Cardiology Flashcards
Differentials for an ejection systolic murmur?
Aortic stenosis Pulmonary stenosis Hypertrophic cardiomyopathy Atrial septal defect Hyperdynamic states: - Normal = pregnancy and athletes - Abnormal = Hyperthyroid and anaemia
How to differentiate aortic stenosis?
Aortic area
Radiates to carotids
Increases on expiration
How to differentiate HoCM?
Aortic area
Nil radiation
Increases on Valsalva
Differentials of a pansystolic murmur?
Mitral regurgitation
Tricupsid regurgitation
Ventricular septal defect
How to differentiate MR?
Mitral area
Radiates to axilla
Increases on expiration
SOFT S1
Differentials of a late systolic murmur?
Mitral prolapse - mid systolic click
Tricuspid prolapse
Differentials of an early diastolic murmur?
Aortic regurgitation
Pulmonary regurgitation
How to differentiate aortic regurgitation?
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
Differentials of a mid-diastolic murmur?
Mitral stenosis - load S1
Tricuspid stenosis
Differentials of a continuous murmur?
Patent ductus arteriosus
Mammary souffle
Causes of a wide S2?
RBBB
Pulm HTN - load S2 in pulm area
Pulm stenosis
Causes of a fixed split S2?
Atrial septal defect
Causes of a paradoxically split S2?
Atrial septal defect
LBBB
HoCM
Cause of 3rd heart sound?
LVF AR MR VSD PDA RVF
Causes of a 4th heart sound?
AS MR HTN IHD HoCM Pulm HTN Pulm Stenosis
Causes of MS?
Rheumatic
Severe mitral annular calcification
Congenital
Clinical signs of MS
Small pulse pressure Early-opening snap Long mid-diastolic rumble Presence of pulmonary HTN Tapping apex beat Load S1
Signs of Pulmonary HTN?
Prominent a wavw in JVP Right ventricular impulse Load P2 Palpable P2 Pulmonary regurgitation Tricuspid regurgitation
Results of investigations for MS?
ECG: AF, P mitrale, RV systolic overload, right axis deviation
CXR: large L atrium, mitral valve calcification, signs of Pulm HTN
Chronic causes of MR?
Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction - LVF and IHD
Connective tissue disease - RA, Ank. spond.
Congenital
Acute causes of MR?
Infective endocarditis
MI
Surgery
Trauma
Signs of MR?
Enlarged left ventricle Pulm HTN Third heart sound Early diastolic rumble Soft 1st heart sound Small volume pulse LVF
Results of Ix of MR?
ECG: P mitrale, AF, LVH, right axis deviation
CXR: Large left atrium and LVH, mitral annular calcification
Valvular causes of AR?
Rheumatic
Congenital
Seronegative Arthropathy - ank. spond
Aortic root causes of AR?
Marfan's syndrome Aortitis HTN Dissecting aneurysm Old age
Signs of Aortic regurgitation?
Collapsing pulse Wide pulse pressure Length of the decrescendo diastolic murmur Third heart sound Soft A2 Austin flint murmur LVF
Results of investigations for AR?
ECG - LVH
CXR - LVH, valve calcification
Indications for surgery for MR?
Class 3 or 4 HF
LV dysfunction
What kind of surgery for MR?
Usually repair
Replacement = mechanical
Indications for surgery for AR?
SOB on exertion
Worsening LVF
Progressive LV dilatation
Causes of AS?
Degenerative disease
Rheumatic
Calcific bicuspid valve
Clinical signs of AS?
Plateau pulse Aortic thrill Long harsh systolic murmur 4th heart sound Paradoxical splitting of the 2nd heart sound LVF
Results of investigation for AS?
ECG - LVH
CXR - LVH, valve calcification
TTE - valve gradient, LV dysfunction
Indications for surgery for AS?
SOB
Syncope
Angina
Critical obstruction
What kind of surgery for as?
Valve replacement or TAVI
Mechanical or tissue
Signs of TR?
Large V waves on JVP RV heave Pansystolic murmur increases on inspiration Pulsatile enlarged tender liver Ascites and oedema
Causes of TR?
Function secondary to cor pulmonale Rheumatic Infective endocarditis in IDU Congenital - ebsteins RV infarct --> papillary muscle dysfunction Trauma
Results of Ix for TR?
CXR = RV enlargement CXR = Box heart and narrow cardiac pedicle if ebsteins abnormality TTE = jet volume
Signs of Pulmonary stenosis?
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
Signs of chronic constrictive pericarditis?
Cachexia and ascites present Low BP Pulsus paradoxus Raised JVP Distant heart sounds Hepatosplenomegaly, ascites and oedema
Signs of HoCM?
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
Investigation findings of HoCM?
ECG: LVH, lateral ST and T wave changes
CXR: LVH, hump on left heart border
TTE: Hypertrophy of the LV septal wall, MR
Signs of ASD ostium secundum?
Fixed splitting of 2nd heart sound
Pulmonary ESM increasing on inspiration
Pulmonary HTN
Investigation finding of ASD - ostium secondum?
ECG: Right axis deviation, RBBB and RVH
CXR: Increased pulmonary vasculature, enlarged RA and RV
TTE: RV dilation, Shunt on bubble studies
Signs of ASD - ostium primum?
Fixed splitting of 2nd heart sound Pulmonary ESM increasing on inspiration Pulmonary HTN MR TR VSD signs
Investigation findings of ASD - Ostium secondum?
Left axis deviation and RBBB on ECG
Signs of VSD?
Thrill
Harsh pan-systolic murmur at left sternal edge
MR
Associated with Down’s Syndrome
Results of investigations for VSD?
ECG: LVH
CXR: LVH, increased pulm vasculature and enlarged RV
TTE: VSD and shunt
When to close ASD/VSD?
Presence of Right to left shunt
Signs of PDA?
Continuous murmur
If shunt reversed –> pulmonary artery to aorta = cyanosis and toe clubbing
Investigation findings of PDA?
ECG: LVH
CXR: increased pulm vasculature, calcification of duct, LV enlargement
TTE = presence of shunt
Signs of CoA?
Developed upper body Radiofemoral delay HTN in arms only Chest collateral vessels Midsystolic murmur in the precordium and back
Investigation findings in CoA?
ECG: LVH
CXR: Enlarged LV, Dilated ascending aorta, aortic indentation, rib notching
Signs of Eisenmergers Syndrome?
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
Investigation findings of Eisenmenger syndrome?
ECG: RVH, p pulmonale
CXR: RV and RA enlargement, pulmonary artery prominence, increased hilar markings but attenuated peripheral vessels
Signs of ToF?
VSD
RVoT obstruction
Overriding aorta
RVH
--> Clubbing Cyanosis Polycythaemia RV heave Thrill at left sternal edge
Investigation findings of ToF?
ECH: RVH, right axis deviation
CXR: Boot shaped heart, RV enlargement, decreased vascularity of the lungs, right sided aortic knob and arch
Secondary causes of HTN?
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
Fundoscopy grades in HTN?
I = silver wiring II = + AV nipping III = + haemorrhages and exudates IV = + papilloedema
Signs of Marfan’s Syndrome?
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
Causes of Oedema?
Drugs - CCB Cardiac - CCF, cor pulmonale, constrictive pericarditis Renal - nephrotic syndrome Liver cirrhosis Malabsorption or starvation Protein-losing enteropathy Myxoedema Cyclical oedema
Causes of SVC obstruction?
Lung carcinoma Retrosternal tumours - lymphoma, thymona, dermoid Retrosternal goitre Massive mediastinal lymphadenopathy Aortic aneurysm
