Cardiology Flashcards
Aortic regurgitation
General signs: Marfan’s syndrome, ankylosing spondylitis, Argyll Robinson pupils
Diastolic murmur heard best at R 3rd/4th ICS
- high-pitched, decrescendo
- heard best sitting forward on deep expiration
Collapsing “water-hammer” pulse
Wide pulse pressure
prominent carotid pulsations - Corrigan’s sign
Displaced, hyperkinetic apex beat
diastolic thrill at LSE, sitting forward on expiration
Mitral Regurgitation
1) Definition: abnormal blood flow from LV to LA
2) Causes: MVP, Rheumatic heart disease, Infective endocarditis, Cardiomyopathy, Annular calcification, IHD.
3) Palpation: brisk carotid upstroke + hyperdynamic cardiac impulse.
4) Auscultation: Diminished S1, Splitting S2 (AV closes early), Murmur: high pitched, holosystolic, apex –>axilla
Severe AR
water hammer pulse
wide pulse pressure > 80mmHg
loud decrescendo murmur (grade 3+ = mod - severe)
displaced apex
Austin Flint murmur (short rumbling diastolic murmur - the AR jet impinges on the anterior mitral valve leaflet causing functional MS)
signs of LV failure
Pulmonary Regurgitation
- loudest at LSE
- increased on inspiration
- high pitched early diastolic murmur
- trivial PR is physiological
- pulm HTN (Graham steel murmur - due to PA dilatation)
- IE
- surgery for PS (TOF repair, balloon valvotomy)
Mitral stenosis
Causes: Rheumatic congenital
General signs: tachypnoea, mitral facies
Signs: rumbling diastolic murmur, low/normal pulse volume/BP, AF, tapping apex, RV heave, loud S1
Severity: Valve area less than 1cm, gradient greater than 50mmHg
Aortic stenosis
Def: Narrowing of AV restricting LV outflow and increasing pressures in LV
Signs: Narrow PP, slow rising pulse, hyperdynamic apex, ES murmur radiating to carotids and can extend to apex.
Severity: Valve area less than 1cm, gradient greater than 50mmHg, reduced carotid pulse
Causes: Degenerative, congenital: bicuspid aortic valve, rheumatic
Tetralogy of Fallot
Primary lesion (most common cyanotic heart lesion)
- large subaortic VSD, pulmonary stenosis, overriding aorta, RV hypertrophy
- signs: central cyanosis, clubbing, RV heave, systolic thrill from RVOT, single S2, pulmonary ejection systolic murmur
Post repair:
- most common complications are PR and arrhythmias
- Signs: median sternotomy scar, long diastolic murmur which is high pitched at left sternal edge, increased on inspiration, RV heave
- ECG: RBBB, wide QRS
- CXR: boot shaped heart, enlarged RA, R sided aortic arch
Marfans syndrome
Marfanoid habitus
- tall slender build
- long narrow face
- long limbs, long fingers
- wide arm span (exceeds height)
Hands and arms
- joint hypermobility
- arachnoidactyly
- thumb sign - make fist and thumb sticks out
- wrist sign - thumb and little finger around wrist
- check BP in both arms
Mouth/Face
- overcrowded dentition
- high arched palate
- Eyes: glasses, visual acuity, lens dislocation, blue sclera
Chest
- pectus carnitum/excavatum
- AR, MVP, coarctation
- scoliosis/kyphosis
- upper lobe bullae/spontaneous pneumothroax
Feet
- hindfoot valgus (ankles pointed in)
- pes cavus (high arch feet)
Skin striaeSystolic Murmurs
1) does it change with respiration? (R sided murmurs increase)
2) does it increase with hand grip? (increase rules out aortic and pulmonary, decrease excludes mitral and tricuspid)
3) Aortic vs Pulm stenosis: Is there an S2? (aortic stenosis), loudest over L 2 ICS? (pulmonary stenosis)
4) Aortic stenosis vs sclerosis: Pulse pressure
Systolic Murmurs
Aortic sclerosis, Aortic Stenosis, Mitral Stenosis, Tricuspid Stenosis, Tricuspid Regurgitation, Mitral Regurgitation, Aortic Regurgitation, Idiopathic hypertrophic sub aortic stenosis.
