Cardiology Flashcards
What is the diagnosis;
Signs = slow rising pulse, narrow pulse pressure, ESM
aortic stenosis
Where are Osler’s nodes? Are they painful?
finger pulp. yes
Where are Janeway lesions? Are they painful?
palms. no
Differential of systolic murmur
AS, MR, VSD,, aortic sclerosis (musical no radiation), HOCM (decreases with squatting)
Stigmata of endocarditis are…
Osler’s nodes, Janeway lesions, Roth spots,splinter haemorrhages, splenomegaly, haematuria
Causes of aortic stenosis?
degenerative calcification, biscuspid aortic valve(1-2% pop), rheumatic heart disease
Symptoms of severe AS?
syncope, angina, breathlessness
Echo definition of severe AS?
area of valve <1cm2
mean gradient across valve >40mmHg, max gradient across valve >60mmHg
max velocity >4m/s
When should you refer for surgical repair of AS?
severe AS on echo PLUS symptoms or LVEF <50%
What is the diagnosis?
Signs; soft early diastolic murmur loudest at left sternal edge on expiration
AR
Causes of AR?
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)
What is the genetics of Marfan’s?
Autosomal dominant fibrillin-1 mutation
What is the echo criteria for severe AR?
moderate/severe LV enlargement
central jet width >65% of outflow tract
vena contracta >0.6cm2
Causes of mitral stenosis?
Rheumatic heart disease, calcification, endocarditis
Echo criteria of severe mitral stenosis?
valve area <1cm2
gradient across valve >10mmHg
pulmonary artery pressure >50mmHg
Causes of mitral regurgitation?
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
Echo criteria for severe MR?
vena contract >0.7cm2
regurgitation volume >60ml/beat
When to refer MR for surgical repair?
severe MR on echo + symptoms
or acute MR (endocarditis or pupillary muscle rupture post MI)
Right heart murmurs are louder with;
a) inspiration
b) expiration
a) Inspiration
- Carvello’s sign
What is the diagnosis?
Signs; pansystolic murmur, louder with inspiration at left sternal edge
tricuspid regurgitation
also giant c-v waves on JVP, pulsatile liver
Causes of TR?
- Primary causes
- Secondary causes
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)
What conduction defect is Ebstein’s anomaly (and therefore TR) associated with?
Wolf-Parkinson-White. Look for delta wave on ECG.
What is the diagnosis?
Signs; ESM heard loudest in inspiration at pulmonary area. Widely split S2.
Pulmonary stenosis
Wide split due to delayed emptying of RV causing delayed P2
Causes of pulmonary stenosis?
Calcification, Tetralogy of Fallot, Carcinoid syndrome
4 components of tetralogy of fallot
Pulmonary stenosis
Overriding aorta
VSD
RV hypertrophy
What is the diagnosis?
Pansystolic murmur at lower left sternal edge, no radiation.
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
Causes of VSD
Congenital (Tetralogy of Fallot)
Trauma
Post MI
What is the diagnosis?
Fixed split S2. May also have mid systolic pulmonary flow murmur and diastolic tricuspid flow murmur.
ASD
Causes of ASD
Congenital (Down’s), PFO
What is the diagnosis?
ESM, jerky pulse, S4
HOCM
HOCM is associated with what conditions?
Mitral valve prolapse
Fredrich’s ataxia
Myotonic dystrophy
Family history (AD)
