Cardiology Flashcards
Murmur - pansystolic
MR
TR
VSD
AP shunts
Murmur - mid-systolic
AS
PS
HOCM
ASD (pulmonary flow)
Murmur - early systolic
VSD
MR (acute)
TR
Murmur - late systolic
MV prolapse
Papillary muscle dysfunction (eg. HOCM)
Murmur - early diastolic
AR
PR
Murmur - mid-diastolic
MS TS Atrial myxoma AR (Austin Flint) Rheumatic fever (Carey Coombs)
Murmur - pre-systolic
MS
TS
Atrial myxoma
Murmur - continuous
PDA AV fistula Venous hum Sinus of Valsalva rupture AP connection Mammary souffle
JVP - dominant a wave
TS
PS
Pulmonary HTN
JVP - dominant v wave
TR
JVP - cannon a wave
Complete heart block
Paroxysmal nodal tachycardia (with retrograde atrial conduction)
VT (with retrograde atrial conduction, or AV dissociation)
JVP - elevated CVP
RV failure TS or TR Pericardial effusion Constrictive pericarditis SVC obstruction Fluid overload Hyperdynamic circulation
Hyperdynamic circulation - causes
Fever Anaemia Thyrotoxicosis AV fistula Pregnancy Exercise Beri beri Hypoxia Hypercapnia
Pulse - anacrotic
AS
small volume, slow upstroke, a wave on upstroke
Pulse - plateau
AS
slow upstroke
Pulse - bisferiens
AS plus AR
anacrotic plus collapsing
Pulse - collapsing (waterhammer)
AR PDA Hyperdynamic circulation Arteriosclerotic aorta Peripheral AV aneurysm
Pulse - small volume
AS
Pericardial effusion
Pulse - alternans
LV failure
alternating strong and weak beats
Apex - pressure-loaded
AS
HTN
(hyperdynamic, systolic overloaded)
(forceful, sustained impulse)
Apex - volume-loaded
MR
AR
(hyperkinetic, diastolic overloaded)
(forceful, unsustained impulse)
Apex - tapping beat
MS
palpable 1st heart sound
Apex - double/triple impulse
HOCM
Apex - dyskinetic
Previous large MI
Heart sounds - loud S1
MS
TS
Tachycardia
Hyperdynamic circulation
Heart sounds - soft S1
MR
Calcified mitral valve
LBBB
1st degree HB
Heart sounds - loud A2
Congenital AS
Systemic HTN
Heart sounds - soft A2
AR
Calcified aortic valve
Heart sounds - loud P2
Pulmonary HTN
Heart sounds - soft P2
PS
Heart sounds - S2 increased splitting on inspiration
RBBB
PS
VSD
MR
Heart sounds - S2 fixed splitting
ASD
Heart sounds - S2 reversed splitting
P2 first
LBBB
AS
Coarctation of aorta
PDA (large)
Heart sounds - LV S3
louder at apex, on expiration
Physiological LV failure AR MR VSD PDA
Heart sounds - RV S3
louder left sternal edge, on inspiration
RV failure
Constrictive pericarditis
Heart sounds - LV S4
louder at apex, on expiration
AS MR (acute) HTN IHD HOCM
Heart sounds - RV S4
louder left sternal edge, on inspiration
Pulmonary HTN
PS
Pulmonary hypertension - signs
Prominent a wave JVP RV impulse Loud P2 PR TR
Mitral stenosis - causes
Rheumatic
Congenital (rare)
Mitral stenosis - signs of severity
Small pulse pressure Diastolic thrill at apex Pulmonary HTN Early opening snap Long mid-diastolic rumbling murmur
Mitral stenosis - ECG
P mitrale (in SR)
AF
RV systolic overload
RAD
Mitral stenosis - CXR
Mitral valve calcification
Large LA - double LA shadow, displaced left main bronchus, big left atrial appendage
Pulmonary HTN - large central pulmonary arteries, pruned peripheral artery tree
Cardiac failure signs
Mitral stenosis - surgical indications
Not responding to medical therapy
- Progressive dyspnoea
- Pulmonary oedema
- Major haemoptysis
Valve area ≤1cm
Mitral regurgitation - causes (chronic)
Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction (LV failure, ischaemia)
Connective tissue disease (RA, ank spond)
Congenital (ASD, parachute valve, corrected transposition)
Mitral regurgitation - causes (acute)
Infective endocarditis
MI
Surgery
Trauma
Mitral regurgitation - signs of severity
Small volume pulse Enlarged LV Pulmonary HTN Soft S1 Early A2 S3 Early diastolic rumble LV failure
Mitral regurgitation - ECG
P mitrale
AF
LV diastolic overload
RAD
Mitral regurgitation - CXR
Large LA
Large LV size
Mitral annular calcification
Pulmonary HTN
Mitral regurgitation - surgical indications
Class III or IV symptoms
LV dysfunction
Progressive LV dimension increase
Mitral valve prolapse - signs
Systolic click
- Valsalva (murmur longer, click earlier)
- Handgrip (murmur shorter)
Mitral valve prolapse - associations
Marfans
ASD
Anorexia nervosa
Aortic regurgitation - causes (chronic)
Rheumatic Congenital Seronegative arthropathy Marfans Aortitis Dissecting aneurysm Old age
Aortic regurgitation - causes (acute)
Infective endocarditis
Marfans
HTN
Dissecting aneurysm
Aortic regurgitation - signs of severity
Collapsing pulse Wide pulse pressure S3 Soft A2 Decrescendo diastolic murmur length Austin Flint murmur LV failure
Aortic regurgitation - ECG
LV hypertrophy
Aortic regurgitation - CXR
LV dilation
Aortic root dilatation / aneurysm
Valve calcification
Aortic regurgitation - surgical indications
Symptoms (dyspnoea on exertion)
LV function (low EF)
Progressive LV dilatation (LVESD more than 5.5 cm)
Aortic stenosis - causes
Degenerative (senile, calcific)
Rheumatic (rare in isolation)
Calcific bicuspid valve
Aortic stenosis - signs of severity
Plateau pulse Aortic thrill Paradoxical splitting S2 S4 Systolic murmur (long, late, harsh peak) LV failure
Aortic stenosis - ECG
LV hypertrophy
Aortic stenosis - CXR
LV hypertrophy
Valve calcification
Aortic stenosis - surgical indications
Symptoms (exertional angina, dyspnoea, syncope) Critical obstruction (area less than 0.7 cm²/m², or valve gradient less than 70 mmHg)
Tricuspid regurgitation - causes
Functional (RV failure) Rheumatic Infective endocarditis Congenital (Ebstein's anomaly) Tricuspid valve prolapse RV papillary muscle infarction Trauma
Tricuspid regurgitation - signs of severity
JVP dominant v wave RV heave Pansystolic murmur (lower sternum, inspiration) Pulsatile liver Oedema, ascites, pleural effusion
Tricuspid regurgitation - CXR
RV or biventricular enlargement
Box-shaped heart, narrow cardiac base (Ebstein’s anomaly)
Pulmonary stenosis - causes
Congenital
Carcinoid syndrome
Pulmonary stenosis - clinical signs
Peripheral cyanosis Reduced pulse JVP dominant a wave, elevated RV heave Thrill (pulmonary area) S4 Ejection systolic murmur (pulmonary area, inspiration louder) Pulsatile liver (presystolic)
(Signs of severity: Late peaking ESM Absence of ejection click S4 RV failure)
Constrictive pericarditis - clinical signs
Low BP Pulsus paradoxus JVP (raised, Kussmaul's sign, prominent x and y descent) Apex beat impalpable S3 Hepatosplenomegaly Oedema/ascites
Hypertrophic cardiomyopathy - clinical signs
Pulse (sharp, jerky) JVP prominent a wave Apex double/triple impulse S4 Late ESM (left sternal edge) PSM (apex due to MR) Valsalva (louder murmur)
Hypertrophic cardiomyopathy - ECG
LV hypertrophy
Lateral ST segment / T wave changes
Deep Q waves
Conduction defects
Hypertrophic cardiomyopathy - CXR
LV enlarged, hump along border
No valve calcification
Atrial septal defect - clinical signs
Fixed splitting S2
Pulmonary ESM (louder inspiration)
Pulmonary HTN
Atrial septal defect - ECG
RAD
RBBB
RV hypertrophy
Atrial septal defect - CXR
Increased pulmonary vasculature
Enlarged RA and RV
dilated pulmonary artery
Small aortic knob
Atrial septal defect - surgical indications
Left to right shunt 1.5 to 1
Ventricular septal defect - clinical signs
Pansystolic murmur (left sternal edge, louder expiration) MR
(associated Down syndrome)
Ventricular septal defect - ECG
LV hypertrophy
Ventricular septal defect - CXR
LV hypertrophy
Increased pulmonary vasculature
Enlarge RV
Ventricular septal defect - surgical indications
Left to right shunt more than 1.5 to 1
