Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical exam - short cases > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What clinical signs are associated with mitral stenosis?

A 
Small pulse pressure
Early opening snap (raised LA pressure)
Mid-diastolic rumbling murmur
Diastolic thrill at apex
Pulmonary HTN
- Loud P2
- Pulmonary regurgitation
- RV heave
- TR (can produce large V waves)
- Prominent "a" wave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinical signs of aortic regurgitation?

A

Collapsing pulse / waterhammer pulse
Wide pulse pressure
Early diastolic murmur (aortic or left sternal edge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the ECG findings in right ventricular hypertrophy?

A

Right axis deviation > 110
Dominant R wave in V1 (>7mm or R>S)
Dominant S wave in V5 or V6 (>7mm or S>R)
QRS < 120msec (not RBBB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What findings would you expect in the following in mitral regurgitation:

  • ECG
  • CXR
  • TTE
A

ECG: P mitrale, AF, LVH, Right axis deviation

CXR: LA enlargement, LV enlargement, mitral annular calcification, pulmonary HTN (large RA, prominent pulmonary arteries, pruning of peripheral pulmonary vessels)

TTE: thickened leaflets (rheumatic), prolapsing leaflet, LA size (chronicity and severity), LV size and function, L atrium regurgitant jet, mitral annulus calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What clinical signs are associated with aortic stenosis?

A

Pulse
- Low volume pulse with delayed upstroke (pulsus parvus et tardus). Sometimes anacrotic notch. Bisferens pulse if combined with AR.

Heart

  • Heaving apex beat
  • Systolic thrill over aortic region and carotids when sitting up in full expiration
  • ES murmur radiating to carotids
  • Soft S2
  • Ejection click L sternal border
  • S4
  • S3
  • Listen for early diastolic murmur (mild AR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What clinical signs are associated with mitral regurgitation?

A

Pulse - bounding
Apex beat - laterally displaced , brisk/hyperdynamic
Heart sounds
- Holosystolic murmur after S1, best over apex
- Murmur usually radiates to axilla/back
- S3 and palpable thrill
- Soft S1
- Widely split S2 due to early A2 and late P2
Lungs - creps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of mitral regurgitation?

A

Infective endocarditis
AMI
Surgery
Trauma

Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction (LV failure or ischaemia)
Connective tissue disease (RA or AS)
Congenital - endocardial cushion defect, parachute valve, corrected transposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical signs of severity in mitral regurgitation?

A

Low volume pulse
Displaced apex beat
Systolic thrill

Soft S1
Early A2 (wide splitting)
S3
S4
Diastolic rumble

Left ventricular hypertrophy
Left ventricular failure

Pulmonary HTN (late sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical signs of severity in mitral stenosis?

A 
Narrow pulse pressure
Early opening snap
Long duration of diastolic murmur
Pulmonary HTN
Pulmonary congestion
Graham-Steell murmur (PR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are clinical signs of severity in aortic stenosis?

A 
Low volume pulse
Slow-rising pulse
Plateau pulse
Narrow pulse pressure
Heaving apex beat
Systolic thrill over aortic region
Soft S2
Paradoxical splitting of S2
S4
Length, harshness and lateness of systolic murmur peak
Pulmonary congestion
Pumonary HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs of severity in aortic regurgitation?

A 
Wide pulse pressure
Long duration of decrescendo diastolic murmur
3rd heart sound
Austin Flint murmur
Signs of pulmonary HTN
Signs of LV failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the causes of a hyperdynamic circulation?

A 
Exercise
Pregnancy
Fever
Hypoxia
Hypercapnia
AVF
Anaemia
Beriberi (thiamine deficiency)
Thyrotoxicosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of increased splitting (wider on inspiration) of S2?

A

MR
Pulmonary stenosis
VSD
RBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of reversed splitting of S2?

A

AS
LBBB
Coarctation of the aorta
PDA (large)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the components of the hypertensive exam?

A
  • Inspect: Cushing’s, acromegaly, uraemia, polycythaemia

Limbs

  • BP in both arms and one leg
  • Radio-femoral and radio-radial delay
  • Vasculitic changes in upper limbs

Face

  • Conjunctival injection (polycythaemia)
  • Fundi for HTN changes

Chest

  • LV failure (incl 4th heart sound)
  • Coarctation (reversed splitting S2, posterior midsystolic murmur)

Abdomen

  • Renal + adrenal masses
  • AAA
  • Renal bruits (just above the umbilicus, paramedially)

Flanks
- Systolic-diastolic murmur suggests renal AVF)

Extra
- U/A: casts, red cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the changes of HTN on fundscopy?

A

SAV HEX OEDEMA

Grade I - Silver wiring
Grade II - AV nipping
Grade III - Haemorrhages, exudates
Grade IV - Papilloedema

17
Q

What are the components of the Marfan’s examination?

A

Limbs

  • Arachnodactyly
  • Hypermobility

Face

  • Iridodonesis (suggests lens dislocation)
  • Blue sclera
  • High arched palate

Chest

  • Pectus excavatum or carinatum
  • AR, MVP, MR
  • AAA, coarctation

Back

  • Kyphoscoliosis
  • Hypermobility

Arm span > height
Upper:lower segment ratio < 0.85

18
Q

What are the components of the oedema examination?

A
  • Nutritional status (low alb, B1 deficiency)
  • Myxoedema

Lower limbs

  • DVT signs
  • Varicose veins

Groin
- LN

Abdomen

  • Inferior prominent veins that drain into umbilicus (IVC obstruction)
  • Ascites
  • Abdominal masses (liver, kidneys)

Neck

  • JVP
  • LN exam

Other

  • Delayed reflexes (myxoedema)
  • U/A: proteinuria

Causes of non-pitting oedema: Myxoedema, malignant infiltration, congenital disease, Milroy’s disease

19
Q

What are the causea of SVC obstruction?

A

Lung cancer (90%)
Retrosternal masses (goitre, thymoma, lymphoma, germ cell tumour)
Massive mediastinal LN
Aortic aneurysm

20
Q

What are the ECG findings in HOCM?

A

LVH

Q waves < 40ms in lateral leads (I, aVL, V5, V6) and inferior leads

21
Q

What the features of mitral valve prolapse?

A

Mid-systolic click followed by systolic murmur

  • Earlier with decreased cardiac volume (standing, Valsalva)
  • Later with increased cardiac volume (squatting, beta blockers)
  • Louder with isometric hand grip
22
Q

Which conditions are associated with mitral valve prolapse?

A 
Marfan's
Ehlers-Danos
Pseudoxanthoma elasticum
Osteogenesis imperfecta
Polycystic kidney disease
SLE
Psoriatic arthritis
23
Q

What are the causes of secondary pulmonary stenosis?

A

Rheumatic heart disease
Carcinoid syndrome
Noonan’s syndrome
Tetralogy of Fallot

24
Q

What are the causes of hypertrophic cardiomyopathy and what are the associated clinincal findings?

A

Causes

  • HTN
  • Aortic stenosis
  • Aortic coarctation
  • Autosomal dominant
  • Friedrich’s ataxia
  • Haemochromatosis
  • Amyloidosis
  • Glycogen storage diseases
  • Lysosomal diseases
  • Mitochondrial cardiomyopathy

Signs:

  • Sharp rising and jerky or double pulse (bisferiens)
  • Prominant a waves due to RA contraction against stiff RV
  • Double-impulse “tapping” apex beat
  • Left sided systolic murmur (LVOTO) that increases on release of Valsalva
25
Q

What symptoms are associated with mitral valve prolapse?

What are the associated complications?

A

Symptoms

  • Palpitations associated with mild tachyarrhythmias
  • Increased adrenergic symptoms
  • Chest pain
  • Anxiety or fatigue

Complications

  • Severe MR
  • Arrhythmias: VEBs, VT, paroxysmal SVT
  • Infective endocarditis in those with MR
  • TIA, embolism
  • Sudden death
26
Q

What are the common causes of mixed aortic valve disease (AS+AR)?

A

Degenerative disease
Bicuspid aortic valve (younger)
Rheumatic heart disease

27
Q

What manoeuvres increase the intensity of an MS murmur?

A

Valsalva
Exercise
Squatting or handgrip (increases afterload)

28
Q

Why does differential cyanosis occur in a patent ductus arteriosus?

A

Deoxygenated blood from PDA is delivered to aorta distal to the left subclavian artery root

29
Q

Where are the lines of reference to separate mechanical AVR and MVR on PA and lateral CXR?

A

PA: between LA appendage and right cardiophrenic recess

Lateral: Carina and cardiac apex

30
Q

Pulmonary stenosis and patent ductus arteriosus are associated with which maternal infection?

A

Congenital rubella

31
Q

What is the only right heart sound that is softer on inspiration?

A

Pulmonary valvular opening click

- Atrial click in inspiration prematurely opens the pulmonary valve, reducing the intensity of the opening snap

32
Q

What is a Blalock-Taussig shunt?

A

Anastomosis of left subclavian artery to left pulmonary artery for Tetralogy of Fallot

33
Q

What are the common causes of Eisenmenger’s syndrome?

Which is associated with cardiomegaly?

A

ASD, VSD and PDA

- ASD may cause cardiomegaly

34
Q

What are the causes of bradycardia?

A
  • Physical fitness in athletes
  • Aging
  • AMI
  • AV nodal blockers
  • Hypothyroidism
  • Obstructive jaundice
  • Increase ICP
  • Hypothermia
  • Hypokalaemia
35
Q

What are the causes of TR?

A
  • Pulmonary HTN
  • AMI
  • Pulmonary stenosis
  • Pulmonary artery stenosis
  • Infective endocarditis
  • Carcinoid syndrome
  • Ebstein’s anomaly
  • Endomyocardial fibrosis
  • Tricuspid valve prolapse
36
Q

What are the indications for mitral valve repair in asymptomatic but severe mitral regurgitation?

A
  • LVEF30-60 and/or LVESD≥40mm
  • New onset AF or new PHTN
  • If another cardiothoracic operation is required, MV repair may be done simulatneously

Clinical exam - short cases (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions