Cardiology Flashcards
ECG Rule of 4 - Four initial features
Clinical information
Rate
Rhythm
Axis
ECG Rule of 4 - Four Intervals
PR interval (0.12-0.2 seconds or 3-5 small squares) - prolonged is heart block, shortened is WPW QRS width (normally less than 0.12, or 3 small squares) - widened QRS is conduction defect with L or R BB ST segment - sloping, flattening or elevation QT interval - time from start of Q wave to end of T wave
ECG Rule of 4 - Four waves
P wave (lead II best for morphology) QRS complexes (presence of Q waves and QRS progression through chest leads) T waves (inversion, concordance with QRS, flattening) U waves (present or not)
Aortic Stenosis Clinical Features
chest pain
dyspnoea
syncope
Aortic Stenosis examination signs
narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure
Aortic Stenosis causes and treatment
degenerative calcification (most common) if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery cardiovascular disease may coexist. For this reason an angiogram is often done prior to surgery so that the procedures can be combined balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement
Aortic Regurgitation signs
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Austin flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
Aortic Regurgitation causes
rheumatic fever
infective endocarditis
connective tissue diseases e.g. RA/SLE
bicuspid aortic valve
Mitral stenosis features
mid-late diastolic murmur (best heard in expiration) loud S1, opening snap low volume pulse malar flush atrial fibrillation
Features of severe mitral stenosis
length of murmur increases
opening snap becomes closer to S2
Causes of mitral stenosis
RHEUMATIC FEVER
Mitral Regurgitation causes
Following coronary artery disease or post-MI Mitral valve prolapse Infective endocarditis Rheumatic fever Congenital
Mitral regurgitation signs
The murmur heard on auscultation of the chest is typically a pansystolic murmur described as “blowing”. It is heard best at the apex and radiating into the axilla. S1 may be quiet as a result of incomplete closure of the valve. Severe MR may cause a widely split S2
Systolic murmur causes
Aortic stenosis (ejection systolic radiates to carotids - crescendo decrescendo)
Mitral regurgitation (holosystolic at apex radiating to axilla)
Tricuspid regugitation (holosystolic in tricuspid area radiating to left sternal border)
VSD
Pulmonary stenosis
Mitral valve prolapse
Diastolic murmur causes
Aortic regurgitation (left sternal border peaking at beginning of diastole then decreasing)
Mitral stenosis
Tricuspid stenosis
