Cardiology - Specific Findings

Question 1

Mitral Valve Stenosis - Echo findings & Murmur

Answer 1

Left atrial enlargement, pulmonary hypertension, right ventricular hypertrophy

Opening snap followed by late diastolic rumbling murmur

Question 2

Torsades de Pointes

Answer 2

Ventricular tachycardia (250-350 bpm) characterized by shifting sinusoidal waveform on ECG; can progress to ventricular fibrillation

May be caused by hypokalemia, hypomagnesemia, long QT syndrome, or meds:

Sotalol 
Risperdone
Macrolides
Chloroquine
Protease Inhibitors (-navir)
Quinidine
Thiazides 

Treated with Mg2+

Question 3

Aschoff Bodies

Answer 3

Areas of perivascular fibrinoid necrosis within the myocardium

Finding in rheumatic heart disease

Question 4

Anitschkow Cells

Answer 4

Enlarged macrophages with “wavy” nuclei

Finding in rheumatic heart disease

Question 5

S1

Answer 5

Mitral and tricuspid valve closure

Loudest at mitral area (L. 5th intercostal space)

Question 6

S2

Answer 6

Aortic and pulmonic valve closure

Loudest at left sternal border

Question 7

S3

Answer 7

Heart during early diastole during rapid ventricular filling phase; associated with increased filling pressures (i.e. mitral regurgitation, CHF) and dilated ventricles (dilated cardiomyopathy) but normal in children and pregnant women

Best heard at mitral site (L. 5th intercostal space)

Question 8

S4

Answer 8

AKA “atrial kick” of late diastole

Represents high atrial pressure generated by atrial pushing against a stiff LV wall in ventricular hypertrophy

Question 9

Beck Triad

Answer 9

Hypotension + elevated JVP + muffled heart sounds

Seen in cardiac tamponade

Question 10

Pulsus Paradoxus

Answer 10

Increased systolic blood pressure > 10 mmHg with inspiration

Decreased intrathoracic pressure causes increased filling of RV; external pressure from fluid within the pericardial sac causes bulging of the IV septum into the LV, reducing systemic CO

Seen in cardiac tamponade

Question 11

Kussmaul sign

Answer 11

Elevated JVP with inspiration (instead of normal decrease)

Negative intrathoracic pressure is not transmitted to heart, causing impaired filling of the RV with back-up of blood into IVC

Seen in cardiac tamponade / restrictive cardiomyopathy

Question 12

“Heart failure cells”

Answer 12

Hemosiderin-laden macrophages

Seen in the setting of left heart failure; the LV cannot keep up with incoming blood from the pulmonary veins, causing blood to back up within the pulmonary vasculature; increased pressure within the pulmonary capillaries leads to extravasation of RBCs through the vessel wall and into the lung parenchyma, where they are taken up by alveolar macrophages

Question 13

Granulomatosis with Polyangiitis - Associated antibodies

Answer 13

PR3-ANCA

c-ANCA

Question 14

Microscopic Polyangiitis - Associated antibodies

Answer 14

MPO-ANCA

p-ANCA

Question 15

Churg-Strauss Syndrome - Associated antibodies

Answer 15

MPO-ANCA
p-ANCA
Elevated IgE

Question 16

Bacterial Endocarditis - Associated findings

Answer 16

Roth spots - small, white spots on the retina surrounded by hemorrhage

Osler Nodes - tender, raised lesions on the finger/toe pads

Janeway lesions - small, painless, erythematous lesions of the palms and soles

Splinter hemorrhages of the fingernails

Question 17

Most common causative pathogen in acute bacterial endocarditis?

Answer 17

S. aureus

Question 18

Most common causative pathogen in subacute bacterial endocarditis?

Answer 18

Viridans streptococcus

Question 19

Most common causative pathogen in endocarditis on an artificial valve?

Answer 19

Strep. epidermiditis

Question 20

Most common causative pathogen and site of infection when endocarditis presents in an IDU?

Answer 20

S. aureus
Pseudomonas

Tricuspid valve

Question 21

Erythema Marginatum

Answer 21

Non-pruritic, pink, circular eruption on the trunk seen in a minority of cases of acute rheumatic fever

Question 22

Electrical alternans

Answer 22

ECG finding - characterized by oscillation of QRS complex amplitude with each heart beat

Finding seen in cardiac tamponade; thought to occur as the heart “swings” within the pericardial fluid

Question 23

Troponin I

Answer 23

Most specific protein marker for MI

Levels become elevated in the first 4 hours after MI and remain elevated for 7-10 days

Question 24

CK-MB

Answer 24

Protein marker of choice for detection of re-infarction within the first week post-MI

Levels peak within 24 hours and return to normal by 48 hours