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PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the diagnosis;

Signs = slow rising pulse, narrow pulse pressure, ESM

A

aortic stenosis

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2
Q

Where are Osler’s nodes? Are they painful?

A

finger pulp. yes

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3
Q

Where are Janeway lesions? Are they painful?

A

palms. no

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4
Q

Differential of systolic murmur

A

AS, MR, VSD,, aortic sclerosis (musical no radiation), HOCM (decreases with squatting)

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5
Q

Stigmata of endocarditis are…

A

Osler’s nodes, Janeway lesions, Roth spots,splinter haemorrhages, splenomegaly, haematuria

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6
Q

Causes of aortic stenosis?

A

degenerative calcification, biscuspid aortic valve(1-2% pop), rheumatic heart disease

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7
Q

Symptoms of severe AS?

A

syncope, angina, breathlessness

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8
Q

Echo definition of severe AS?

A

area of valve <1cm2
mean gradient across valve >40mmHg, max gradient across valve >60mmHg
max velocity >4m/s

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9
Q

When should you refer for surgical repair of AS?

A

severe AS on echo PLUS symptoms or LVEF <50%

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10
Q

What is the diagnosis?

Signs; soft early diastolic murmur loudest at left sternal edge on expiration

A

AR

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11
Q

Causes of AR?

A

bicuspid valve, rheumatic heart disease, connective tissue disease (Ehler’s Danlos, Marfans), degenerative aortic valve disease, Ankylosing spondylitis, endocarditis

Rare (syphilis, vasculitis (GCA or Takayasu’s)

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12
Q

What is the genetics of Marfan’s?

A

Autosomal dominant fibrillin-1 mutation

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13
Q

What is the echo criteria for severe AR?

A

moderate/severe LV enlargement
central jet width >65% of outflow tract
vena contracta >0.6cm2

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14
Q

Causes of mitral stenosis?

A

Rheumatic heart disease, calcification, endocarditis

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15
Q

Echo criteria of severe mitral stenosis?

A

valve area <1cm2
gradient across valve >10mmHg
pulmonary artery pressure >50mmHg

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16
Q

Causes of mitral regurgitation?

A

mitral valve prolapse, rheumatic heart disease, Connective tissue disease (Marfan’s, Ehlers Danlos),
Ischaemic heart disease - rupture of papillary muscles
Functional MR (normal valve morphology, due to LV dilatation displacing pupillary muscles, causes are heart failure and cardiomyopathy)
endocarditis

17
Q

Echo criteria for severe MR?

A

vena contract >0.7cm2

regurgitation volume >60ml/beat

18
Q

When to refer MR for surgical repair?

A

severe MR on echo + symptoms

or acute MR (endocarditis or pupillary muscle rupture post MI)

19
Q

Right heart murmurs are louder with;

a) inspiration
b) expiration

A

a) Inspiration

- Carvello’s sign

20
Q

What is the diagnosis?

Signs; pansystolic murmur, louder with inspiration at left sternal edge

A

tricuspid regurgitation

also giant c-v waves on JVP, pulsatile liver

21
Q

Causes of TR?

  • Primary causes
  • Secondary causes
A

Primary::: rheumatic heart disease, myxomatous disease, Ebsteins anomaly (leaflets displaced towards apex of RV), endocarditis

Secondary::: left heart failure, pulmonary hypertension + cor pulmonale, inferior MI causing RV dilation, L>R shunt (e.g. ASD/VSD)

22
Q

What conduction defect is Ebstein’s anomaly (and therefore TR) associated with?

A

Wolf-Parkinson-White. Look for delta wave on ECG.

23
Q

What is the diagnosis?

Signs; ESM heard loudest in inspiration at pulmonary area. Widely split S2.

A

Pulmonary stenosis

Wide split due to delayed emptying of RV causing delayed P2

24
Q

Causes of pulmonary stenosis?

A

Calcification, Tetralogy of Fallot, Carcinoid syndrome

25
Q

4 components of tetralogy of fallot

A

Pulmonary stenosis
Overriding aorta
VSD
RV hypertrophy

26
Q

What is the diagnosis?

Pansystolic murmur at lower left sternal edge, no radiation.

A

VSD
If Eisenmenger’s developed (L>R becomes R>L) there will be signs of Pulmonary hypertension (loud P2 and RV heave) alongside cyanosis an clubbing

27
Q

Causes of VSD

A

Congenital (Tetralogy of Fallot)
Trauma
Post MI

28
Q

What is the diagnosis?

Fixed split S2. May also have mid systolic pulmonary flow murmur and diastolic tricuspid flow murmur.

A

ASD

29
Q

Causes of ASD

A

Congenital (Down’s), PFO

30
Q

What is the diagnosis?

ESM, jerky pulse, S4

A

HOCM

31
Q

HOCM is associated with what conditions?

A

Mitral valve prolapse
Fredrich’s ataxia
Myotonic dystrophy
Family history (AD)

PACES (5 decks)

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