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FRACP short case > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Differentials for an ejection systolic murmur?

A 
Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Atrial septal defect
Hyperdynamic states:
- Normal = pregnancy and athletes
- Abnormal = Hyperthyroid and anaemia
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2
Q

How to differentiate aortic stenosis?

A

Aortic area
Radiates to carotids
Increases on expiration

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3
Q

How to differentiate HoCM?

A

Aortic area
Nil radiation
Increases on Valsalva

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4
Q

Differentials of a pansystolic murmur?

A

Mitral regurgitation
Tricupsid regurgitation
Ventricular septal defect

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5
Q

How to differentiate MR?

A

Mitral area
Radiates to axilla
Increases on expiration
SOFT S1

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6
Q

Differentials of a late systolic murmur?

A

Mitral prolapse - mid systolic click

Tricuspid prolapse

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7
Q

Differentials of an early diastolic murmur?

A

Aortic regurgitation

Pulmonary regurgitation

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8
Q

How to differentiate aortic regurgitation?

A 
Aortic area --> left sternal edge on leaning forward
Increased on expiration
Collapsing pulse
Wide pulse pressure
Nailbed pulsations
Head bobbing
Soft S2
Severe --> austin flint murmur - mid-diastolic rumble
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9
Q

Differentials of a mid-diastolic murmur?

A

Mitral stenosis - load S1

Tricuspid stenosis

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10
Q

Differentials of a continuous murmur?

A

Patent ductus arteriosus

Mammary souffle

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11
Q

Causes of a wide S2?

A

RBBB
Pulm HTN - load S2 in pulm area
Pulm stenosis

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12
Q

Causes of a fixed split S2?

A

Atrial septal defect

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13
Q

Causes of a paradoxically split S2?

A

Atrial septal defect
LBBB
HoCM

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14
Q

Cause of 3rd heart sound?

A 
LVF
AR
MR
VSD
PDA
RVF
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15
Q

Causes of a 4th heart sound?

A 
AS
MR
HTN
IHD
HoCM
Pulm HTN
Pulm Stenosis
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16
Q

Causes of MS?

A

Rheumatic
Severe mitral annular calcification
Congenital

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17
Q

Clinical signs of MS

A 
Small pulse pressure
Early-opening snap
Long mid-diastolic rumble
Presence of pulmonary HTN
Tapping apex beat
Load S1
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18
Q

Signs of Pulmonary HTN?

A 
Prominent a wavw in JVP
Right ventricular impulse
Load P2
Palpable P2
Pulmonary regurgitation
Tricuspid regurgitation
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19
Q

Results of investigations for MS?

A

ECG: AF, P mitrale, RV systolic overload, right axis deviation
CXR: large L atrium, mitral valve calcification, signs of Pulm HTN

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20
Q

Chronic causes of MR?

A

Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction - LVF and IHD
Connective tissue disease - RA, Ank. spond.
Congenital

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21
Q

Acute causes of MR?

A

Infective endocarditis
MI
Surgery
Trauma

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22
Q

Signs of MR?

A 
Enlarged left ventricle
Pulm HTN
Third heart sound
Early diastolic rumble
Soft 1st heart sound
Small volume pulse
LVF
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23
Q

Results of Ix of MR?

A

ECG: P mitrale, AF, LVH, right axis deviation
CXR: Large left atrium and LVH, mitral annular calcification

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24
Q

Valvular causes of AR?

A

Rheumatic
Congenital
Seronegative Arthropathy - ank. spond

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25
Q

Aortic root causes of AR?

A 
Marfan's syndrome
Aortitis
HTN
Dissecting aneurysm
Old age
26
Q

Signs of Aortic regurgitation?

A 
Collapsing pulse
Wide pulse pressure
Length of the decrescendo diastolic murmur
Third heart sound
Soft A2
Austin flint murmur
LVF
27
Q

Results of investigations for AR?

A

ECG - LVH

CXR - LVH, valve calcification

28
Q

Indications for surgery for MR?

A

Class 3 or 4 HF

LV dysfunction

29
Q

What kind of surgery for MR?

A

Usually repair

Replacement = mechanical

30
Q

Indications for surgery for AR?

A

SOB on exertion
Worsening LVF
Progressive LV dilatation

31
Q

Causes of AS?

A

Degenerative disease
Rheumatic
Calcific bicuspid valve

32
Q

Clinical signs of AS?

A 
Plateau pulse
Aortic thrill
Long harsh systolic murmur
4th heart sound
Paradoxical splitting of the 2nd heart sound
LVF
33
Q

Results of investigation for AS?

A

ECG - LVH
CXR - LVH, valve calcification
TTE - valve gradient, LV dysfunction

34
Q

Indications for surgery for AS?

A

SOB
Syncope
Angina
Critical obstruction

35
Q

What kind of surgery for as?

A

Valve replacement or TAVI

Mechanical or tissue

36
Q

Signs of TR?

A 
Large V waves on JVP
RV heave 
Pansystolic murmur increases on inspiration
Pulsatile enlarged tender liver
Ascites and oedema
37
Q

Causes of TR?

A 
Function secondary to cor pulmonale
Rheumatic
Infective endocarditis in IDU
Congenital - ebsteins
RV infarct --> papillary muscle dysfunction
Trauma
38
Q

Results of Ix for TR?

A 
CXR = RV enlargement
CXR = Box heart and narrow cardiac pedicle if ebsteins abnormality
TTE = jet volume
39
Q

Signs of Pulmonary stenosis?

A 
Peripheral cyanosis
Giant A waves on JVP
Right ventricular heave
Harsh ejection systolic murmur loader on inspiration with preceding click
S4 may be present
Signs of RV failure
40
Q

Signs of chronic constrictive pericarditis?

A 
Cachexia and ascites present
Low BP
Pulsus paradoxus
Raised JVP
Distant heart sounds
Hepatosplenomegaly, ascites and oedema
41
Q

Signs of HoCM?

A 
Sharp jerky pulse
Prominent A wave on JVP
Double or triple impulse apex beat
Late systolic ejection murmur at left sternal edge louder with valsalva and decreased with handgrip
Pansystolic murmur of MR
4th heart sound
42
Q

Investigation findings of HoCM?

A

ECG: LVH, lateral ST and T wave changes
CXR: LVH, hump on left heart border
TTE: Hypertrophy of the LV septal wall, MR

43
Q

Signs of ASD ostium secundum?

A

Fixed splitting of 2nd heart sound
Pulmonary ESM increasing on inspiration
Pulmonary HTN

44
Q

Investigation finding of ASD - ostium secondum?

A

ECG: Right axis deviation, RBBB and RVH
CXR: Increased pulmonary vasculature, enlarged RA and RV
TTE: RV dilation, Shunt on bubble studies

45
Q

Signs of ASD - ostium primum?

A 
Fixed splitting of 2nd heart sound
Pulmonary ESM increasing on inspiration
Pulmonary HTN
MR
TR
VSD signs
46
Q

Investigation findings of ASD - Ostium secondum?

A

Left axis deviation and RBBB on ECG

47
Q

Signs of VSD?

A

Thrill
Harsh pan-systolic murmur at left sternal edge
MR
Associated with Down’s Syndrome

48
Q

Results of investigations for VSD?

A

ECG: LVH
CXR: LVH, increased pulm vasculature and enlarged RV
TTE: VSD and shunt

49
Q

When to close ASD/VSD?

A

Presence of Right to left shunt

50
Q

Signs of PDA?

A

Continuous murmur

If shunt reversed –> pulmonary artery to aorta = cyanosis and toe clubbing

51
Q

Investigation findings of PDA?

A

ECG: LVH
CXR: increased pulm vasculature, calcification of duct, LV enlargement
TTE = presence of shunt

52
Q

Signs of CoA?

A 
Developed upper body
Radiofemoral delay
HTN in arms only
Chest collateral vessels
Midsystolic murmur in the precordium and back
53
Q

Investigation findings in CoA?

A

ECG: LVH
CXR: Enlarged LV, Dilated ascending aorta, aortic indentation, rib notching

54
Q

Signs of Eisenmergers Syndrome?

A 
Older adults
Cyanosis
Clubbing 
Signs of polycythaemia
JVP = dominant a wave
RV heave
Palpable P2
Loud split P2
4th heart sound
Pulmonary ejection click, PR and TR
55
Q

Investigation findings of Eisenmenger syndrome?

A

ECG: RVH, p pulmonale
CXR: RV and RA enlargement, pulmonary artery prominence, increased hilar markings but attenuated peripheral vessels

56
Q

Signs of ToF?

A

VSD
RVoT obstruction
Overriding aorta
RVH

-->
Clubbing
Cyanosis
Polycythaemia
RV heave
Thrill at left sternal edge
57
Q

Investigation findings of ToF?

A

ECH: RVH, right axis deviation
CXR: Boot shaped heart, RV enlargement, decreased vascularity of the lungs, right sided aortic knob and arch

58
Q

Secondary causes of HTN?

A 
Renal artery atherosclerosis
Fibromuscular disease
Diffuse renal disease
Conn's syndrome
Cushing's syndrome
CAH - 17 and 11 beta hydroxylase defects
Acromegaly
Myoedema
OCP
Co-arctation of the aorta
Polycythaemia
Uraemia
Neurogenic
OSA
EtOH
59
Q

Fundoscopy grades in HTN?

A 
I  = silver wiring
II = + AV nipping
III = + haemorrhages and exudates
IV = + papilloedema
60
Q

Signs of Marfan’s Syndrome?

A 
Arachnodactyly
Joint hypermobility
Long thin limbs
Long and narrow face
Blue sclera
High-arched palate
Pectus carination or excavatum
AR and MV prolapse
CoA
AAA
Kyphoscoliosis
Arm span greater than height
61
Q

Causes of Oedema?

A 
Drugs - CCB
Cardiac - CCF, cor pulmonale, constrictive pericarditis
Renal - nephrotic syndrome
Liver cirrhosis
Malabsorption or starvation
Protein-losing enteropathy
Myxoedema
Cyclical oedema
62
Q

Causes of SVC obstruction?

A 
Lung carcinoma
Retrosternal tumours - lymphoma, thymona, dermoid
Retrosternal goitre
Massive mediastinal lymphadenopathy
Aortic aneurysm

FRACP short case (11 decks)

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