Cardiovascular system Flashcards
What are the symptoms of aortic stenosis? The classic triad and other symptoms
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
What are the pulse abnormalities in aortic stenosis?
Pulse - Narrow pulse pressure, slow rising pulse
What signs on palpation indicate aortic stenosis?
- 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.
What signs on auscultation indicate aortic stenosis? Where is it heard best?
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)
What is the most common cause of aortic stenosis? And 2 other less common causes
Most common cause - Degenerative calcification
Other causes - Rheumatic heart disease, congenital (bicuspid valve, William’s syndrome)
What are the investigations for aortic stenosis?
ECG - P mitrale, LV hypertrophy with strain pattern, poor R wave progression
CXR - LV hypertrophy
Echocardiogram - Diagnostic
What is the management for aortic stenosis? Medical, surgical
Medical: Symptom control - diuretics, nitrates, beta-blocker
Surgery: Aortic valve replacement
What are the symptoms of aortic regurgitation?
Exertional dyspnoea, orthopnea, paroxysmal nocturnal dyspnoea,
Other symptoms - Palpitation, angina, syncope, congestive heart failure
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.
Aortic stenosis
What are the signs of aortic regurgitation on palpation?
- Displaced apex beat (Due to LV dilatation from an increase in LV end-diastolic pressure)
- Hyperdynamic (forceful impulse) apex beat
What are the pulse and blood pressure abnormalities in aortic regurgitation?
- Collapsing pulse
- Wide pulse pressure in blood pressure
What other signs can be seen in aortic regurgitation?
- 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
What are the causes of aortic regurgitation?
Acute: Infective endocarditis, ascending aortic dissection, chest trauma
Chronic: Congenital, connective tissue disorders (Marfan’s, Ehlers-Danlos), rheumatic fever, autoimmune, syphilis aortitis
What type of murmur is heard in aortic regurgitation? Where? How is it heard best?
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
What are the symptoms of mitral regurgitation?
Dyspnoea, fatigue, palpitations, infective endocarditis
What are the signs on palpation in mitral regurgitation?
Right ventricular heave, displaced apex, hyperdynamic apex
What type of murmur is heard in mitral regurgitation? Where is heard best?
Pansystolic murmur
Best heard in the apex, radiate to axilla
What are the causes of mitral regurgitation?
Annular calcification in elderly, functional (LV dilatation), rheumatic fever, IE, mitral valve prolaspe, ruptured chordae tendinae, papillary muscle dysfunction/rupture, connective tissue disorder, cardiomyopathy
What is the pulse abnormality in mitral regurgitation?
atrial fibrillation
What does malar flush on cheeks indicate?
Mitral stenosis due to decreased cardiac output
What is the pulse abnormality in mitral stenosis?
atrial fibrillation, low volume pulse
What are the symptoms of mitral stenosis?
Dyspnoea, fatigue, palpitation, chest pain
Which valvular heart disease has respiratory symptoms?
What are the symptoms?
Mitral stenosis
haemoptysis, systemic emboli, chronic bronchitis-like picture
What is found on auscultation in mitral stenosis?
Where and how is it heard best?
Rumbling mid-diastolic murmur
Best heard during expiration, with patient on the left side
What are the causes of mitral stenosis?
Rheumatic, congenital, mucopolysaccharidoses, endocardial fibroelastosis, malignant carcinoid, prosthetic valve
