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Short case > cardiology > Flashcards

cardiology Flashcards

1
Q

Fundoscopy changes in hypertension

A

Grade I: silver wiring
Grade II: above change plus AV nipping
Grade III: above changes plus haemorrhages and exudates, soft exudates,
Grade IV: above changes plus papilloedema

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2
Q

The Causes of Aortic regurgitating

A 
Valvular: 
1. Congenital 
2rheumatic
3. Seronegative arthropathy, eps. ankylosing spondylitis
Aortic root (murmur may be maximal at the right sternal border)
1. Marfan's syndrome
2. Aortis (seronegative arthropahty, RA)
3 dissecting aneurysm
4. old age
Acut eaortic regurgitation:
1. infective endocarditis
2. Aortic root : Marfan's syndrome, hypertension, dissecting aneurysm
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3
Q

Clinical signs of severity in chronic aortic regurgitation

A
  1. collapsing pulse
  2. Wide pulse pressure
  3. length of the decrescendo diastolic murmur
  4. third heart sound
  5. soft aortic component of the second heart sound
  6. Austin Flint murmur (diastolic rumble
  7. left ventricular failure
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4
Q

indications for surgery in aortic regurgitation

A
  1. dyspnoea on exertion
  2. worseing left ventricular function, such as low ejection fraction
    3 progressive left ventricular dilatation on serial echocardiograms: lVESD>5.5cm
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5
Q

causes of mitral regurgitaion

A
  1. congenital
  2. degenerative
  3. mitral valve prolapse
  4. rheumatic
  5. Papillary msucle dysfunction
  6. connective tissue disease-RA Ankylosing spondylitis
    acute : infective endocarditis, MI, surgery, trauma
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6
Q

clinical signs of severity of mitral regurgitation

A
  1. enlarged left ventricle
  2. pulmonary hypertenison
  3. third heart sound
  4. early diastolic rumble
  5. soft first heart sound
  6. aortic componet of second heart osund is earlier
  7. small - volume pulse
    8 left ventricular failure
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7
Q

Indications for surgery for mitral regurgitation

A 
NYHA class III and IV, 
left ventricular dysfunction, LVEF 45mm)
repair of a prolapsing posterior and often anterior leaflet is now undertaken earlier than valve replacement
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8
Q

What conditions related to Mitral valve prolapse

A

associations with Marfan’s syndrome, ASD

complications : mitral regurgitation, infective endocarditis

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9
Q

other causes of a collapsing or bounding pulse, apart from aortic regurgitation

A

anaemia, fever, pregnancy, thyrotoxicosis

Patent ductus arteriosus, AV fistula, severe bradycardia

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10
Q

what is the role of vasodilators in aortic regurgitation

A

is to reduce systolic blood pressure, vasodilator therapy with nifedipine and ACEI/ARB, vasodilators is recommended for patietns with asymptomatic severe aortic regurgitaion and left ventricular dilatation.

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11
Q

what are the investigations in AR

A

ECG, CXR, echo, CT/MRI(assess aortic root and ascending aorta), cardiac catherization ( to assess coronary stenosis, would require bypass grafting at the time of valve replacement).

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12
Q

How would you manage a patient with mitral regurgitaiton

A

asymptomatic patients:
annual echocardiograhy to assess progression of mitral regurgitation
management of AF
rate control:
Rhythm control
anticoagulant: warfarin or aspirin
Heart Failure
Diuretics for congestive symptoms
ACEI /ARB, beta blockers, spironolactone, and digoxin
patients with heart failure should be considered for surgery

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13
Q

signs of pulmonary hypertension

A

giant systolic ‘V’ waves of tricuspid regurgitation, parasternal heave and thrill, and a loud pulmonary component to the second heart sound or pulmonary congestion/cardiac failure(bibasal crepitations).

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14
Q

what are the indicaiton for aortic valve replacement

A

Symptomatic patietns
symptomatic severe aortic stenosis (mean gradient >50mmHg)
Asymptomatic patients
1. moderte/sever aortic stenosis undergoing other cardiac surgery i.e. coronary artery bypass surgery, aortic surgery or other valve sugery
2. severe aortic stenosis and any of the following:
exertional angina, exertional dyspnoea, exertional syncope
critical obstruction <0.7, and severe left ventricular hypertrophy even if asymptomatic

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15
Q

What are a, c and v waves, x y descent

A

a wave: due to atrial contraction
x descent atrial emptying with downward movemnet of heart
c wave a small flicker in the x descent due to transmission of right ventricular systolic pressure before the closure of the tricuspid valve
v wave due to passive filling of right atrium against aclosed tricuspid valve
y descent : opening of the tricuspid valve with passive emptying of blood from right atrium into right ventricle

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16
Q

What are differential of small volume pulse?

A

Aortic stenosis, pericardial effusion

17
Q

What are differential of collapsing pulse?

A

Aortic regurgitation, hyper dynamic circulation, arteriosclerosis aorta( elderly patients), patent ductus arteriosus, peripheral arteriovenous aneurysm

18
Q

Atrial Septal Defect, clinical signs, result of investigations?

A 
clinical signs:
1.fixed splitting of the second heart sound
2. pulmonary sytolic ejection murmur (increasing on inspiration)
3. pulmonary hypertension
results of investigations:
1. ECG:
right axis deviation, right buncle brance block pattern
right ventricular hypertrophy
2. chest x ray:
increased pulmonary vasculature
enlarged right atrium and ventricle
dilated main pulmonary artery
small aortic knob
3. Echocardiography:
paradoxical septal motion, right ventricular dilation
echo dropout in atrial septum
a shunt
bubble study using agitated saline
19
Q

signs of Marfan syndrome

A

apart from cardiovascular signs of Aortic regurgitation, or mitral valve prolapse
a. arachnodactyly (spider fingers) and joint hypermobility
b. face: long and narrow face, lens dislocation, high-arched palate
c. chest: pectus carinatum or excavatum
d. back: kyphoscoliosis and hypermobility
arm span exceed the height

20
Q

What are signs of Turner’s syndrome

A 
short stature
square chest
webbed neck
high arched palate
short fourth metacarpals.
complications:
cardiac; bicuspid aortic valve, coarctation of the aorta, HTN
diabets:
hyothyroidism
hypogonadism
21
Q

WHat are signs of Down’s syndrome

A

short stature
low set, dysplastic ears
flattened nasal bridge
neck is short
generalized hypotonia, single transverse palmar crease
complications of down’s syndrome
congenital heart disease - atrioventricular septal defect, patent ductus arteriosus, tetralogy of fallot

22
Q

Causes of splitting second heart sound?

A

Heard over 3LICS and 4LICS (also called LLSB), where P2 is loudest.

Associated Conditions

Physiologic splitting (split appears with inspiration)

Normal
Paradoxical Splitting (split appears with expiration)

—caused by delayed onset of LV systole:

Left Bundle Branch Block (LBBB)
Right Ventricular Pacemaker
—caused by prolongation of LV Systole:

Aortic Stenosis: Valvar, Sub & Supravalvar
Hypertrophic Cardiomyopathy

Persistent Splitting (split throughout respiration)

—caused by delayed onset of RV systole:

Right Bundle Branch Block (RBBB)
—caused by prolongation of RV systole

Atrial Septal Defect (ASD)
Pulmonic Stenosis
Pulmonary Embolism (Acute elevation of PA pressure)
—caused by shortened Duration of LV Systole:

Mitral Regurgitation
Ventricular Septal Defect (VSD)
See Also

Short case (8 decks)

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