Cardiovascular system

Question 1

What are the symptoms of aortic stenosis? The classic triad and other symptoms

Answer 1

Triad of AS = Angina, syncope, heart failure - exertional dyspnoea (after 60 y/o)
Other symptoms = Exertional dyspnoea, dizziness, faints, systemic emboli if IE, sudden death

Question 2

What are the pulse abnormalities in aortic stenosis?

Answer 2

Pulse - Narrow pulse pressure, slow rising pulse

Question 3

What signs on palpation indicate aortic stenosis?

Answer 3

• Left ventricle heave but undisplaced apex beat due to hypertrophy and not dilatation. (Dilatation leads to cardiomegaly which displaces the apex beat)
• Thrill - systolic thrill may be felt in the aortic area.

Question 4

What signs on auscultation indicate aortic stenosis? Where is it heard best?

Answer 4

Ejection systolic murmur
Low pitched
Radiate to carotids
Softening of the aortic component of the 2nd heart sound
Heard the loudest in the aortic area (right 2nd intercostal space)

Question 5

What is the most common cause of aortic stenosis? And 2 other less common causes

Answer 5

Most common cause - Degenerative calcification

Other causes - Rheumatic heart disease, congenital (bicuspid valve, William’s syndrome)

Question 6

What are the investigations for aortic stenosis?

Answer 6

ECG - P mitrale, LV hypertrophy with strain pattern, poor R wave progression
CXR - LV hypertrophy
Echocardiogram - Diagnostic

Question 7

What is the management for aortic stenosis? Medical, surgical

Answer 7

Medical: Symptom control - diuretics, nitrates, beta-blocker
Surgery: Aortic valve replacement

Question 8

What are the symptoms of aortic regurgitation?

Answer 8

Exertional dyspnoea, orthopnea, paroxysmal nocturnal dyspnoea,
Other symptoms - Palpitation, angina, syncope, congestive heart failure

Question 9

What do the following signs indicate?
Left ventricle heave but undisplaced apex beat due to hypertrophy and not dilatation. (Dilatation leads to cardiomegaly which displaces the apex beat)
- Thrill - systolic thrill may be felt in the aortic area.

Answer 9

Aortic stenosis

Question 10

What are the signs of aortic regurgitation on palpation?

Answer 10

• Displaced apex beat (Due to LV dilatation from an increase in LV end-diastolic pressure)
• Hyperdynamic (forceful impulse) apex beat

Question 11

What are the pulse and blood pressure abnormalities in aortic regurgitation?

Answer 11

• Collapsing pulse

- Wide pulse pressure in blood pressure

Question 12

What other signs can be seen in aortic regurgitation?

Answer 12

• Capillary pulsations in nail beds = Quincke’s sign
• Carotid pulsation = Corrigan’s sign
• Head nodding with each heart beat = de Musset’s sign
• Finger compressing the femoral artery to give a systolic murmur or diastolic murmur = Durozier’s sign
• ‘Pistol shots’ over femoral arteries = Traube’s sign

Question 13

What are the causes of aortic regurgitation?

Answer 13

Acute: Infective endocarditis, ascending aortic dissection, chest trauma
Chronic: Congenital, connective tissue disorders (Marfan’s, Ehlers-Danlos), rheumatic fever, autoimmune, syphilis aortitis

Question 14

What type of murmur is heard in aortic regurgitation? Where? How is it heard best?

Answer 14

High pitched early diastolic murmur
also Mid-diastolic murmur at the apex = Austin Flint murmur
Hear loudest when patient leaning forward at lower left sternal edge

Question 15

What are the symptoms of mitral regurgitation?

Answer 15

Dyspnoea, fatigue, palpitations, infective endocarditis

Question 16

What are the signs on palpation in mitral regurgitation?

Answer 16

Right ventricular heave, displaced apex, hyperdynamic apex

Question 17

What type of murmur is heard in mitral regurgitation? Where is heard best?

Answer 17

Pansystolic murmur

Best heard in the apex, radiate to axilla

Question 18

What are the causes of mitral regurgitation?

Answer 18

Annular calcification in elderly, functional (LV dilatation), rheumatic fever, IE, mitral valve prolaspe, ruptured chordae tendinae, papillary muscle dysfunction/rupture, connective tissue disorder, cardiomyopathy

Question 19

What is the pulse abnormality in mitral regurgitation?

Answer 19

atrial fibrillation

Question 20

What does malar flush on cheeks indicate?

Answer 20

Mitral stenosis due to decreased cardiac output

Question 21

What is the pulse abnormality in mitral stenosis?

Answer 21

atrial fibrillation, low volume pulse

Question 22

What are the symptoms of mitral stenosis?

Answer 22

Dyspnoea, fatigue, palpitation, chest pain

Question 23

Which valvular heart disease has respiratory symptoms?

What are the symptoms?

Answer 23

Mitral stenosis

haemoptysis, systemic emboli, chronic bronchitis-like picture

Question 24

What is found on auscultation in mitral stenosis?

Where and how is it heard best?

Answer 24

Rumbling mid-diastolic murmur

Best heard during expiration, with patient on the left side

Question 25

What are the causes of mitral stenosis?

Answer 25

Rheumatic, congenital, mucopolysaccharidoses, endocardial fibroelastosis, malignant carcinoid, prosthetic valve