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PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Fixed splitting of second heart sound

A

Due to P2 closing later than A2 secondary to increased volume in RV and/or increased resistance in pulmonary vasculature:

  1. Right heart failure
  2. PE
  3. Pulmonary hypertension
  4. ASD
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2
Q

Reverse splitting of second heart sound

A

P2 before A2 due to failing LV or increased resistance in outflow

  1. Aortic stenosis
  2. LBBB
  3. HOCM
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3
Q

Systolic murmurs

A
  1. Aortic stenosis
  2. Mitral regurgitation
  3. Pulmonary stenosis
  4. Tricuspid regurgitation
  5. Mitral valve prolapse
  6. HOCM
  7. ASD
  8. VSD
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4
Q

Ejection systolic murmur

A
  1. Aortic stenosis
    - loudest in aortic region
    - increases on expiration
    - radiates to carotids
    - reverse splitting of 2nd heart sound
    - narrow pulse pressure
  2. Pulmonary stenosis
    - loudest in pulmonary area
    - increases on inspiration
    - no radiation
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5
Q

Pansystolic murmur

A
  1. Mitral regurgitation
    - loudest in mitral region
    - radiates to axilla
    - increases on expiration
  2. Tricuspid regurgitation
    - loudest LLSE
    - no radiation
    - increases on inspiration
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6
Q

Diastolic murmur

A
  1. Aortic regurgitation
  2. Pulmonary regurgitation
  3. Mitral stenosis
  4. Pulmonary stenosis
  5. PDA
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7
Q

Early diastolic murmur

A
  1. Aortic regurgitation
    - loudest in LLSE leaning forward
    - large pulse pressure
  2. ## Pulmonary regurgitation
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8
Q

Late diastolic

A
  1. Mitral stenosis
    - malar flush
    - mid diastolic with opening snap
    - tapping apex
    - heard best in left lateral position with bell of stethoscope
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9
Q

Aortic valve replacement indications

A
  1. Aortic regurgitation
  2. Aortic stenosis
  3. Infective endocarditis
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10
Q

Clinical findings of aortic valve replacement

A

Metallic second heart sound - click at end of pulse
ejection systolic flow murmur
features of anticoagulation

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11
Q

Mitral regurgitation - causes

A
  1. Degenerative
  2. Functional secondary to LV dilatation
  3. Ischaemic
  4. MV prolapse
    - hereditary
    - idiopathic
    - Marfan’s syndrome
    - Connective tissue disorder
  5. Rheumatic disease
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12
Q

Pulmonary stenosis - causes/associated syndromes

A
  1. Congenital
    - Rubella
    - Down’s Syndrome
    - Turner’s syndrome
    - Noonan’s syndrome
    - Tetralogy of Fallot
  2. Acquired
    - carcinoid syndrome
    - rheumatic fever
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13
Q

Tetralogy of Fallot - 4 features

A
  1. Pulmonary stenosis
  2. VSD
  3. Right ventricular hypertrophy
  4. Overriding aorta
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14
Q

Marfan’s syndrome

  • definition/genetic
  • cardiac issues/examination
  • face + hands:
  • chest inspection:
A

Autosomal dominant condition affecting fibrillin gene

Cardio:

  • aortic regurgitation secondary to aortic root dilatation
  • aortic dissection/aneurysm
  • on ausulcation: metallic second heart sound + ejection systolic murmur. If features of aortic incompetence (diastolic murmur, loss of second heart sound) then worry that valve is failing
  • mitral valve prolapse - pansystolic murmur in mitral region

Face + hands:

  • clubbing
  • arachnodactyly
  • hyperextensible joints
  • high arched palate
  • irdodonesis - upward lens dislocation

Chest inspection:
pectus carinatum or excavatum
- scoliosis
- sternotomy scar = AVR
- thoracotomy scar = thoracic aortic aneurysm/dissection surgery
- posterior chest drain scars - pneumothorax

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15
Q

Management of Marfan’s

A

Surveillance:

  • monitoring of aortic root to assess for dilatation
  • monitoring of valves

Medical management:

  • beta blockage + ACEi to reduce dilatation of aortic root
  • anti-coagulation if metallic valve/AF secondary to valvular disease

Surgical management:

  • aortic valve replacement
  • aortic root surgery

Genetics:
- screening of family members as autosomal dominant

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16
Q

Indications for aortic surgery in Marfan’s patients

A
  1. Dilatation of root >50mm
  2. Dilatation of root >45mm in patient with family history of aortic aneurysm/dissection
  3. Rate of dilatation >3mm/year
17
Q

Indications for mitral valve replacement

A
  1. Severe symptomatic mitral regurgitation
    - SOB
  2. Asymptomatic mitral regurgitation with the following:
    - LVEF <60%
    - LV end systolic diameter >45mm
    - Atrial fibrillation
    - Systolic pulmonary arterial pressures >50mmHg
  3. Acute mitral regurgitation
    - papillary muscle rupture following MI
18
Q

Noonan syndrome features

A

Phenotypic features:

  • webbed neck
  • wide spaced nipples
  • scoliosis
  • pectus carinatum/excavatum
  • short stature
  • ptosis

Eye signs:

  • proptosis
  • ptosis
  • strabismus

Cardiac

  • pulmonary stenosis
  • hypertrophic cardiomyopathy
  • ASD
  • VSD

Gastro

  • failure to thrive
  • intestinal malrotation
  • gastroparesis

Haematology
- coagulopathy

Neurological

  • learning difficulties
  • seizures
  • Arnold Chiari malformation
19
Q

Differential diagnosis of pulmonary stenosis

A
  1. Valvular pulmonary stenosis
  2. Infra + supra valvular pulmonary stenosis
  3. Aortic stenosis
  4. Ventricular septal defect
  5. Atrial septal defect
20
Q

Conditions associated with mitral valve prolapse

A

Primary
- degenerative myxomatous disease

Secondary:

  1. Marfan’s syndrome
  2. Ehlos Danlos syndrome
  3. Osteogenesis imperfecta
  4. Polycystic kidney disease
21
Q

Complications of mitral valve prolapse

A
  1. Infective endocarditis
  2. Thrombo-embolic events
  3. Cerebral vascular accidents
  4. Sudden death
  5. Requirement for mitral valve prolapse
22
Q

Patent ductus arteriosus - clinical findings

A

Collapsing pulse

Clubbed feet but NOT clubbed hands

Thrusting apex beat

Right ventricular heave if right sided heart failure/RV hypertrophy

Loud continuous machinery murmur loudest below left clavicle and heard posterior chest loudest behind left scapula

23
Q

Complications of PDA

A
  1. Right sided heart failure

2. Eisenmenger’s - left sided heart failure and cynanosis (deoxygenated blood direct flow into left sided circulation

24
Q

Causes of PDA

A
  1. Congenital
  2. Neonatal rubella syndrome
  3. Prematurity
  4. Birth at high altitude
  5. Prostaglandin infusion to keep PDA open in patients with transposition of great vessels
25
Q

Medical management of aortic stenosis

A
  1. Beta blockade
  2. Avoid vasodilating medications which will increase gradient across the valve
    - ACEi + CCB + nitrites
26
Q

Differential diagnosis of aortic stenosis ejection systolic murmur

A
  1. Aortic sclerosis
    - has normal pulse character
    - normal 2nd heart sound
  2. Hypertrophic obstructive cardiomyopathy (HOCM)
  3. VSD
  4. Pulmonary stenosis
    - loudest in pulmonary region
    - no radiation
    - features of right heart failure
    - loudest on inspiration
27
Q

How to assess for severity of aortic stenosis

A
  1. Pulse character
    - low volume pulse indicates severe AS
  2. Loss of 2nd heart sound
  3. Symptoms: SOB/CP/syncope
  4. Echo
    - aortic valve area: <1cm2 = severe
    - mean valve gradient: >40mmHg = severe
  5. Features of left ventricular failure
    - pulm oedema
    - displaced apex beat
28
Q

Duke’s criteria for IE

A

Major criteria:

  • positive BC: typical organism in 2 separate cultures OR persistently +ve BC
  • endocardium involvement: +ve Echo (vegetation/abscess/dehiscence of prosthetic valve) OR NEW valvular regurgitant murmue

Minor criteria:

  • risk factor: cardiac lesion/IV drug user
  • Fever >38
  • vascular/immunological signs
  • positive blood culture that doesn’t meet major criteria
  • positive ehco findings that does not meet major criteria

2 major OR 1 major + 3 minor OR all 5 minor

29
Q

Rheumatic fever diagnostic criteria

A

Evidence of group A beta-haemolytic strep infection + 2 major OR 1 major + 1 minor

Evidence of group A beta-haemolytic strep infection:

  • +ve throat culture
  • rapid streptococcal antigen test
  • elevated or rising streptococcal antibody titre
  • recent scarlet fever

Major criteria:

  • Carditis: tachycardia/murmur/pericardial rub/CCF/cardiomegaly/conduction defects
  • Arthritis: migratory polyathropathy
  • Subcutaneous nodules
  • Erythema marginatum
  • Sydenham’s chorea

Minor criteria:

  • Fever
  • Raised ESR or CRP
  • Athralgia
  • Prolonged PR interval
  • Previous rheumatic fever
30
Q

5 types of pulmonary hypertension

A
  1. Secondary to chronic lung disease
  2. Left ventricular failure
  3. Idiopathic
  4. Chronic thromboembolic disease
  5. Other: sickle cell, sarcoid
31
Q

3 types of Ehlos Danlos Syndrome

A
  1. Hypermobile EDS
    - hypermobile joints
  2. Classical EDS
    - elastic skin
  3. Vascular EDS
    - higher risk of vascular rupture due to fragile blood vessels
    - reduced life expectancy
32
Q

Clinical features of Ehlos Danlos Syndrome

A
  1. Skin
    - elastic
    - cigarette paper thinning/atrophic scars
    - translucent skin
    - easy bruising
    - petechiae
  2. MSK
    - hypermobile joints
    - subluxation/dislocation
    - osteoarthritis
    - spinal deformities - kyphosis/lordosis/scoliosis
    - nerve entrapment
  3. Vascular
    - AR
    - mitral prolapse
    - aortic aneurysm/dilatation
    - Raynaud’s
    - arterial rupture
  4. GI
    - hiatus hernia
    - GORD
    - poor GI motility
    - anal prolapse

PACES (8 decks)

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