Cardiology Flashcards
What ECG changes are found in LV aneurysm?
Persistent ST elevation >2 weeks post-STEMI
What causes the 4th heart sound?
Contraction of the atria into a stiff, hypertrophied ventricle.
It is always abnormal: heart failure, MI, cardiomyopathy, HTN (pressure overload)
Le-lub-dub
What causes the 3rd heart sound?
Can be physiological in children and young adults.
Cause is rapid ventricular filling in early diastole. Stiff or dilated ventricle reaches elastic limit and decelerates incoming rush of blood.
- HF, MI, Cardiomyopathy, HTN
- Mitral or aortic regurgitation: volume overload
constrictive pericarditis
lub-de-dub
4 stages of clubbing
Stage 1 - increase fluctuancy
Stage 2 - Loss of angle
Stage 3 - Increase curvature
Stage 4 - Expansion of terminal phalanx
How can you distinguish AF from multiple ventricular ectopics?
Both cause an irregularly irregular pulse.
Perform an exercise test as exertion causes ectopics to reduce and disappear. Ventricular ectopics occur in diastole, exertion reduces time for diastole thus reducing ventricular ectopic ‘window of opportunity’
What is the pulse deficit in AF?
Due to fast ventricular response in AF there can be sometimes insufficient diastolic filling time to create cardiac output.
This results in there being no palpable distal pulse but heart sounds can still heard at the apex.
How would you asses whether AF is well controlled?
Time apical rate with a stethoscope.
What causes the tapping apex beat in mitral stenosis?
Systole slams shut stenosed mitral valve
LUB-de-Derr = loud S1 + low-pitched, rumbling, mid-diastolic murmur
What cardiac abnormality is visible on CXR in mitral stenosis and how is it caused?
Prominent LA.
Mitral stenosis leads to back pressure in the LA. This causes LA dilatation.
This dilatation also is the cause of the increased risk of AF and the development of emboli.
What indicates the degree of severity of mitral regurgitation?
Degree of apical displacement
‘burrrr’
Bornholme disease
Viral-induced costochondritis
Pain made worse by gently pressing on chest.
Commonest murmur in Marfan syndrome?
Mid-systolic click with a late systolic murmur
Mitral valve prolapse occurs in 75%
Criteria for diagnosing Rheumatic Fever
Jones criteria:
Evidence of recent Streptococcal infection + 2 major or 1 major & 2 minor criteria
Major: CASES
- Carditis
- Arthritis (migratory)
- Subcutaneous nodules
- Erythema marginatum
- Sydenham’s chorea
Minor:
- Fever
- Raised ESR/CRP
- Arthralgia
- prolonged PR
- previous rheumatic fever
Indications for CABG
Multiple complex narrowings
- 3 vessel disease
- LMS stenosis >50%
- proximal LAD or LCx >70%
DM or young patients
- stenting is unsuitable.
How do you distinguish between a JVP and a carotid pulse?
JVP:
- double wave form
- impalpable; disappears on compression
- decreased by inspiration
- increased by hepatojugular reflex and lying supine
Indication for giving patients with aortic stenosis a valve repair
1) Symptomatic
2) Asymptomatic + valvular gradient >50mmHg with evidence of LVF e.g. EF
TAVI = ?
Transcatheter Aortic Valve implantation.
Percutaneous endovascular valve replacement: transfemoral, transapical, transaortic, transcaval.
Prognosis of SOB, angina and syncope in AS?
Angina - 50% in 5 years
Syncope - 50% in 3 years
Dyspnoea - 50% in 2 years
Causes of mitral regurgitation
Acute
1) Valvular
- bacterial endocarditis
2) Chordae/papillae
- Rupture
Chronic
1) Valvular
- Rheumatic heart disease
- MVP: CTD (Marfan’s, Ehlers-Danlos)
2) Functional
- LV dilatation
3) Chordae/papillae
- Infiltration (Amyloidosis)
- Fibrosis (post-MI//trauma)
What is the sign of LV strain found on ECG in patients with aortic regurgitation?
Lateral TWI
How do you reduce the afterload in patients with AR or MR
Give ACEi/B blockers + Diuretics
Indications for valve replacement in aortic regurgitation?
1) Symptomatic with NYHA >2
2) LV dysfunction
- wide pulse pressure > 100mmHg
- ECG : lateral TWI
- CXR = LV enlargement OR Echo = EF 50mm
What is the contraindication for percutaneous balloon valvuloplasty in mitral stenosis?
LA mural thrombus.
Mitral valve must also be pliable and minimally calcified.
Mid-systolic click and late systolic murmur =
Mitral valve prolapse
aka Barlow syndrome
Low-pitched mid-diastolic rumble at the apex
Austin-Flint murmur
Aortic regurgitation → mitral valve disturbance
High pitched early diastolic murmur at ULSE, loudest during inspiration
Graham-Steell murmur, due to pulmonary HTN
JVP morphology in AF
absent ‘a waves’
JVP morphology in complete heart block
Cannon ‘a waves’
3 diagnostic criteria of Prinzmetal angina
Prinzmetal = variable = vasospastic angina
1) Nitrate-responsive angina
2) Transient ischaemic ECG changes
3) Angiographic evidence of coronary artery spasm (>90% on provocation testing)
Classic finding of constrictive pericarditis
Kussmaul’s sign
Paradoxical increase in JVP during inspiration
