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RACP Clinical Exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What causes reverse splitting of S2?

A 
Severe aortic stenosis 
Left bundle branch block 
HOCM
Patent ductus arteriosis
Wolf Parkinson White Syndrome
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2
Q

What are the signs of severity for AS?

A 
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
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3
Q

What are the indications for surgery in a patient with aortic stenosis?

A
  1. Symptomatic patients
    - severe AS
  2. Asymptomatic patients
    - undergoing other cardiac surgery
    - severe disease AND
    - systolic dysfunction
    - VT
    - valve area <0.6cm
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4
Q

What are the differentials for a mid diastolic rumble murmur?

A

Mitral stenosis
Left atrial thrombus or myxoma
Severe mitral regurgitation
Cor triatriatum

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5
Q

What are the causes of mitral stenosis?

A 
Rheumatic heart disease 
Degenerative 
Autoimmune (SLE/RA)
Medication related (methysergide) 
Radiation induced 
Carcinoid Disease 
Lysosomal storage disorders
Whipples disease
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6
Q

What are the markers of severity of MS?

A 
Low pulse pressure 
Increased murmur length 
Early opening snap 
Pulmonary hypertension 
Pulmonary congestion 
Graham steel murmur
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7
Q

What are the complications of mitral stenosis?

A 
Left atrial enlargement 
Atrial fibrillation 
Left atrial thrombus
Pulmonary hypertension 
Right sided heart failure
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8
Q

What is the pathology of malar flush in MS?

A

Reflects low cardiac output state

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9
Q

What are the differentials for a malar flush?

A 
Mitral stenosis 
Hypothyroidism 
Lupus erythematosus
Carcinoid 
Polycythaemia
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10
Q

What are the indications for surgery in MS?

A

Pulmonary congestion
Pulmonary hypertension
Haemoptysis
Recurrent thromboembolic events despite anticoagulation

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11
Q

What is Ortners Syndrome

A

An enlarged left atrium from MS result in in left recurrent laryngeal nerve palsy.

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12
Q

What are the indications for surgery in mitral regurgitation?

A

Signs of left ventricular dysfunction
Ejection fraction <60%
LV end systolic diameter >45mm
Class 3-4 failure symptoms

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13
Q

What are the indications for valve replacement in aortic regurgitation?

A 
Symptomatic 
- severe AR with symptoms 
Asymptomatic 
- moderate AR with other cardiac surgery 
- LV dysfunction (EF <50%)
- dilated left ventricle
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14
Q

What are the complications of prosthetic valves?

A 
Valve dysfunction 
Endocarditis 
Haemolysis 
Complications from anticoagulation 
Thromboembolism
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15
Q

Causes of mitral regurgitation?

A 
Infective endocarditis 
Myocardial infarction with papillary Cord rupture 
Surgery or trauma
Degenerative 
Rheumatic heart disease 
Connective tissue disease associated 
Congenital 
Mitral valve prolapse
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16
Q

What are the signs of severity for mitral regurgitation?

A 
Enlarged LV 
Pulmonary hypertension 
Third heart sounds 
Early diastolic rumble 
Soft s1 
Small volume pulse 
Right sided heart failure
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17
Q

What are the causes of chronic mitral regurgitation?

A 
Rheumatic heart disease
Infective endocarditis 
Functional MR from LV dilation 
Degenerative 
SLE or RA 
Carcinoid 
Marfans Syndrome 
Ehlers Danlos Syndrome
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18
Q

What are the causes of acute mitral regurgitation?

A

Infective endocarditis
Rupture of chordae tendinae
(Infarction)
Trauma

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19
Q

What are the signs of severity for mitral regurgitation?

A 
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
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20
Q

What are the causes of chronic AR?

A 
Bicuspid aortic valve
Hypertension 
Rheumatic fever 
Aortitis (syphilis, takayasu, Ank spon) 
Rheumatoid Arthritis 
Connective tissue disorders (marfans, ehlers danlos)
21
Q

What are the causes of acute aortic regurgitation?

A

Infective endocarditis
Aortic dissection
Ruptured sinus of valsalva

22
Q

What are the signs of severe aortic regurgitation?

A 
Wide pulse pressure 
Long duration of murmur
Third heart sound 
Austin flint murmur 
Pulmonary hypertension 
Left ventricular failure
23
Q

What are the congenital cardiac surgeries associated with a left sided thoracotomy scar?

A

Blalock Thomas Shunt
PDA Ligation
Coarctation repair

24
Q

What are the congenital cardiac surgeries associated with a right sided thoracotomy scar?

A

Mitral valve repair
ASD repair
Right Blalock Thomas Shunt

25
Q

Causes of a loud S1?

A

Mitral stenosis
Hyperdynamic state
Myxoma

26
Q

Causes of a soft S1.

A

LV failure
Left bundle branch block
Mitral regurgitation
1st degree heart block

27
Q

Causes of a split S1.

A

Right bundle branch block
Atrial septal defect (with left to right shunt)
Tricuspid stenosis
Ebstein abnormality

28
Q

Causes of a loud S2?

A

Coarctation of Aorta
Systemic hypertension
Pulmonary artery hypertension
ASD

29
Q

Causes of soft S2?

A

Pulmonary stenosis
Pulmonary regurgitation
Aortic stenosis

30
Q

What causes a split S2?

A

Right bundle block
Atrial septal defect
Ventricular septal defect
Pulmonary stenosis

31
Q

Causes of an S3?

A

Cardiomyopathy
Mitral regurgitation
High output heart failure

32
Q

What are the causes of VSD?

A 
Congenital
- Down/Pantau Syndrome 
- maternal diabetes/alcohol 
Acquired 
- ischaemia 
- iatrogenic
33
Q

What are the types of VSD?

A

Perimembranois - LV outflow tract and can cause Gerbode defects
Supra-Cristal - RV outflow tract.
Muscular - muscular septum
Posterior - posterior to septal leaflet

34
Q

What are the complications of VSD?

A 
infective endocarditis
Pulmonary hypertension 
Eisenmenger Syndrome 
LV dysfunction 
Ventricular arrhythmia
35
Q

What is the indication for VSD closure in Eisenmenger Syndrome?

A

Pulmonary reactivity on vasodilator challenge.

Lung biopsy consistent with reversible pulmonary arterial changes

36
Q

What is Holt Oran Syndrome?

A

Autosomal dominant disorder characterised by heart and upper limb defects.

37
Q

What are the different types of ASD?

A

Ostium primum - 15% (anteroinferior)
Ostium Secundum - 70% (foramen ovale)
Sinus venosus - 15% (posterior to fossa ovalis)
Coronary sinus ASD - 1%

38
Q

What are the complications of ASD?

A 
Atrial arrhythmia 
Infective endocarditis 
Eisenmenger Syndrome 
Paradoxical embolism 
Pulmonary hypertension 
Recurrent pulmonary infections
39
Q

What are the complications of patent foramen ovale?

A

Paradoxical embolism
Cryptogenic stoke
Atrial arrhythmias
Migraines

40
Q

What cardiac defects are associated with coarctation of the aorta?

A

Bicuspid aortic valve
Mitral valve prolapse
Ventricular septal defect
Patent ductus arteriosus

41
Q

What are the complications of coarctation of the aorta?

A

Hypertension
Hypoplastic limbs
Endocarditis
Left ventricular failure

42
Q

What are the causes of Eisenmenger Syndrome?

A

ASD
VSD
PDA
Aortopulmonary window

43
Q

What are the complications of Eisenmenger Syndrome?

A 
Bleeding 
Thrombosis 
Polycythaemia 
Right ventricular failure 
Paradoxical embolism 
Ventricular arrhythmia
44
Q

What are the features of marfans?

A 
Arachnodactyly
Joint hypermobility 
Lens replacement 
High arched palate 
Pectus carinatum/excivatum 
AR/MVP
Kyphoscoliosis 
Arm span to height
45
Q

Indications for MR surgery

A

End systolic diameter 45mm
EF 60%
Severe symptoms

46
Q

AR surgery indications

A

Severe disease
EF 50
End systolic diameter 55mm

47
Q

What are the causes of a reversed split s2?

A 
Aortic Stenosis 
Left bundle branch block 
Patent ductus arteriosus 
Type B WPW 
Hypertrophic Cardiomyopathy
48
Q

What are the causes of a malar flush?

A 
Mitral stenosis 
Hypothyroidism 
SLE/systemic sclerosis
Polycythaemia 
Carcinoid Syndrome 
Irradiation

RACP Clinical Exam (13 decks)

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