Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Basic Physician's Training Clinical Exam Monash > Cardiology Short Case > Flashcards

Cardiology Short Case Flashcards

1
Q

Causes of dominant a wave (JVP) (3)

A
  1. tricuspid stenosis
  2. pulmonary stenosis
  3. pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cause of dominant v wave (JVP) (1)

A
  1. tricuspid regurgitation (important and common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of cannon a waves (JVP) (3)

A
  1. complete heart block
  2. paroxysmal nodal tachycardia with retrograde atrial conduction
  3. ventricular tachycardia with retrograde atrial conduction or AV dissociation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of an elevated central venous pressure (6)

A
  1. right ventricular failure
  2. tricuspid stenosis or regurgitation
  3. pericardial effusion or constrictive pericarditis
  4. superior vena caval obstruction
  5. fluid overload
  6. hyperdynamic circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anacrotic pulse (description and cause)

A
  1. small volume
  2. slow upstroke
  3. plus a wave on the upstroke
  4. caused by aortic stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Plateau pulse (description and cause)

A
  1. slow upstroke

2. caused by aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bisferiens pulse (description and cause)

A
  1. anacrotic plus collapsing

2. aortic regurgitation and aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Collapsing pulse (causes) (5)

A
  1. aortic regurgitation
  2. hyper dynamic circulation
  3. arteriosclerotic aorta
  4. patent ductus arteriosus
  5. peripheral arteriovenous aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Small volume pulse (causes) (2)

A
  1. aortic stenosis

2. pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alternans pulse (description and cause)

A
  1. alternating strong and weak beats

2. caused by left ventricular failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of loud first heart sound (4)

A
  1. mitral stenosis
  2. tricuspid stenosis
  3. tachycardia
  4. hyperdynamic circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of soft first heart sound (4)

A
  1. mitral regurgitation
  2. calcified mitral valve
  3. left bundle branch block
  4. first degree heart block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of loud aortic second heart sound (A2) (2)

A
  1. congenital aortic stenosis

2. systemic hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of soft aortic second heart sound (A2) (2)

A
  1. calcified aortic valve

2. aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cause of loud pulmonary second heart sound (P2)

A

pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cause of soft pulmonary second heart sound (P2)

A

pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of increased normal splitting (4)

A
  1. right bundle branch block
  2. pulmonary stenosis
  3. ventricular septal defect
  4. mitral regurgitation (earlier A2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cause of fixed splitting

A

atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cause of reversed splitting (P2 first) (4)

A
  1. left bundle branch block
  2. aortic stenosis (severe)
  3. coarctation of aorta
  4. patent ductus arteriosus (large)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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.

A
  1. physiological (ie. age <40 or pregnancy)
  2. left ventricular failure
  3. aortic regurgitation
  4. mitral regurgitation
  5. ventricular septal defect
  6. patent ductus arteriosus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of a right ventricular third heart sound (S3) (2)

A
  1. right ventricular failure

2. constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A
  1. aortic stenosis
  2. acute mitral regurgitation
  3. systemic hypertension
  4. ischaemic heart disease
  5. hypertrophic cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of a right ventricular fourth heart sound (S4) (2)

A
  1. pulmonary hypertension

2. pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of a pan systolic murmur (4)

A
  1. mitral regurgitation
  2. tricuspid regurgitation
  3. ventricular septal defect
  4. Aorta-pulmonary shunts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Causes of a midsystolic murmur (4)
1. aortic stenosis 2. pulmonary stenosis 3. hypertrophic cardiomyopathy 4. pulmonary flow murmur of an ASD
26
Causes of an early systolic murmur (3)
1. ventricular septal defect (either very small, or large plus 2. pulmonary hypertension) 3. acute mitral regurgitation 4. tricuspid regurgitation
27
Causes of a late systolic murmur (2)
1. mitral valve prolapse | 2. papillary muscle dysfunction (eg. hypertrophic cardiomyopathy)
28
Causes of an early diastolic murmur (2)
1. aortic regurgitation | 2. pulmonary regurgitation
29
Causes of a mid-diastolic murmur (5)
1. mitral stenosis 2. tricuspid stenosis 3. atrial myxoma 4. Austin Flint murmur of aortic regurgitation 5. Carey Coombs murmur of acute rheumatic fever
30
Causes of a presystolic murmur (3)
1. mitral stenosis 2. tricuspid stenosis 3. atrial myxoma
31
Causes of a continuous murmur (6)
1. patent ductus arteriosus 2. arteriovenous fistula (coronary artery, pulmonary, systemic) 3. venous hum (over the right supraclavicular fossa and abolished by ipsilateral compression of the internal jugular vein) 4. rupture of a sinus of Valsalva into the right atrium or ventricle 5. aortopulmonary connection (eg. Blalock shunt) 6. "mammary souffle" in late pregnancy or early postpartum period
32
Causes of mitral stenosis (4)
1. rheumatic (women more often than men) 2. severe mitral annular calcification (sometimes associated with hypercalcaemia and hyperparathyroidism - rare) 3. after mitral valve repair for mitral regurgitation 4. congenital (very rarely, eg. parachute valve, with all chord inserting into one papillary muscle
33
Clinical signs of severe mitral stenosis (5)
1. small pulse pressure 2. early opening snap (due to raised LA pressure) 3. length of the mid-diastolic rumbling murmur (persists as long as there is a gradient) 4. diastolic thrill at the apex 5. presence of pulmonary hypertension
34
Clinical signs of pulmonary hypertension (5)
1. prominent a wave in the JVP 2. right ventricular impulse 3. loud P2, a palpable P2 is more helpful 4. pulmonary regurgitation 5. tricuspid regurgitation
35
Causes of chronic mitral regurgitation (6)
1. degenerative disease 2. mitral valve prolapse 3. rheumatic 4. papillary muscle dysfunction - LV failure, ischaemia 5. connective tissue disease - RA, ankylosing spondylitis 6. congenital - endocardial cushion defect (including premium atrial septal defect and cleft mitral leaflet), parachute valve, corrected transposition
36
Causes of acute mitral regurgitation (4)
1. infective endocarditis (perforation of anterior leaflet), rupture of myxomatous cord 2. myocardial infarction (chordal rupture or papillary muscle dysfunction) 3. trauma 4. surgery
37
Clinical signs of severe mitral regurgitation (8)
1. enlarge left ventricle 2. pulmonary hypertension (late sign) 3. third heart sound 4. early diastolic rumble 5. soft first heart sound 6. aortic component of second heart sound (A2) Is earlier 7. small volume pulse (very severe) 8. left ventricular failure
38
Dynamic manoeuvres for mitral valve prolapse (2)
1. Valsalva (decreases preload) - murmur longer, click earlier 2. Handgrip (increases afterload) or squatting (increases preload) - murmur shorter
39
Associations of mitral valve prolapse (2)
1. Marfan's syndrome | 2. ASD (secundum)
40
Complications of mitral valve prolapse (2)
1. Mitral regurgitation | 2. Infective endocarditis
41
Causes of chronic aortic regurgitation (7)
Valvular 1. Rheumatic 2. Congenital (eg. bicuspid valve; VSD - an associated prolapse of the aortic cusp) 3. Seronegative arthropathy especially ankylosing spondylitis Aortic root (murmur may be maximal at right sternal border) 4. Marfan's syndrome 5. Aortitis 6. Dissecting aneurysm 7. Old age
42
Causes of acute aortic regurgitation (4)
Valvular 1. Infective endocarditis Aortic root 2. Marfan's syndrome 3. Hypertension 4. Dissecting aneurysm
43
Clinical signs of severity in chronic aortic regurgitation (7)
1. Collapsing pulse 2. Wide pulse pressure 3. Length of the decrescendo diastolic murmur 4. Third heart sound (left ventricular) 5. Soft aortic component of the second heart sound (A2) 6. Austin Flint murmur (a diastolic rumble caused by limitation to mitral inflow by the regurgitation jet) 7. Left ventricular failure
44
Indications for surgery in aortic regurgitation (3)
1. Symptoms 2. Worsening LV function such as low EF 3. Progressive LV dilatation on serial echocardiograms - LV end-systolic dimension of >5.5cm
45
Causes of aortic stenosis (3)
1. Degenerative senile calcific aortic stenosis (most common cause in elderly) 2. Rheumatic (rarely isolated) 3. Calcific bicuspid valve
46
Clinical signs of severity in aortic stenosis (6)
1. Plateau pulse 2. Aortic thrill 3. Length, harshness, and lateness of the peak of the systolic murmur 4. Fourth heart sound (S4) 5. Paradoxical splitting of the second heart sound (delayed left ventricular ejection and aortic valve closure) 6. Left ventricular failure (a late sign - right ventricular failure is preterminal)
47
Clinical signs of tricuspid regurgitation (5)
1. JVP - large v waves 2. Right ventricular heave 3. Pansystolic murmur, maximal at lower end of sternum and on inspiration 4. Pulsatile, large and tender liver 5. Ascites and oedema
48
Causes of tricuspid regurgitation (7)
1. Functional (no disease of the valve leaflets) from RV failure 2. Rheumatic (usually mitral valve disease also present) 3. Infective endocarditis (in IVDU) 4. Congenital - Ebstein's anomaly 5. Tricuspid valve prolapse (rare) 6. Right ventricular papillary muscle infarction 7. Trauma (usually a steering-wheel injury to the sternum)
49
Clinical signs of pulmonary stenosis (8)
1. Peripheral cyanosis 2. Reduced pulse volume 3. Giant a waves (JVP) 4. Right ventricular heave 5. Thrill over pulmonary area 6. Harsh ejection systolic murmur maximal in pulmonary area and on inspiration, may be preceded by an ejection click 7. Fourth heart sound 8. Presystolic pulsation of the liver
50
Signs of severe pulmonary stenosis (4)
1. Ejection systolic murmur peaking late in systole 2. Absence of an ejection click (also absent when the pulmonary stenosis is infundibular ie. below the valve level) 3. Presence of fourth heart sound 4. Signs of right ventricular failure
51
Causes of pulmonary stenosis (2)
1. Congenital | 2. Carcinoid syndrome
52
Clinical signs of chronic constrictive pericarditis (6)
1. Low blood pressure and pulses paradoxus 2. Raised JVP with Kussmaul's sign and prominent x and y descents 3. Impalpable apex beat 4. Distant heart sounds with early pericardial knock or an early third heart sound 5. Hepatosplenomegaly, ascites, oedema 6. Cachexia
53
Causes of chronic constrictive pericarditis (6)
1. Radiation 2. Tumour 3. Tuberculosis 4. Connective tissue disease 5. Chronic renal failure 6. Trauma
54
Clinical features of hypertrophic cardiomyopathy (5)
1. Sharp, rising, jerky pulse 2. Prominent a wave (JVP) 3. Double or triple impulse apex beat 4. Auscultation - late systolic ejection murmur (left sternal edge) - pan systolic murmur (apex) from mitral regurgitation - fourth heart sound 5. Dynamic manoeuvres - murmur is louder with Valsalva manoeuvre, standing and isotonic exercise - murmur is softer with squatting, raising the legs and isometric exercise (forceful handgrip)
55
Echocardiogram features of hypertrophic cardiomyopathy (5)
1. Asymmetrical hypertrophy of the ventricular septum 2. Systolic anterior motion of the anterior mitral valve leaflet 3. Midsystolic closure of the aortic valve 4. Doppler detection of mitral regurgitation 5. Doppler estimation of the gradient in the left ventricular outflow tract
56
Clinical features of ASD: ostium secundum (3)
1. Fixed splitting of the second heart sound 2. Pulmonary systolic ejection murmur (increasing on inspiration) 3. Pulmonary hypertension (late)
57
ECG and CXR findings of ASD: ostium secundum (3 &4)
ECG 1. Right axis deviation 2. RBBB 3. Right ventricular hypertrophy CXR 1. Increased pulmonary vasculature 2. Enlarge RA and RV 3. Dilated main pulmonary artery 4. Small aortic knob
58
Echocardiogram features of ASD: osmium secundum (5)
1. Paradoxical septal motion 2. Echo dropout in atrial septum 3. Doppler detection of a shunt at the atrial level 4. Shunt (bubble) study using agitated saline 5. Right ventricular dilation
59
Features of ASD: ostium primum | Clinical (6) and ECG (3)
``` Endocardial cushion defect Clinical 1. Signs are similar to ASD ostium secundum with addition of 2. Mitral regurgitation 3. Tricuspid regurgitation 4. VSD 5. Presence of Down syndrome 6. Presence of skeletal upper limb defects (Holt-Oram syndrome) ``` ECG 1. Left axis deviation 2. Right bundle branch block 3. Prolonged PR interval
60
Clinical features of VSD (4)
1. Palpable thrill 2. Harsh pan systolic murmur confined to the left sternal edge 3. Sometimes mitral regurgitation 4. Down syndrome (association)
61
Indications for surgery for VSD (3)
1. Left to right shunt is moderate to large 2. Pulmonary to systemic flow being >1.5 to 1 3. Right ventricular dilatation
62
Clinical features of patent ductus arteriosus (2)
1. Differential cyanosis and clubbing (of toes, not fingers) (from reversal of the shunt) 2. Continuous murmur
63
Clinical features of coarctation of the aorta (7)
1. Better developed upper body 2. Radiofemoral delay 3. Hypertension in the arms only 4. Chest collateral vessels 5. Midsystolic murmur over the precordium and back 6. Hypertensive changes in fundi 7. Turner's syndrome (association)
64
CXR findings of coarctation of the aorta (6)
1. Enlarged left ventricle 2. Enlarged left subclavian artery 3. Dilated ascending aorta 4. Aortic indentation 5. Aortic prestenotic and poststenotic dilation 6. Rib notching - second to sixth ribs on the inferior border
65
Echocardiogram findings of coarctation of the aorta (3)
1. Left ventricular hypertrophy 2. Coarctation shelf in the descending aorta 3. Abnormal flow patterns in the same area
66
Clinical features of Eisenmenger's syndrome
1. Cyanosis 2. Clubbing 3. Polycythaemia 4. Dominant a wave (JVP) and sometimes prominent v wave 5. Right ventricular heave 6. Palpable pulmonary component of the second heart sound (P2) 7. Loud P2 8. Fourth heart sound 9. Pulmonary ejection click 10. Pulmonary regurgitation 11. Tricuspid regurgitation 12. Decide on level of shunt - wide fixed split = ASD - single second sound = VSD - normal second sound or reversed splitting = PDA (look for differential cyanosis)
67
ECG and CXR findings of Eisenmenger's syndrome (2 & 4)
ECG 1. Right ventricular hypertrophy 2. P pulmonale CXR 1. Right ventricular and right atrial enlargement 2. Pulmonary artery prominence 3. Increased hilar vascular markings but attenuated peripheral vessels 4. Heart that is not boot shaped
68
Four features of tetralogy of Fallot (4)
1. VSD 2. Right ventricular outflow obstruction (determines severity) 3. Overriding aorta 4. Right ventricular hypertrophy
69
Clinical features of tetralogy of Fallot (8)
1. Cyanosis 2. Clubbing 3. Polycythaemia 4. Right ventricular heave 5. Left sternal edge thrill 6. No cardiomegaly 7. Single second heart sound 8. Short pulmonary ejection murmur
70
ECG and CXR findings of tetralogy of Fallot (2 and 4)
ECG 1. Right ventricular hypertrophy 2. Right axis deviation CXR 1. Normal sized heart with boot shape 2. Right ventricular enlargement 3. Decreased vascularity of lung vessels 4. Right sided aortic knob, arch and descending aorta (25%)
71
Renal causes of hypertension (2)
1. Renovascular disease (renal artery atherosclerosis, fibromuscular disease, aneurysm, vasculitis) 2. Diffuse renal disease
72
Endocrine causes of hypertension (7)
1. Conn's syndrome 2. Cushing's syndrome 3. 17 and 11-B-Hydroxylase defects 4. Phaeochromocytoma 5. Acromegaly 6. Myxoedema 7. Contraceptive pill
73
Other causes of hypertension (8)
1. Coarctation of the aorta 2. Polycythaemia rubra vera 3. Uraemia 4. Toxaemia of pregnancy 5. Neurogenic (increased intracranial pressure, acute intermittent porphyria, lead poisoning) 6. Hypercalcaemia 7. Alcohol 8. Sleep apnoea
74
Grades of hypertensive changes on fundoscopy (4)
Grade I - silver wiring Grade II - arteriovenous nipping Grade III - haemorrhages (flame-shaped), soft exudates (cotton wool spots) due to ischaemia and hard exudates due to lipid residues from leaky vessels Grade IV - papilloedema
75
Clinical features of Marfan's syndrome (9)
1. Arachnodactyly (spider fingers), joint hypermobility, long and thin limbs 2. Long/narrow face 3. Lens dislocation or blue sclerae 4. High arched palate 5. Pectus carinatum or excavatum 6. Aortic regurgitation or mitral valve prolapse, look for signs of dissecting aneurysm or coarctation of aorta 7. Kyphoscoliosis 8. Arm span exceeding height 9. Upper segment to lower segment ratio less than 0.85 (upper segment is from crown to symphysis pubis, and lower segment is from symphysis pubis to ground)
76
Causes of oedema (8)
1. Drugs - calcium channel blockers 2. Cardiac - congestive cardiac failure, cor pulmonale, constrictive pericarditis 3. Renal - nephrotic syndrome 4. Hepatic - cirrhosis 5. Malabsorption or starvation 6. Protein-losing enteropathy 7. Myxoedema 8. Cyclical oedema
77
Causes of non-pitting oedema (5)
1. Malignant infiltration 2. Congenital disease 3. Filariasis 4. Milroy's disease 5. Myxoedema
78
Causes of superior vena caval obstruction (5)
1. Lung carcinoma (90%) 2. Retrosternal tumours - lymphoma, thymoma, dermoid 3. Retrosternal goitre 4. Massive mediastinal lymphadenopathy 5. Aortic aneurysm
79
Cardio exam position and exposure
45 degrees | Chest and neck exposed
80
Findings on general inspection
Congenital syndromes: Marfan's, Turner's, Down Ank spond Acromegaly Dyspnoea
81
Findings in hands
``` Peripheral cyanosis Clubbing (demonstrate Schamroth's sign) Peripheral stigmata of IE: -splinter haemorrhages -Osler's nodes -Janeway lesions Tendon xanthomata Also take pulses: -right, left -radiofemoral delay if hypertension ```
82
Cardiovascular causes of clubbing (2)
Infective endocarditis | Cyanotic congenital heart disease
83
Findings in face
``` Eyes: -arcus cornea -pallor -jaundice -Argyll-Robertson pupil if aortic regurgitation present -Xantelasma Malar flush Mouth: -cyanosis -high arched palate -dentition -petechiae ```
84
Findings in neck
``` JVP height and character -assess on right -measure height from sternal angle -assess throughout respiration (assess for Kussmaul's sign) -hepatojugular reflux Carotid pulse: ```
85
Chest - inspection
``` scars - front and back pacemaker/ICD deformities position and character of apex beat visible pulsations ```
86
Chest - palpation
Apex beat -5th ICS, 1cm medial to MCL -character (pressure loaded AS, volume loaded AR MR, tapping MS, dyskinetic MI, double/triple impulse HCM) Parasternal impulses -left parasternal: RVH, LA enlargement -base of heart: palpable P2, aortic thrills
87
Chest - auscultation | -list the steps
``` Mitral area -bell then diaphragm -identify splitting Aortic and pulmonary areas -time with carotid pulse Below left clavicle for PDA Left lateral position -palpate for apex first -listen with bell for MS Sit forward -palpate for thrills at left sternal and base again -listen at left sternal and base, particularly AR If systolic murmur heard - perform valsalva ```
88
Steps after chest auscultation
``` Respiratory -inspect back deformity -percuss for pleural effusion -auscultate for crackles -if radiofemoral delay, auscultate back for coarctation murmur -palpate sacral oedema Abdomen -lay patient flat -assess for hepatomegaly and pulsatile liver -assess for splenomegaly -assess for aortic aneurysm Legs -palpate femoral arteries and other peripheral pulses -peripheral oedema -toe clubbing -achilles tendon xanthomata -signs of peripheral vascular disease -IE stigmata Ask for: -urinalysis - haematuria for IE -temperature chart - fever for IE -examine fundi - Roth's spots, hypertensive changes ```

Basic Physician's Training Clinical Exam Monash (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions