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BPT Clinical > Cardiology Shorts > Flashcards

Cardiology Shorts Flashcards

1
Q

Valve lesions associated with Marfan’s syndrome

A

Aortic regurgitation

Mitral valve prolapse

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2
Q

JVP: causes of dominant a wave

A

Tricuspid stenosis (also causes slow y descent)
Pulmonary stenosis
Pulmonary HTN

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3
Q

JVP: causes of dominant v wave

A

Tricuspid regurgitation

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4
Q

JVP: causes of cannon a waves

A

Complete heart block
Paroxysmal nodal tachycardia with retrograde atrial conduction
VT with retrograde atrial conduction or AV dissociation

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5
Q

Causes of elevated CVP

A

RV failure
TS or TR
Pericardial effusion/constrictive pericarditis
SVC obstruction
Fluid overload
Hyperdynamic circulation (fever, anaemia, thyrotoxicosis, AV fistula, pregnancy, exercise, beri beri, hypoxia, hypercapnia)

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6
Q

Define anacrotic pulse, and cause

A

Small volume, slow upstroke, plus a wave on the upstroke

Cause: AS

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7
Q

Define plateau pulse, and cause

A

Slow upstroke

Cause: AS

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8
Q

Define bisferiens pulse, and cause

A

Anacrotic plus collapsing pulse

Cause: AS + AR

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9
Q

Collapsing pulse causes

A

Aortic regurgitation, hyperdynamic circulation, arteriosclerotic aora (in elderly), PDA, peripheral AV aneurysm

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10
Q

Small volume pulse causes

A

AS, pericardial effusion

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11
Q

Alternans pulse definition and cause

A

Alternating strong and weak beats

Cause: LV failure

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12
Q

Causes of left parasternal impulse

A

RV hypertrophy or LA enlargement

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13
Q

Causes of loud S1

A

Mitral stenosis, TS, tachycardia, hyperdynamic circulation

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14
Q

Causes of soft S1

A

MR, calcified mitral valve, LBBB, 1st degree HB

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15
Q

Causes of loud A2

A

Congenital AS, systemic HTN

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16
Q

Causes of soft A2

A

Calcified aortic valve, AR

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17
Q

Causes of loud P2

A

pHTN

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18
Q

Causes of soft P2

A

Pulmonary stenosis

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19
Q

Causes of increased normal splitting second heart sound (wider on inspiration)

A

RBBB, pulm stenosis, VSD, MR (earlier A2)

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20
Q

Cause of fixed splitting second heart sound

A

ASD

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21
Q

Causes of reverse splitting 2nd heart sounds (P2 first)

A

LBBB, AS (severe), coarctation of aorta, PDA

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22
Q

Causes of LV S3 (heard louder at apex and on expiration)

A

Physiological (under 40yo or during pregnancy)

LV failure, AR, MR, VSD, PDA

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23
Q

Causes of RV S3 (louder at left sternal edge and on inspiration)

A

RV failure, constrictive pericarditis

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24
Q

Causes of LV S4

A

AS, acute MR, systemic HTN, IHD, HCM

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25
Q

Causes of RV S4

A

Pulm HTN, pulm stenosis

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26
Q

Differential diagnosis pansystolic murmur

A

MR, TR, VSD, aortopulmonary shunts

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27
Q

Differential diagnosis midsystolic murmur

A

AS, PS, HCM, pulmonary flow murmur of an ASD

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28
Q

DDx early systolic murmur

A

VSD (either very small, or large + pHTN

Acute MR, TR

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29
Q

DDx late systolic murmur

A

MVP, papillary muscle dysfunction (e.g. HCM)

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30
Q

DDx early diastolic murmur

A

AR, PR

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31
Q

DDx mid diastolic murmur

A

MS, TS, atrial myxoma, Austin Flint murmur of AR, Carey coombs murmur of acute rheumatic fever

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32
Q

DDx pre-systolic murmur

A

MS, TS, atrial myxoma

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33
Q

DDx continuous murmur

A

PDA, AVF, venous hum , rupture of sinus of valsalve into RA/RV, aortopulmonary connection (blalock shunt), Mammary souffle (in late pregnancy or early postpartum period)

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34
Q

If can’t hear anything on exam, what should you consider?

A 
MS - position and exercise if necessary
ASD - listen for fixed splitting
MVP - perform valsalva
Pulm HTN
Constrictive pericarditis
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35
Q

Signs of severe MS

A

1) Small pulse pressure
2) Early opening snap (due to raised LA pressure)
3) Length of mid-diastolic rumbling murmur
4) Diastolic thrill at apex (rare)
5) Presence of pulmonary HTN signs
6) Pulmonary congestion
7) pulmonary regurgitation murmur

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36
Q

Signs of pulmonary HTN

A

1) Prominent a wave on JVP
2) RV impulse
3) Loud P2, although palpable P2 more specific
4) PR
5) TR

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37
Q

Causes of MS

A
  1. Rheumatic (in women > men)
  2. Severe mitral annular calcification (sometimes ass. with hyperCa/PTH)
  3. After MV repair for MR
  4. Congenital (very rarely e.g. parachute valve)
  5. Carcinoid, Rheumatoid Arthritis, SLE, Fabry’s
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38
Q

ECG findings in MS

A
  1. P mitrale
  2. AF
  3. RV systolic overload
  4. RAD
39
Q

CXR in MS

A
  1. Mitral valve calcification
  2. Big LA
  3. Pulm HTN
  4. Cardiac failure
40
Q

Valve area for severe MS

A

< 1cm^2

41
Q

Causes of chronic MR

A
  1. Degenerative disease
  2. MVP
  3. Rheumatic (men > women)
  4. Papillary muscle dysfunction - LVF, ischaemia
  5. CTD - RA, Ank spon
  6. Congenital - endocardial cushion defect (including primum ASD and cleft mitral leaflet), parachute valve, corrected TGA
42
Q

Causes of acute MR

A
  1. IE
  2. MI
  3. Surgery
  4. Trauma
43
Q

Signs of severe MR

A
  1. Enlarged LV- displaced apex
  2. Pulm HTN
  3. S3
  4. Early diastolic rumble
  5. Soft S1
  6. Aortic component of A2 earlier/ widely split second heart sound
  7. Small-volume pulse (very severe)
  8. LV failure
  9. Precordial thrill
44
Q

ECG in MR

A
  1. P mitrale
  2. AF
  3. LV diastolic overload
  4. RAD
45
Q

CXR in MR

A
  1. Large LA
  2. Increased LV size
  3. Mitral annular calcification
  4. Pulm HTN
46
Q

Valsalva increases which two murmurs?

A

HCM

MVP - murmur longer, click earlier

47
Q

Effect of handgrip or squatting on MVP murmur

A

Murmur shorter

48
Q

MVP associated with which conditions?

A
  1. Marfan’s

2. ASD (secundum)

49
Q

Complications of MVP

A
  1. MR

2. IE

50
Q

Causes of chronic AR

A

Valvular - 1. Rheumatic, 2. congenital (bicuspid, VSD), 3. seronegative arthropathy esp AnkSpon
Aortic root - 1. Marfan’s, aortitis, 2. dissecting aneurysm, 3. old age

51
Q

Causes of acute AR

A

Valvular - IE

Aortic root - Marfan’s, HTN, dissecting aneurysm

52
Q

Signs of severe AR

A
  1. Collapsing pulse
  2. Wide pulse pressure
  3. Length of the decrescendo diastolic murmur
  4. Third heart sound (LV)
  5. Soft A2
  6. Austin Flint murmur (diastolic rumble caused by limitation to mitral inflow by the regurgitation jet)
  7. LV failure
53
Q

ECG findings in AR

A

LV hypertrophy

54
Q

CXR in AR

A

LV dilatation, aortic root dilatation or aneurysm, valve calcification

55
Q

Indications for surgery in AR

A

Symptoms
LVEF < 50%
LVEDD > 5.5cm

56
Q

Causes of AS

A
  1. Degenerative senile calcific AS
  2. Rheumatic
  3. Calcific bicuspid valve
57
Q

Signs of severe AS

A
  1. Plateau pulse
  2. Aortic thrill
  3. Length, harshness and lateness of peak of systolic murmur
  4. S4
  5. Paradoxical splitting of S2
  6. LV failure
58
Q

ECG in AS

A

LVH

59
Q

CXR in AS

A

LVH, valve calcification

60
Q

JVP findings in TR

A

Large V waves, and elevated if RV failure

61
Q

TR murmur

A

Pansystolic, maximal lower end of sternum and on inspiration. Multiple systolic clicks characteristic of Ebstein’s anomaly of TV

62
Q

Causes of TR

A
  1. Functional (RV failure)
  2. Rheumatic
  3. IE
  4. Congenital - Ebstein’s anomaly
  5. TV prolapse
  6. RV papillary muscle infarction
  7. Trauma
63
Q

JVP findings in pulmonary stenosis

A

Giant a waves secondary to RA hypertrophy, and JVP may be elevated

64
Q

Palpation findings for pulmonary stenosis

A

RV heave, thrill over pulmonary area (common)

65
Q

Murmur of pulmonary stenosis

A

May be preceded by ejection click, harsh ESM in pulmonary area and louder with inspiration. S4 may be present (secondary to RA hypertrophy)

66
Q

Signs of severe pulmonary stenosis

A
  1. ESM peaking late in systole
  2. Absence of ejection click (also absent when pulm stenosis is infundibular - below valve level)
  3. Presence of S4
  4. RV failure
67
Q

Causes of pulm stenosis

A
  1. Congenital

2. Carcinoid

68
Q

JVP in constrictive pericarditis

A

Raise, rarely Kussmaul’s sign, prominent x and y descents

69
Q

Apex beat in constrictive pericarditis

A

Impalpable

70
Q

Heart sounds in constrictive pericarditis

A

Distant, may be early S3 and early pericardial knock (as rapid ventricular filling abruptly halted)

71
Q

Pulse in HCM

A

Sharp, rising and jerky owing to rapid ejection by hypertrophied ventircle early in systole, followed by obstruction - not like the pulse of AS

72
Q

JVP in HCM

A

Prominent a wave owing to forceful atrial contraction against a non-compliant ventricle

73
Q

Apex beat in HCM

A

Double or triple impulse owing to presystolic ventricular expansion following atrial contraction

74
Q

Murmur(s) of HCM

A
  1. Late ESM left sternal edge
  2. PSM at apex from MR
  3. S4
75
Q

Dynamic manoevres in HCM

A

Louder with Valsalve and standing, softer with squatting, raising legs and isometric exercise (handgrip)

76
Q

ECG in HCM

A
  1. LVH + lateral ST segment and T wave changes
  2. Deep Q waves
  3. Conduction defects
77
Q

Most common type of ASD

A

Ostium secundum

78
Q

Signs of ostium secundum ASD

A
  1. Fixed splitting S2
  2. Pulmonary ESM
  3. Pulm HTN
79
Q

ECG in ostium secundum ASD

A
  1. RAD
  2. RBBB
  3. RV hypertrophy
80
Q

CXR in ostium secundum ASD

A

Increased pulmonary vasculature, enlarged RA and ventricle, dilated main pulmonary artery, small aortic knob

81
Q

Indication for closure of ASD

A

Left to right shunt > 1.5:1 - unless reversal of shunt

82
Q

Signs of ostium primum ASD

A

Same as ostium secundum but can have associated MR, TR or VSD

83
Q

ECG in ostium primum ASD

A

LAD, RBBB, sometimes prolonged PR interval

84
Q

VSD murmur

A

Harsh pansystolic murmur left sternal edge, sometimes MR also present

85
Q

VSD association

A

Down syndrome

86
Q

Sign of reversal of PDA shunt

A

Differential cyanosis and clubbing (of toes, not fingers)

87
Q

Murmur of PDA

A

Continuous murmur

88
Q

Most common site of coarctation of the aorta

A

Just distal to origin of left subclavian artery

89
Q

Signs of coarctation of aorta

A 
Better-developed upper body
Radiofemoral delay
HTN in arm only
Chest collateral vessels
Midsystolic murmur over praecordium and back
Hypertensive changes in fundi
90
Q

Association of coarctation of aorta

A

Turner’s syndrome

91
Q

Common causes of cyanotic congenital heart disease in adults

A
  1. Eisenmenger’s syndrome (pHTN + ASD, VSD or PDA)
  2. Tetralogy of Fallot
  3. Complex lesions - univentricular heart, Ebstein’s anomaly (if associated ASD with R-L shunt)
92
Q

Signs of Eisenmenger’s

A
  1. Cyanosis, clubbing and polycythaemia
  2. JVP may have dominant a waves and sometimes prominent v wave
  3. RV heave and palpable P2
  4. Loud P2, S4, pulmonary ejection click, PR and sometimes TR (but can be no murmurs)
93
Q

How to work out level of shunt in Eisenmenger’s?

A

Wide fixed split - ASD
Single S2 - VSD
Normal S2 or reversed splitting - PDA (look for differential cyanosis)

BPT Clinical (5 decks)

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