Cardiology Flashcards
What pathophysiologically causes the 4th heart sound?
Atrial contraction into a non-compliant or hypertrophied ventricle
Note: Atrial contraction is not normally heard - but if you do it is a ‘low pitched sound’
What are the aetiological causes of a 4th heart sound? (4)
- Heart failure
- Myocardial infarction
- Cardiomyopathy
- Hypertension (pressure overload)
(Note: these all cause a non-compliant 4th ventricle)
Describe the sound of 4th heart sound?
Le Lub …….Dub
it is low pitched
Which added sound can be a normal finding and when?
3rd heart sound - in children and young adults up to 30 yo
4th heart sound is always abnormal
What pathophysiologically causes the 3rd heart sound?
It is caused by a sudden deceleration of blood into the left ventricle from the left atrium and this is because the ventricle reaches its elastic limit suddenly
What are the aetiological causes of a 4th heart sound? (6)
- Heart failure
- Myocardial Infarction
- Cardiomyopathy
- Hypertension
- Mitral and Aortic regurgitation (volume overload)
- Constrictive pericarditis
What are the causes of constrictive pericarditis? (6)
- TB (developing countries)
- Renal failure
- Inflammatory: SLE, sarcoidosis, scleroderma,
- Myocardial infarction
- Dressler’s syndrome
- Drugs: doxorubicin , cyclophosphaimde, phenytoin
Describe the effects of volume overload vs pressure overload on the apex beat
Volume overload: the apex beat = displaced and not powerful
Pressure overload: the apex beat = not displaced and powerful
AR and MR can cause volume overload, therefore what is a late sign/severe of AR and MR?
a displaced apex beat
What are the 3 causes of splinter haemorrhages/?
- micro- trauma to the nail (most common)
- infective endocarditis
- vasculitis
What are the signs of infective endocarditis? 2 in the hands 1 in the heart 2 in the abdomen plue the rarities
2 in the hands: splinters and clubbing 1 in the heart: changing murmurs 2 in the abdomen: splenomegaly microscopic haematuria rare: janeway lesions, oslers nodes, roth spots
What are the stages of clubbing? (4)
Stage 1. Increased fluctuancy of the nail bed
Stage 2. Loss of the angle
Stage 3. Increased curvature of the nail
Stage 4. Expansion of the terminal phalynx
What is the name of the window test for clubbing?
Schamroth’s window test
If you spot clubbing - how should you state it as a finding?
Evidence of digital clubbing
Where should you be looking during collapsing pulse?
In the neck! It can be often be seen there (Corrigan’s sign)
Note: the pulse in the arm is called Corrigan’s pulsation - both detect Aortic regurgitation
Why does the neck need to be relaxed when looking forJVP?
Because the JVP is behind the sternocleiodomastoid
so the muscle needs to be relaxed
Where should you positionally look for JVP?
From the front and the side
How can you tell the difference between the arterial pulse and the JVP?
Jugular venous pulsation is a ‘double pulsation’ whereas arterial pulse is a flickering
If the JVP is raised, what should you check for?
Sacral or Ankle oedema
JVP stands for jugular venous pulsation - it is the pulsation of which vein?
the INTERNAL jugular vein
What does the JVP indicate?
The pressure of the right atrium (internal jugular vein –> SVC –> right atrium)
Why is it bad if the examiner says examine the heart?
Because it could be the cardiovascular system or the praecordium
- always ask them to clarify
How do you perform the manoeuvre for mitral stenosis?
Patient rolls to the left side + listen with the bell
How do you perform the manoeuvre for aortic regurgitation?
Patient sits forward, at the end of EXpiration + listen with the diaphragm