Cardiology Flashcards
Which chamber of the heart is measured using JVP?
Right atrium
What does the a wave represent in JVP?
Atrial contraction
What does the c wave represent in JVP?
Closure of the tricuspid valve
What does the x descent represent in JVP?
Downward movement of the heart causing atrial stretch and drop in pressure
What does the v wave represent in JVP?
Passive filling of the blood into the atrium against a closed tricuspid valve
What does the y descent represent in JVP?
Opening of the tricuspid valve with passive movement of blood from the right atrium to the right ventricle
What can cause a raised JVP?
Heart failure Fluid overload Severe bradycardia Inspiration SVC syndrome
What is Kussmaul’s sign in JVP?
Raised JVP on expiration and drop on inspirations (i.e. backwards from normal). It is caused by the inability fo the right heart chambers to increase in size.
How does atrial fibrillation affect the JVP wave?
Loss of a wave
How does tricuspid regurgitation affect the JVP wave?
Large c-V waves
How does raised right atrial pressure affect the JVP wave?
Prominent a waves
How does constriction affect the JVP wave?
Prominent and deep x and y descents
How does tamponade affect the JVP wave?
Prominent x descent only. Y descent is slow or absent.
What can cause an absent radial pulse?
Latrogenic: post-catheterisation or arterial line
Blalock-Taussig shunt for congenital heart disease
Aortic dissection with subclavian involvement
Trauma
Takayasu’s arteritis
Peripheral arterial embolus
What can cause a collapsing pulse?
Aortic regurgitation
Arteriovenous fistula
Patent ductus arteriosus
What can cause a slow rising pulse?
Aortic stenosis (delayed percussion wave)
What can cause bisferiens pulse?
A double shudder due to mixed aortic valve disease with significant regurgitation
What can cause a jerky pulse?
Hypertrophic obstructive cardiomyopathy
What can cause an alternans pulse?
Severe left ventricular dysfunction. Ejection fraction is reduced meaning the end-diastolic volume is elevated. This may stretch the myocytes to improve the ejection fraction of the next heartbeat leading to alternating strong and weak pulses.
What can cause a paradoxical pulse?
Excessive reduction on inspiration caused by ventricular compression, tamponade, constrictive pericarditis, or severe asthma
What is the cardiac apex?
The ventricle striking the chest wall during isovolumetric contractions
What can cause an absence of the apical impulse?
Obesity/emphysema
Right pneumonectomy with displacement
Pericardial effusion or constriction
Dextrocardia
What can cause a heaving apical impulse?
Left ventricular hypertrophy
What can cause a thrusting/hyperdynamic apical pulse?
High left ventricular volume (e.g. in mitral regurgitation, aortic regurgitation, PDA, ventricular septal defect)
What can cause a tapping apical pulse?
Palpable first heart sound in mitral stenosis
What can cause a displaced apical pulse?
Left ventricular impairment and dilatation
What can cause a double apical pulse?
(with dyskinesia) left ventricular aneurysm
(without dyskinesia) hypertrophic cardiomyopathy
What can cause a pericardial knock?
Constrictive pericarditis
What can cause a parasternal heave?
Right ventricular hypertrophy
Pulmonary hypertension
Chronic obstructive pulmonary disease
Pulmonary stenosis
What can cause a palpable third heart sound?
Heart failure and severe mitral regurgitation
What can cause loud first heart sounds?
Mobile mitral stenosis Hyperdynamic states Tachycardic states Left-to-right shunts Short PR interval
What can cause soft first heart sounds?
Immobile mitral stenosis Hypodynamic states Mitral regurgitation Poor ventricular function Long PR interval
What can cause split first heart sounds?
RBBB LBBB VT Inspiration Ebstein's anomaly
What can cause variable first heart sounds?
Atrial fibrillation
Complete heart block
What can cause loud second heart sounds?
Systemic hypertension
Pulmonary hypertension
Tachycardic states
ASD
What can cause soft or absent second heart sounds?
Severe aortic stenosis
What can cause fixed second heart sounds?
ASD
What can cause widely split second heart sounds?
RBBB
Pulmonary stenosis
Deep inspiration
Mitral regurgitation
What can cause a single second heart sound?
Severe pulmonary/aortic stenosis Hypertension Large VSD Tetralogy of Fallot Eisenmenger's syndrome Pulmonary atresia Elderly
What can cause a reversed split second heart sound?
LBBB
Right ventricular pacing
PDA
Aortic stenosis
What can cause left axis deviation?
LBBB Left anterior hemi-block LVH Primum ASD Cardiomyopathies Tricuspid atresia
What can cause low-voltage ECG?
Pulmonary emphysema Pericardial effusion Myxoedema Severe obesity Incorrect calibration Cardiomyopathies Global ischaemia Amyloid
What can cause right axis deviation?
Infancy
RBBB
Right ventricular hypertrophy
What are some abnormalities seen in ECGs of athletes?
Sinus arrhythmia Sinus bradycardia First-degree heart block Wenckebach's phenomenon Junctional rhythm
