cardiology Flashcards
Fundoscopy changes in hypertension
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
The Causes of Aortic regurgitating
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
Clinical signs of severity in chronic aortic regurgitation
- collapsing pulse
- Wide pulse pressure
- length of the decrescendo diastolic murmur
- third heart sound
- soft aortic component of the second heart sound
- Austin Flint murmur (diastolic rumble
- left ventricular failure
indications for surgery in aortic regurgitation
- dyspnoea on exertion
- worseing left ventricular function, such as low ejection fraction
3 progressive left ventricular dilatation on serial echocardiograms: lVESD>5.5cm
causes of mitral regurgitaion
- congenital
- degenerative
- mitral valve prolapse
- rheumatic
- Papillary msucle dysfunction
- connective tissue disease-RA Ankylosing spondylitis
acute : infective endocarditis, MI, surgery, trauma
clinical signs of severity of mitral regurgitation
- enlarged left ventricle
- pulmonary hypertenison
- third heart sound
- early diastolic rumble
- soft first heart sound
- aortic componet of second heart osund is earlier
- small - volume pulse
8 left ventricular failure
Indications for surgery for mitral regurgitation
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
What conditions related to Mitral valve prolapse
associations with Marfan’s syndrome, ASD
complications : mitral regurgitation, infective endocarditis
other causes of a collapsing or bounding pulse, apart from aortic regurgitation
anaemia, fever, pregnancy, thyrotoxicosis
Patent ductus arteriosus, AV fistula, severe bradycardia
what is the role of vasodilators in aortic regurgitation
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.
what are the investigations in AR
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).
How would you manage a patient with mitral regurgitaiton
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
signs of pulmonary hypertension
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).
what are the indicaiton for aortic valve replacement
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
What are a, c and v waves, x y descent
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
What are differential of small volume pulse?
Aortic stenosis, pericardial effusion
What are differential of collapsing pulse?
Aortic regurgitation, hyper dynamic circulation, arteriosclerosis aorta( elderly patients), patent ductus arteriosus, peripheral arteriovenous aneurysm
Atrial Septal Defect, clinical signs, result of investigations?
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
signs of Marfan syndrome
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
What are signs of Turner’s syndrome
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
WHat are signs of Down’s syndrome
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
Causes of splitting second heart sound?
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
