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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
Causes of RV S4
Pulm HTN, pulm stenosis
26
Differential diagnosis pansystolic murmur
MR, TR, VSD, aortopulmonary shunts
27
Differential diagnosis midsystolic murmur
AS, PS, HCM, pulmonary flow murmur of an ASD
28
DDx early systolic murmur
VSD (either very small, or large + pHTN | Acute MR, TR
29
DDx late systolic murmur
MVP, papillary muscle dysfunction (e.g. HCM)
30
DDx early diastolic murmur
AR, PR
31
DDx mid diastolic murmur
MS, TS, atrial myxoma, Austin Flint murmur of AR, Carey coombs murmur of acute rheumatic fever
32
DDx pre-systolic murmur
MS, TS, atrial myxoma
33
DDx continuous murmur
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)
34
If can't hear anything on exam, what should you consider?
``` MS - position and exercise if necessary ASD - listen for fixed splitting MVP - perform valsalva Pulm HTN Constrictive pericarditis ```
35
Signs of severe MS
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
36
Signs of pulmonary HTN
1) Prominent a wave on JVP 2) RV impulse 3) Loud P2, although palpable P2 more specific 4) PR 5) TR
37
Causes of MS
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
38
ECG findings in MS
1. P mitrale 2. AF 3. RV systolic overload 4. RAD
39
CXR in MS
1. Mitral valve calcification 2. Big LA 3. Pulm HTN 4. Cardiac failure
40
Valve area for severe MS
< 1cm^2
41
Causes of chronic MR
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
Causes of acute MR
1. IE 2. MI 3. Surgery 4. Trauma
43
Signs of severe MR
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
ECG in MR
1. P mitrale 2. AF 3. LV diastolic overload 4. RAD
45
CXR in MR
1. Large LA 2. Increased LV size 3. Mitral annular calcification 4. Pulm HTN
46
Valsalva increases which two murmurs?
HCM | MVP - murmur longer, click earlier
47
Effect of handgrip or squatting on MVP murmur
Murmur shorter
48
MVP associated with which conditions?
1. Marfan's | 2. ASD (secundum)
49
Complications of MVP
1. MR | 2. IE
50
Causes of chronic AR
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
Causes of acute AR
Valvular - IE | Aortic root - Marfan's, HTN, dissecting aneurysm
52
Signs of severe AR
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
ECG findings in AR
LV hypertrophy
54
CXR in AR
LV dilatation, aortic root dilatation or aneurysm, valve calcification
55
Indications for surgery in AR
Symptoms LVEF < 50% LVEDD > 5.5cm
56
Causes of AS
1. Degenerative senile calcific AS 2. Rheumatic 3. Calcific bicuspid valve
57
Signs of severe AS
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
ECG in AS
LVH
59
CXR in AS
LVH, valve calcification
60
JVP findings in TR
Large V waves, and elevated if RV failure
61
TR murmur
Pansystolic, maximal lower end of sternum and on inspiration. Multiple systolic clicks characteristic of Ebstein's anomaly of TV
62
Causes of TR
1. Functional (RV failure) 2. Rheumatic 3. IE 4. Congenital - Ebstein's anomaly 5. TV prolapse 6. RV papillary muscle infarction 7. Trauma
63
JVP findings in pulmonary stenosis
Giant a waves secondary to RA hypertrophy, and JVP may be elevated
64
Palpation findings for pulmonary stenosis
RV heave, thrill over pulmonary area (common)
65
Murmur of pulmonary stenosis
May be preceded by ejection click, harsh ESM in pulmonary area and louder with inspiration. S4 may be present (secondary to RA hypertrophy)
66
Signs of severe pulmonary stenosis
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
Causes of pulm stenosis
1. Congenital | 2. Carcinoid
68
JVP in constrictive pericarditis
Raise, rarely Kussmaul's sign, prominent x and y descents
69
Apex beat in constrictive pericarditis
Impalpable
70
Heart sounds in constrictive pericarditis
Distant, may be early S3 and early pericardial knock (as rapid ventricular filling abruptly halted)
71
Pulse in HCM
Sharp, rising and jerky owing to rapid ejection by hypertrophied ventircle early in systole, followed by obstruction - not like the pulse of AS
72
JVP in HCM
Prominent a wave owing to forceful atrial contraction against a non-compliant ventricle
73
Apex beat in HCM
Double or triple impulse owing to presystolic ventricular expansion following atrial contraction
74
Murmur(s) of HCM
1. Late ESM left sternal edge 2. PSM at apex from MR 3. S4
75
Dynamic manoevres in HCM
Louder with Valsalve and standing, softer with squatting, raising legs and isometric exercise (handgrip)
76
ECG in HCM
1. LVH + lateral ST segment and T wave changes 2. Deep Q waves 3. Conduction defects
77
Most common type of ASD
Ostium secundum
78
Signs of ostium secundum ASD
1. Fixed splitting S2 2. Pulmonary ESM 3. Pulm HTN
79
ECG in ostium secundum ASD
1. RAD 2. RBBB 3. RV hypertrophy
80
CXR in ostium secundum ASD
Increased pulmonary vasculature, enlarged RA and ventricle, dilated main pulmonary artery, small aortic knob
81
Indication for closure of ASD
Left to right shunt > 1.5:1 - unless reversal of shunt
82
Signs of ostium primum ASD
Same as ostium secundum but can have associated MR, TR or VSD
83
ECG in ostium primum ASD
LAD, RBBB, sometimes prolonged PR interval
84
VSD murmur
Harsh pansystolic murmur left sternal edge, sometimes MR also present
85
VSD association
Down syndrome
86
Sign of reversal of PDA shunt
Differential cyanosis and clubbing (of toes, not fingers)
87
Murmur of PDA
Continuous murmur
88
Most common site of coarctation of the aorta
Just distal to origin of left subclavian artery
89
Signs of coarctation of aorta
``` Better-developed upper body Radiofemoral delay HTN in arm only Chest collateral vessels Midsystolic murmur over praecordium and back Hypertensive changes in fundi ```
90
Association of coarctation of aorta
Turner's syndrome
91
Common causes of cyanotic congenital heart disease in adults
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
Signs of Eisenmenger's
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
How to work out level of shunt in Eisenmenger's?
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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