Cardiology Flashcards
What causes reverse splitting of S2?
Severe aortic stenosis Left bundle branch block HOCM Patent ductus arteriosis Wolf Parkinson White Syndrome
What are the signs of severity for AS?
Slow rising pulse Anacrotic pulse Narrow pulse pressure Pressure loaded apex beat Aortic area thrill Late peaking murmur Soft S2 Reverse split S2 S3 S4 Pulmonary congestion Pulmonary hypertension and right heart failure
What are the indications for surgery in a patient with aortic stenosis?
- Symptomatic patients
- severe AS - Asymptomatic patients
- undergoing other cardiac surgery
- severe disease AND
- systolic dysfunction
- VT
- valve area <0.6cm
What are the differentials for a mid diastolic rumble murmur?
Mitral stenosis
Left atrial thrombus or myxoma
Severe mitral regurgitation
Cor triatriatum
What are the causes of mitral stenosis?
Rheumatic heart disease Degenerative Autoimmune (SLE/RA) Medication related (methysergide) Radiation induced Carcinoid Disease Lysosomal storage disorders Whipples disease
What are the markers of severity of MS?
Low pulse pressure Increased murmur length Early opening snap Pulmonary hypertension Pulmonary congestion Graham steel murmur
What are the complications of mitral stenosis?
Left atrial enlargement Atrial fibrillation Left atrial thrombus Pulmonary hypertension Right sided heart failure
What is the pathology of malar flush in MS?
Reflects low cardiac output state
What are the differentials for a malar flush?
Mitral stenosis Hypothyroidism Lupus erythematosus Carcinoid Polycythaemia
What are the indications for surgery in MS?
Pulmonary congestion
Pulmonary hypertension
Haemoptysis
Recurrent thromboembolic events despite anticoagulation
What is Ortners Syndrome
An enlarged left atrium from MS result in in left recurrent laryngeal nerve palsy.
What are the indications for surgery in mitral regurgitation?
Signs of left ventricular dysfunction
Ejection fraction <60%
LV end systolic diameter >45mm
Class 3-4 failure symptoms
What are the indications for valve replacement in aortic regurgitation?
Symptomatic - severe AR with symptoms Asymptomatic - moderate AR with other cardiac surgery - LV dysfunction (EF <50%) - dilated left ventricle
What are the complications of prosthetic valves?
Valve dysfunction Endocarditis Haemolysis Complications from anticoagulation Thromboembolism
Causes of mitral regurgitation?
Infective endocarditis Myocardial infarction with papillary Cord rupture Surgery or trauma Degenerative Rheumatic heart disease Connective tissue disease associated Congenital Mitral valve prolapse
What are the signs of severity for mitral regurgitation?
Enlarged LV Pulmonary hypertension Third heart sounds Early diastolic rumble Soft s1 Small volume pulse Right sided heart failure
What are the causes of chronic mitral regurgitation?
Rheumatic heart disease Infective endocarditis Functional MR from LV dilation Degenerative SLE or RA Carcinoid Marfans Syndrome Ehlers Danlos Syndrome
What are the causes of acute mitral regurgitation?
Infective endocarditis
Rupture of chordae tendinae
(Infarction)
Trauma
What are the signs of severity for mitral regurgitation?
Soft first heart sound Third heart sound Fourth heart sound Displaced apex beat Pulmonary congestion Pulmonary hypertension Right sided heart failure Precordial thrill Mid diastolic flow murmur Widely split second heart sound
What are the causes of chronic AR?
Bicuspid aortic valve Hypertension Rheumatic fever Aortitis (syphilis, takayasu, Ank spon) Rheumatoid Arthritis Connective tissue disorders (marfans, ehlers danlos)
What are the causes of acute aortic regurgitation?
Infective endocarditis
Aortic dissection
Ruptured sinus of valsalva
What are the signs of severe aortic regurgitation?
Wide pulse pressure Long duration of murmur Third heart sound Austin flint murmur Pulmonary hypertension Left ventricular failure
What are the congenital cardiac surgeries associated with a left sided thoracotomy scar?
Blalock Thomas Shunt
PDA Ligation
Coarctation repair
What are the congenital cardiac surgeries associated with a right sided thoracotomy scar?
Mitral valve repair
ASD repair
Right Blalock Thomas Shunt
Causes of a loud S1?
Mitral stenosis
Hyperdynamic state
Myxoma
Causes of a soft S1.
LV failure
Left bundle branch block
Mitral regurgitation
1st degree heart block
Causes of a split S1.
Right bundle branch block
Atrial septal defect (with left to right shunt)
Tricuspid stenosis
Ebstein abnormality
Causes of a loud S2?
Coarctation of Aorta
Systemic hypertension
Pulmonary artery hypertension
ASD
Causes of soft S2?
Pulmonary stenosis
Pulmonary regurgitation
Aortic stenosis
What causes a split S2?
Right bundle block
Atrial septal defect
Ventricular septal defect
Pulmonary stenosis
Causes of an S3?
Cardiomyopathy
Mitral regurgitation
High output heart failure
What are the causes of VSD?
Congenital - Down/Pantau Syndrome - maternal diabetes/alcohol Acquired - ischaemia - iatrogenic
What are the types of VSD?
Perimembranois - LV outflow tract and can cause Gerbode defects
Supra-Cristal - RV outflow tract.
Muscular - muscular septum
Posterior - posterior to septal leaflet
What are the complications of VSD?
infective endocarditis Pulmonary hypertension Eisenmenger Syndrome LV dysfunction Ventricular arrhythmia
What is the indication for VSD closure in Eisenmenger Syndrome?
Pulmonary reactivity on vasodilator challenge.
Lung biopsy consistent with reversible pulmonary arterial changes
What is Holt Oran Syndrome?
Autosomal dominant disorder characterised by heart and upper limb defects.
What are the different types of ASD?
Ostium primum - 15% (anteroinferior)
Ostium Secundum - 70% (foramen ovale)
Sinus venosus - 15% (posterior to fossa ovalis)
Coronary sinus ASD - 1%
What are the complications of ASD?
Atrial arrhythmia Infective endocarditis Eisenmenger Syndrome Paradoxical embolism Pulmonary hypertension Recurrent pulmonary infections
What are the complications of patent foramen ovale?
Paradoxical embolism
Cryptogenic stoke
Atrial arrhythmias
Migraines
What cardiac defects are associated with coarctation of the aorta?
Bicuspid aortic valve
Mitral valve prolapse
Ventricular septal defect
Patent ductus arteriosus
What are the complications of coarctation of the aorta?
Hypertension
Hypoplastic limbs
Endocarditis
Left ventricular failure
What are the causes of Eisenmenger Syndrome?
ASD
VSD
PDA
Aortopulmonary window
What are the complications of Eisenmenger Syndrome?
Bleeding Thrombosis Polycythaemia Right ventricular failure Paradoxical embolism Ventricular arrhythmia
What are the features of marfans?
Arachnodactyly Joint hypermobility Lens replacement High arched palate Pectus carinatum/excivatum AR/MVP Kyphoscoliosis Arm span to height
Indications for MR surgery
End systolic diameter 45mm
EF 60%
Severe symptoms
AR surgery indications
Severe disease
EF 50
End systolic diameter 55mm
What are the causes of a reversed split s2?
Aortic Stenosis Left bundle branch block Patent ductus arteriosus Type B WPW Hypertrophic Cardiomyopathy
What are the causes of a malar flush?
Mitral stenosis Hypothyroidism SLE/systemic sclerosis Polycythaemia Carcinoid Syndrome Irradiation
