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
