Cardiology Flashcards
Features of the severity of AS
- Low amplitude pulse
- Slow rising pulse
- Narrow pulse pressure
- Pressure loaded/heaving Apex beat
- Palpable thrill over Aortic area
- Soft or absent S2
- Reverse splitting (A2 occurs after P2 as it closes late due to severe stenosis and slow output)
- 4th HS (occurs before S1 - indicates forceful atrial contraction against hypertrophied heart)
- Loud EJS
- Late peaking murmur
- LVF
- Pulmonary HTN
Causes of AS (6)?
Congenital
Bicuspid valve
Degenerative calcification
Rheumatic HD
Endocarditis
Hyperuricaemia
AS - indication for surgery? (5)
- Symptomatic, Severe AS
- Severe AS with +ve stress test or BP drop
Asymptomatic severe AS with:
- LVEF <50%
- Those undergoing other Cardiac surgery for other indication
- Maximum aortic velocity of ≥4.5m/s
Features of severe MR?
- Volume loaded, displaced Apex (thrusting)
- Precordial thrill
- Mid-diastolic flow murmur
- Soft or absent S1
- Splitting of S2 (AV closes early than PV)
- S3
- S4
- LVF
- P-HTN
Causes of MR? (5+)
Functional: LV dilatation
Structural: Rheumatic HD, MVP**, Endocarditis, Connective Tissue Diseases, Marfan’s, Ehler Danlos
Indications for MV surgery? (5)
Severe, symptomatic MR + LVEF ≥30% otherwise missed boat → LV function does not improve after surgery - due to irreversible depression of ventricular contractility)
If Asymptomatic severe MR (+LVEF ≥30%)
- AF
- P-HTN
- LVESD (>45mm)
- Or other surgery (e.g. CABG)
Causes of MS? (4)
Rheumatic heart disease
Connective Tissue Disease (RA/SLE)
Congenital
Carcinoid
MS - Clinical signs of severity? (7)
- AF
- Narrow PP
- Opening snap
- Long-duration of the diastolic murmur
- PR murmur (Graham Steel murmur) from back flow
- LVF
- P-HTN
MS - indication for surgery? (4)
- Moderate-Severe MS with symptoms
- Mod-Sev MS with P-HTN
- New AF
- Suitable valve: non-calcified with little or no sub-valvular fusion
AR - signs of severity (6)
- Wide PP
- S3
- Long duration of decrescendo diastolic murmur
- Austin-Flint murmur (mid-diastolic murmur at apex caused by regurgitant jet impinging on MV → functional MS)
- LVF
- P-HTN
4 eponymous signs ass with AR? (4)
- Corrigan’s sign: visible carotid pulsations in the neck
- Quinke’s sign: capillary pulsations in finger nails
- De Musset’s sign: head nodding with each heartbeat
- Muller’s sign: systolic pulsations of the uvula (Mouth)
DDx for systolic murmur? (5)
MR (rad to axilla, louder on exp)
AS (rad to carotids, louder on exp)
TR (louder on insp, RV heave, giant V, pulsatile liver)
PS (EJS, louder on insp, RV heave)
VSD (holosystolic) - 3-4th LICS with thrill
DDx for diastolic murmur? (4)
AR: early diastolic, louder on leaning forward + exp. Displaced apex.
PR: louder on insp + pul. HTN
MS - mid, rumbling diastolic. Loud 1st HS. Raised JVP.
TS - mid diastolic, tricuspid area, pulsatile liver, louder on insp
AS signs
