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Cardiology > CLINICAL DDx > Flashcards

CLINICAL DDx Flashcards

1
Q

DDx of clubbing

A

CLUBBING

  • Cardiac: congenital (R→L shunt), IE
  • Lungs: Suppurative dis (abscess, empyema), bronchiectasis, IPF, CF, asbestosis
  • Uncommon:
  • Bronchogenic Carcinoma (not sml cell)
  • Bilary cirrhosis
  • Idiopathic (thyrotoxocosis)
  • Not COPD
  • GI: IBD, Cirrhosis (esp bilary cirrhosis as above), Coeliac
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2
Q

DDx splinter haemorrhages

A
  • Trauma (occupation)
  • IE (2* vasculitis in nail bed)
  • Vasculitis - PAN, APS
  • Sepsis, RA, haemotological malignancy, profound anaemia
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3
Q

DDx - BRADYCARDIA regular

A
  • Physiological (sleep, increased vagal tone)
  • Drugs
  • Hypothyr (dec sympathetic activity)
  • Hypothermia
  • Raised ICP (effects central sympathetic outflow - late sign)
  • 3rd deg AV or 2nd deg AV block
  • MI
  • Jaundice (severe 2* BR deposition in conducting system)
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4
Q

DDx - TACHYCARDIA - regular

A
  • Hyperdynamic circulation (preg, thyrotoxicosis, anaemia, arteriovenous fistula, thiamine def - beriberi)
  • CCF
  • Constrictive pericarditis
  • Drugs (sympathomimetics)
  • Denervated heart (DM)
  • Conduction: SVT, A.flutter 2:1/variable, VT, Multifocal atrial tachy
  • Sinus (PE, MI, hypoxia, hypercapnia, myocarditis)
    *
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5
Q

DDx - TACHYCARDIA - regular

A
  • Hyperdynamic circulation (preg, thyrotoxicosis, anaemia, arteriovenous fistula, thiamine def - beriberi)
  • CCF
  • Constrictive pericarditis
  • Drugs (sympathomimetics)
  • Denervated heart (DM)
  • Conduction: SVT, A.flutter 2:1/variable, VT, Multifocal atrial tachy
  • Sinus (PE, MI, hypoxia, hypercapnia, myocarditis)
    *
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6
Q

DDx - AF causes

A
  • Structural HD (ageing, HTN) - specifically left atrial enlargement (MV dis)
  • Thyrotoxicosis
  • PE
  • Sick sinus
  • Myocarditis
  • Acute insult (fever, hypoxia etc)
  • ALCOHOL
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7
Q

DDx

PULSUS PARADOXUS

A

>10mmHg BP reduction on inspiration is assoc w/

1) constricive pericarditis
2) pericardial effusion
3) asthma

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8
Q

Ddx

POSTURAL HYPOTn

A

HANDI

  • Hypovolaemia & hypopituatism
  • Addisions
  • Neuropathy (DM, amyloidosis, Shy-Drager)
  • Drugs (inc TCA, antipsych)
  • Idiopathic autonomic dysfxn
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9
Q

DDx - arterial pulse

COLLAPSING

A
  • AR
  • Hyperdynamic circulation
  • PDA
  • Peripheral arteriovenous fistula
  • Arteriosclerotic aorta (elderly pts especially)
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10
Q

DDx - arterial pulse

SML VOL

A
  • AS
  • Pericardial effusion
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11
Q

DDx - arterial pulse

ALTERNANS

A
  • LVF
  • (alternating strong & weak beats)
  • Could also be bigemny?
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12
Q

Ddx - JVP

ELEVATED JVP on INSPIRATION

(Kussmauls)

A

Opposite of what normally happens (best elicited at 90deg with pt mouth breathing) - caused by Limited RV filling

  • Constrictive pericarditis
  • Cardiac tamponade
  • RV infarction
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13
Q

DDx - JVP

ELEVATED JVP

A
  • RVF
  • TS/TR
  • Pericardial effusion/constrictive pericarditis
  • SVC obstruction
  • Fluid overload
  • Hyperdynamic circulation
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14
Q

DDx

APEX BEATS

A
  • Pb loaded: sustained forceful impulse (AS, HTN)
  • Vol loaded: diffuse, displaced, non sustained (MR, dilated CM)
  • Dyskinetic: uncooradianted, larger than normal area (LV dysfxn eg ant MI)
  • Double impulse: 2 distinct beats w/ each systole (Hypertrophic CM)
  • Tapping: (shouldnt usu feel heart sounds) - Mitral (Tricuspid rarely) stenosis
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15
Q

DDx

ABSENT apex beat

A
  • Thick chest wall
  • COPD
  • Pericardial effusion
  • Shock
  • Dextrocardia (feel on right)
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16
Q

DDx

Parastenal impulse

A

Felt when heel of hand rested to left of sternum with fingers lifted just off chest - usu can’t feel pulse

RV enlargement (or severe LA enlargement)

Grade I if visible but not palpable

Grade III if can’t obliterate

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17
Q

DDx

Thrills

A

Turbulent blood flow indicates organic lesion

usu felt w/ flat of hand in time w/apex (systolic) or not (diastolic)

apex, left sternal edge (best of left lateral)

BASE of heart (aortic/pulm areas, upper chest wall)
- best sitting up learning forward fully expired

18
Q

DDx - Murmurs

MITRAL AREA

A

Bell (low pitched) - diastolic murmur of MS, 3rd HS

Diaphragm (high pitch) - systolic murmur of MR, 4th HS

19
Q

DDx - Split HS

A

Split S1 usu not heard (complete RBBB)

Split S2 as aortic closes prior to pulm 70% adults
- Heard in pulmonary area & along L) sternal edge on INSPIRATION

Wider in:

  • RBBB (delayed RV depolarisation)
  • Pulm stenosis (delayed RV ejection)
  • VSD (increased RV vol load)
  • MR (earlier AV closure due to more rapid LV emptying)
  • Fixed splitting is in ASD
  • Reversed splitting (wider on EXP) in LBBB, severe AS, coarction (or PDA)
20
Q

DDx - heart sounds

LOUD S1

A
  • MS
  • Tachycardia

Occues when MV or TV remain wide open at end of systole & shut forcefully w/ onset ventricular systole

21
Q

DDx - heart sounds

SOFT S1

A
  • 1st deg HB (prolonged diastolic filling time)
  • LBBB (delayed onset LB systole)
  • MR (failure of leaflets)
22
Q

DDx - heart sounds

LOUD S2

A
  • HTN (loud A2)
  • AS (loud A2)
  • Pulm HTN (loud P2)
23
Q

DDx - heart sounds

SOFT S2

A
  • AS
  • AR
24
Q

DDx - heart sounds

3rd heart sound

A
  • Gallop rhythm (KENTUCKY)
    • low pitched - hear with bell (mid-diastolic)
    • Physiological in kids/young adults
    • Pathological assoc w/ reduced ventricular compliance
  • LV S3 - louder at apex & on expiration
    • Assoc w/ Inc CO (preg, thyrotoxicosis), LVF/LVH, AR, MR, VSD, PDA
  • RV S3 - louder at L) sternal edge & on inspiration
    • Assoc w/ RVF, constrictive pericarditis
25
Q

DDx - heart sounds

4th HS

A

Slightly higher pitched than S3 but still use bell (TENESSEE) - gallop rhythm

Doesnt occur in AF as depends on effective atrial contraction

LV S4 - LV compliance reduced (AS, MR, HTN, IHD, age)

RV S4 - RV compliane reduced (pulm HTN, Pulm Stenosis)

26
Q

DDx - heart sounds

Clicks

A

Systolic ejection click: high pitched early systolic sound followed by murmur, heard anywhere except MITRAL area

aortic/pulm stenosis

Non ejeciton systoic click: high pitched sound MITRAL area

Proplapse of MV or ASD

27
Q

DDx - murmurs

PANSYSTOLIC

A

Leaky ventricle (to lower Pb chamber or vessel)

  • MR
  • TR
  • VSD
28
Q

DDx - murmurs

EJECTION (mid) SYSTOLIC

A

Doesn’t begin at S1 but increases after and wanes (crescendo-decrescendo)

  • AS
  • PS
  • Hypertrophic CM
  • ASD
29
Q

DDx - murmurs

LATE SYSTOLIC MURMUR

A

Can hear S1 - gap- murmur to S2

  • MVP
  • Papillary mm dysfxn (MI, hypertrophic CM)
30
Q

DDx - murmurs

DIASTOLIC

A

EARLY: begins at S2 (DECRESCENDO) - high pitched

  • AR, PR

MID-DIASTOLIC: extends right to S1 - lower pitched

Due to impaired filling

  • MS, TS, (atrial myxoma)
31
Q

DDx - murmurs

CONTINUOUS

A

Communication exists w/ permanant Pb gradient

  • PDA
  • Arteriovenous distula
  • Aortopulmonary connection
  • Venous hum
32
Q

Fixed split S2

A

ASD

33
Q

Split S2 (wider)

A

RBBB Vsd PS

34
Q

C waves

A

TR (W/ lrg pulsatilla liver)

35
Q

A waves

A

TS

36
Q

Systolic murmurs manoeuvres

A

Valsalva- louder HOCM (+MVP) (Decreases preload) Isometric handgrip- reduces AS, HOCM/MVP, increased left sided regurg (AR, MR) & MS (Increases after load)

37
Q

All systolic mumurs

A

MR, AS, TR, PS ASD, VSD MVP, HOCM

38
Q

All diastolic

A

MS, AR, TS, PR AUSTIN FLINT

39
Q

Continuous

A

PDA (Combination)

40
Q

Systolic murmur timing

A

Mid sys: AS, PS, ASD, HOCM Pan sys: MR, TR, VSD Late systolic: MVP (click)

41
Q

Diastolic murmur Timing

A

Early: AR, PR, Austin flint Mid/late: MS, TS (Rare PDA)

Cardiology (7 decks)

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