Pressures >25)
What are the JVP waves in TR?
CV waves
Causes of restrictive cardiomyopathy?
Systemic sclerosis
Haemochromatosis
Amyloidosis
Lofflers
Tx is like HF
Any surgical procedures to treat AF
LAAO or MAZE
What other murmur do you get with AR?
Austin flint (dont need to auscultate but just inacse they ask afterwards)
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
When do you consider cardiac resynchronisation therapy in HF?
If eGFR <35%
If prolonged QRS
At maximum medical therapy
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
- Pulse pressure? not really - but you do get a collapsing pulse
- S3
- 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
