Cardiology Flashcards
JVP vs carotid pulse
JVP
- has 2 peaks
- lower and lateral
- not palpable
- can be obliterated
- inspiration –> more visible( carotid no change)
- positive hepatojugular reflex
- posture dependent (decrease with upright posture)
AR signs
- Marfanoid features
- peripheral stigmata of IE
- Collapsing Pulse
- head nodding
- marked capillary pulsation
- wide pulse pressure >60 mmhg (systolic okay but diastolic blood rushes back)
- displaced apex
- early diastolic murmur, loudest during expiration in sit-up and lean -forward position
- Austin Flint murmur
AR murmur
early diastolic murmur loudest during expiration in sit-up and lean-forward position
AR causes
- rheumatic
- congenital bicuspid aortic valve
- degenerative
- syphilis
- causes of a dilated aortic root/aortic aneurysm eg Marfan Syndrome, aortic dissection
- seronegative arthritis (ankylosing spondylitis, Reiter’s syndrome, colitis, psoriatic arthropathy)
AR Ix
- Blood test for VDRL and IE blood culture
- CXR for dilated aortic arch and cardiomegaly
- Echo for LV size and function, aortic root size, degenerative or bicuspid valve, severity of AR
AR vs PR
PR
- no collapsing pulse
- no LVH
AR vs MS
MS
- no austin flint murmur, instead has loud S1 and opening snap
AS signs
- small volume and slow-rising pulse
- sustained and thrusting, not or slightly displaced apex
- systolic thrill in aortic area
- soft s2 at aortic area if calcified and severely stenotic
- ejection systolic murmur at aortic area radiating to neck
small volume and slow rising pulse
AS
collapsing pulse
AR or PDA
AS murmur
ejection systolic murmur at aortic area radiating to neck
AS causes
- rheumatic
- degenerative calcification
- congenital bicuspid aortic valve
AS vs aortic sclerosis
aortic sclerosis
- normal volume pulse
- normal or wide pulse pressure
- intact s2
- no LVH
AS vs hypertrophic cardiomyopathy
hypertrophic cardiomyopathy
- jerky pusle
- normal s2
- murmur louder on standing
AS vs MR
MR pansystolic murmur at apex radiating to axilla
AS Ix
- ECG for LVH
- CXR for cardiomegaly and aortic valve calcification
- Echo for LVH, pressure gradient across aortic valve and aortic valvular area
ASD signs
- if HF then raised JVP
- parasternal heave
- fixed wide splitting of S2
- loud P2
- ejection systolic murmur at pulmonic area
- mid-diastolic murmur at tricuspid area
ASD murmurs
- ejection systolic murmur at pulmonic area
- mid-diastolic murmur at tricuspid area
ASD vs PS
PS soft S2
ASD vs PHT
PHT loud S2 without fixed splitting
ASD Ix
ECG for RBBB
CXR for plethoric lung fileds with RV enlargement
Echo for dilated RV, PHT, assess size of defect
