Clinical Cardio Flashcards
Prosthetic valves
- complications
- causes of anemia
- pros and cons of porcine valves
- thromboembolism, endocarditis, anemia, valvular dysfunction (peri valvular leak, dehiscence, obstruction)
- MAHA, bleeding from anticoagulation, endocarditis
- pros: no anti coagulation
- cons: can calcify and degenerate over time
What types of cardiac replacement valves are there? What are some pros and cons?
Mechanical valve
- Starr Edwards (ball in cage),Medtronic hall (tilting disc)
- pros: durability, young patients, patients on anticoagulation for AF already
Porcine
- pros: no anticoagulation
- cons: 7-10 yr lifespan, aorta>mitral
Cadaveric (aorta, pulmonary)
- pros: young patients no anti coagulation, replacing infected valve as resistant to re-infection
Heart failure
- signs of ventricular dysfunction
- causes
Signs of dysfunction
- Tachyardia
- Displaced L apex beat
- RVH
- 3rd or 4th heart sound
- functional MR or TR
- Dependent oedema
Cause of HF
- Atherosclerosis
- HTN
- Valvular disease
- Severe anaemia/ vol overload (AV shunt)
- Arrhythmias
- Ischemia
Definition of
- systolic dysfunction
- diastolic dysfunction
Systolic dysfunction
- impaired contractability
Diastolic dysfunction
- impaired relaxation/filling due to stiffness
- HCM, LV hyper trophy (AS, HTN), restrictive CMP (amyloidosis)
Indications for heart transplant in CHF
Refractory to medical and surgical (valve replace) management
+
NYHA IV
= unlikely to survive 1 year
Causes of raised JVP
CHF Cor pulmonale Tricuspid regurgitation(v waves) Tricuspid stenosis (a waves) CHB SVC obstruction
Differentiate JVP from carotid
What is kussmauls sign
- fills from above
- hepatojugular reflex
- no pulse
- falls with inspiration
- kausnall: increased JVP with inspiration (normally decreases). Heart unable to accept increase in ventricular volume
Nystagmus away and towards a lesion. Which one is cerbellar and which one is vestibular
CT my VW
Cerebellar Towards
Vestibular aWay
Salient features of aortic stenosis
History
- soboe
- syncope
- cp
Pulse
- parvus et tardus
- BP usually low
- Narrow pulse pressure
Palpate
- heaving apex
- thrill aortic region
Auscultation
- soft 2nd HS
- narrow or reverse split 2nd HS
- ej systolic murmur aortic region radiates to carotid, loudest on expiration.
- early diastolic murmur as mild a. Regurg accompanies AS
- 4th HS
- *Cardiac failure
Grading (valve area)
- mild >1.5
- mod 1-1.5
- severe
Differentiate aortic stenosis and aortic sclerosis
Aortic sclerosis
- does not radiate to neck
- apex beat normal
- normal volume pulse
Second heart sound splitting- what causes it during
1) inspiration
2) expiration
3) inspiration and expiration
During inspiration: normal
During expiration (reverse splitting): AS, Hypertrophic CMP, LBBB, pacemaker
Fixed split: ASD
Signs of sever aortic stenosis
- Narrow pulse pressure
- Soft second HS
- Delayed peak in ej systole murmur
DDx for ej systolic murmur
AS
PS
Hypertrophic obstructive CMP
What is the mechanism for syncope in AS?
Inability of ventricle to contract against stenosed valve
Cardiac arrhythmia (Brady, tachy, fib)
Concomitant vasodilation and the inability to increase CO during exercise
ECG changes in AS
CXR changes
- LVH
- ST changes
- LAD
- L atrial hyper trophy (neg twaves V1)
- Conduction abnormalities from calcification (LBBB, 1st d HB)
- enlarged CTR
- aortic valve calcification
