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MRCP PACES Cardiology > Clinical Signs > Flashcards

Clinical Signs Flashcards

1
Q

What are splinter hemorrhage and digital infarcts?
Causes of splinter haemorrhages?

A

Occlusion of small vessels/capillaries (dermal papillary vessels) resulting in longitudinal hemorrhage under the nails

Causes: TICS
- Trauma (most common)
- Infective endocarditis (15%)
- Connective tissue diseases (SLE)
- Systemic vasculitis (polyarteritis nodosa)

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2
Q

Causes of displaced apex beat

A
  • Left sided valvular regurgitation (AR, MR, VSD)
  • Left heart failure
  • Dilated CMP
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3
Q

Causes of undisplaced but abnormal apex beat

A

Heaving
- Aortic stenosis
- Coaractation of aorta
- Hypertension

Tapping
- Mitral stenosis

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4
Q

Causes of dextrocardia

A
  • Kartagener syndrome
    (triad: chronic sinusitis, situs inversus, bronchiectasis)
  • Turner syndrome
  • Asplenia
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5
Q

Midline sternotomy scar in Cardiology

A
  • CABG surgery - concomittant vein harvesting in lower limbs
  • Valvular surgery
  • Complex heart repair
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6
Q

Left and right thoracotomy scars in Cardiology

A

Right side:
- BT shunt
- PA banding

Left side:
- Coaractation repair
- PDA ligation
- BT shunt
- PA banding

Always lift up the left breast to examine for scars in female patients

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7
Q

What is collapsing pulse?
Causes of collapsing pulse?

A

Pulse with fast upstroke and fast downstroke on raising of arm
- Volume overload -> high stroke volume and bounding pulse
- Diastole -> arterial pressure fall significantly causing pulse to collapse -> widened pulse pressure

Causes:
- Aortic regurgitation (classic)
- AV fistula
- PDA
- Hyperdynamic circulation: anaemia, thyrotoxicosis, CO2 retention, fever

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8
Q

Description of JVP

A

A C X V Y

A wave: atrial systole, peaks with S1

C point: ventricular contraction, coincides with tricuspid closure
(usually not visible)

X descent: atrial relaxation, ventricular systole

V wave: passive filling of right atrium while tricuspid valve closed. Peaks after S2

Y descent: decrease right atrial pressure deu to opening of tricuspid valve

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9
Q

Causes of Elevated JVP

A
  • Right heart failure
  • Volume overload
  • Tricuspid stenosis or regurgitation
  • Pericardial effusion or constrictive pericarditis
  • SVC obstruction
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10
Q

Causes of prominent A wave

A

Increased resistance to atrial emptying (during right ventricular systole)
- RV diastolic dysfunction (reduced RV compliance)
- Tricuspid stenosis
- Pulmonary hypertension
- Right ventricular outflow tract obstruction
> PS (Pulmonary stenosis)
> HOCM

Cannon A wave: RA contracts against closed TV (presystolic event)
Rises more rapidly, flickering motion
- Complete heart block
- Paroxysmal SVT or junctional tachycardia

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11
Q

Causes of X descent abnormalities

A

Exaggerated: cardiac tamponade

Diminished: AF/flutter

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12
Q

Causes of prominent V wave

A
  • Tricuspid regurgitation
  • ASD (v wave as high as a wave)
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13
Q

Causes of Y descent abnormalities

A

Sharp Y: constrictive or restrictive heart disease

Slow Y: tricuspid stenosis

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14
Q

Causes of wide pulse pressure

A
  1. High output states
    - Thyrotoxicosis
    - Severe anaemia
    - Paget’s disease
    - Beri-beri
    - Pregnancy
  2. Increased run-off of left ventricular outflow
    - PDA
    - AR
    - AV fistula
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15
Q

Causes of narrow pulse pressure

A
  1. Pump problem
    - Pericardial effusion
    - Constrictive pericarditis
    - Cardiogenic shock
  2. Obstructive
    - AS
  3. Hypovolaemia
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16
Q

What is the murmur of mitral regurgitation?

A

Pansystolic
Loudest at apex
Radiates to axilla

17
Q

What is the murmur of mitral stenosis?

A

Low pitch, rumbling diastolic murmur

Loudest at the apex, best heard with the patient in the left lateral position with their breath held in expiration

18
Q

What murmurs might you hear in mixed aortic valve disease?

A

Ejection systolic murmur
Early diastolic murmur
Austin Flint murmur - rergurgitant jet passing through the aortic valve and hitting the adjacent mitral valve leaflet

19
Q

What are the causes of secondary hypertension?

A

Renal : renal parenchymal disease, revovascular disease, CKD

Endocrine: Cushing’s, hyperaldosteronism, adrenal hyperplasia, phaeochromocytoma, acromegaly, thyroid disease

Drug induced : NSAIDs, decongestants, oral contraceptives, corticosteroids, ciclosporin, anabolic steroids, illicit drug use

OSA
Coarctation of the aorta

20
Q

Which patients with hypertension should receive treatment?

A

10 year cardiovascular risk score >20%

Persistent BP of >160/100

All patients with co-existing diabetes or cardiovascular disease

21
Q

What are the causes of unilateral diminished or absent radial pulse?
(M: STARE)

A
  1. Shunt (Blalock-Taussig) - right/left thoracotomy scar corresponding to side of diminished pulse
  2. Takayasu arteritis
  3. Atherosclerosis - a/w diabetes mellitus
  4. Rib (cervical) - palpate anterior to trapezius muscle
  5. Embolism (AF)
22
Q

Describe this heart murmur

A

Ejection systolic murmur - AS

Crescendo-decrescdo murmur after S1, peaks in mid to late sustole and ends before S2

23
Q

What is the underlying pathology of malar flush?

A

Development of severe pulmonary hypertension leading to low output cardiac state

24
Q

Describe this heart murmur

A

Pansystolic murmur - MR

25
Q

Describe this heart murmur

A

Mid diastolic murmur - MS

26
Q

Describe this heart murmur

A

Early diastolic murmur - AR

27
Q

Describe this heart sound

A

S3

28
Q

Describe this heart sound

A

S4

29
Q

Describe this heart sound

A

Midsystolic click

MRCP PACES Cardiology (20 decks)

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