Cardiology Short Case Flashcards
Causes of dominant a wave (JVP) (3)
- tricuspid stenosis
- pulmonary stenosis
- pulmonary hypertension
Cause of dominant v wave (JVP) (1)
- tricuspid regurgitation (important and common)
Causes of cannon a waves (JVP) (3)
- complete heart block
- paroxysmal nodal tachycardia with retrograde atrial conduction
- ventricular tachycardia with retrograde atrial conduction or AV dissociation
Causes of an elevated central venous pressure (6)
- right ventricular failure
- tricuspid stenosis or regurgitation
- pericardial effusion or constrictive pericarditis
- superior vena caval obstruction
- fluid overload
- hyperdynamic circulation
Anacrotic pulse (description and cause)
- small volume
- slow upstroke
- plus a wave on the upstroke
- caused by aortic stenosis
Plateau pulse (description and cause)
- slow upstroke
2. caused by aortic stenosis
Bisferiens pulse (description and cause)
- anacrotic plus collapsing
2. aortic regurgitation and aortic stenosis
Collapsing pulse (causes) (5)
- aortic regurgitation
- hyper dynamic circulation
- arteriosclerotic aorta
- patent ductus arteriosus
- peripheral arteriovenous aneurysm
Small volume pulse (causes) (2)
- aortic stenosis
2. pericardial effusion
Alternans pulse (description and cause)
- alternating strong and weak beats
2. caused by left ventricular failure
Causes of loud first heart sound (4)
- mitral stenosis
- tricuspid stenosis
- tachycardia
- hyperdynamic circulation
Causes of soft first heart sound (4)
- mitral regurgitation
- calcified mitral valve
- left bundle branch block
- first degree heart block
Causes of loud aortic second heart sound (A2) (2)
- congenital aortic stenosis
2. systemic hypertension
Causes of soft aortic second heart sound (A2) (2)
- calcified aortic valve
2. aortic regurgitation
Cause of loud pulmonary second heart sound (P2)
pulmonary hypertension
Cause of soft pulmonary second heart sound (P2)
pulmonary stenosis
Causes of increased normal splitting (4)
- right bundle branch block
- pulmonary stenosis
- ventricular septal defect
- mitral regurgitation (earlier A2)
Cause of fixed splitting
atrial septal defect
Cause of reversed splitting (P2 first) (4)
- left bundle branch block
- aortic stenosis (severe)
- coarctation of aorta
- patent ductus arteriosus (large)
Causes of a left ventricular third heart sound (S3) (6)
Mechanism - tautening of the mitral or tricuspid cusps at the end of rapid diastolic filling.
- physiological (ie. age <40 or pregnancy)
- left ventricular failure
- aortic regurgitation
- mitral regurgitation
- ventricular septal defect
- patent ductus arteriosus
Causes of a right ventricular third heart sound (S3) (2)
- right ventricular failure
2. constrictive pericarditis
Causes of a left ventricular fourth heart sound (S4) (5)
Mechanism - a high atrial pressure wave is reflected back from a poorly compliant ventricle, is always abnormal
- aortic stenosis
- acute mitral regurgitation
- systemic hypertension
- ischaemic heart disease
- hypertrophic cardiomyopathy
Causes of a right ventricular fourth heart sound (S4) (2)
- pulmonary hypertension
2. pulmonary stenosis
Causes of a pan systolic murmur (4)
- mitral regurgitation
- tricuspid regurgitation
- ventricular septal defect
- Aorta-pulmonary shunts
Causes of a midsystolic murmur (4)
- aortic stenosis
- pulmonary stenosis
- hypertrophic cardiomyopathy
- pulmonary flow murmur of an ASD
Causes of an early systolic murmur (3)
- ventricular septal defect (either very small, or large plus 2. pulmonary hypertension)
- acute mitral regurgitation
- tricuspid regurgitation
Causes of a late systolic murmur (2)
- mitral valve prolapse
2. papillary muscle dysfunction (eg. hypertrophic cardiomyopathy)
Causes of an early diastolic murmur (2)
- aortic regurgitation
2. pulmonary regurgitation
Causes of a mid-diastolic murmur (5)
- mitral stenosis
- tricuspid stenosis
- atrial myxoma
- Austin Flint murmur of aortic regurgitation
- Carey Coombs murmur of acute rheumatic fever
Causes of a presystolic murmur (3)
- mitral stenosis
- tricuspid stenosis
- atrial myxoma
Causes of a continuous murmur (6)
- patent ductus arteriosus
- arteriovenous fistula (coronary artery, pulmonary, systemic)
- venous hum (over the right supraclavicular fossa and abolished by ipsilateral compression of the internal jugular vein)
- rupture of a sinus of Valsalva into the right atrium or ventricle
- aortopulmonary connection (eg. Blalock shunt)
- “mammary souffle” in late pregnancy or early postpartum period
Causes of mitral stenosis (4)
- rheumatic (women more often than men)
- severe mitral annular calcification (sometimes associated with hypercalcaemia and hyperparathyroidism - rare)
- after mitral valve repair for mitral regurgitation
- congenital (very rarely, eg. parachute valve, with all chord inserting into one papillary muscle
Clinical signs of severe mitral stenosis (5)
- small pulse pressure
- early opening snap (due to raised LA pressure)
- length of the mid-diastolic rumbling murmur (persists as long as there is a gradient)
- diastolic thrill at the apex
- presence of pulmonary hypertension
Clinical signs of pulmonary hypertension (5)
- prominent a wave in the JVP
- right ventricular impulse
- loud P2, a palpable P2 is more helpful
- pulmonary regurgitation
- tricuspid regurgitation
Causes of chronic mitral regurgitation (6)
- degenerative disease
- mitral valve prolapse
- rheumatic
- papillary muscle dysfunction - LV failure, ischaemia
- connective tissue disease - RA, ankylosing spondylitis
- congenital - endocardial cushion defect (including premium atrial septal defect and cleft mitral leaflet), parachute valve, corrected transposition