High Yield Cardio Flashcards
Mitral Stenosis Valve Area
Normal 4-6cm2, Severe <1cm2
Mitral Stenosis: Causes
Rheumatic (Women > Men)
Severe Mitral Annular Calcification (Can be associated with hypercalcaemia/high PTH)
After mitral valve repair for MR
Congenital Parachute Valve
Mitral Stenosis: Signs of Severity
Small Pulse Pressure
Soft First Heart Sound
Early-opening Snap
Length of mid-diastolic rumbling murmur
Diastolic Thrill at the Apex (rare)
Mitral Stenosis: Murmur
Apex
Low Pitched
Middle and Late Diastolic
Pre-systolic accentuation in sinus
Left Lateral Position
Exercise
Signs of pulmonary Hypertension
Prominent A wave in JVP (If in sinus rhythm)
Right Ventricular Impulse
Loud P2, or palpable P2
Pulmonary Regurgitation
Tricuspid Regurgitation
Mitral Regurgitation: Murmur
Apex
Pansystolic or Middle and Late Systolic
Radiates to axilla or left sternal Edge
Can be blowing if MVP
Longer and louder with Valsalva (MVO)
Mitral Regurgitation: Causes of Chronic
Degenerative Disease
Mitral Valve Prolapse
Rheumatic (Men > Women, usually other lesions)
Papillary muscle dysfunction (LVF or IHD)
Connective tissue disease - Rheumatoid Arthritis or Ank spond
Congenital (endocardial cushion defect, parachute valve, corrected transposition)
Functional MR
Mitral Regurgitation: Causes of Acute
Infective Endocarditis - perf of anterior leaflet, rupture of myxomatous cord
Myocardial Infarction
Trauma
Mitral Regurgitation: Signs of Severity
Enlarged Left Ventricle + Left Ventricular Failure
Pulmonary Hypertension
Third Heart Sound
Soft First Heart Sound
Early Aortic Component of second heart sound
Small volume pulse (very-severe)
Mitral Valve Prolapse
Click at apex
Valsalva Manoeuvre (Decreases preload) - Murmur longer, click earlier
Handgrip (Increases afterload) or squatting (Increases preload) - murmur shorter
A/w Marfan syndrome, secundum ASD
Complicated by Mitral Regurgitation
Infective endocarditis
Aortic Regurgitation: Causes
Valvular
- Rheumatic (rarely only murmur)
- Congenital (Bicuspid valve, VSD with prolapse of aortic cusp)
- Seronegative arthropathy, especially ank spond
Aortic Root (murmur may be maximal at right sternal border)
- Marfan’s Syndrome
- Aortitis (Seronegative arthropathies, rheumatoid arthritis, tertiary syphilis)
- Dissecting aneurysm
- Old age
Acute (Murmur may be soft because of increased LVEDP)
- Valvular - infective endocarditis
- Aortic Root - Marfan’s Syndrome, hypertension, dissecting aneurysm
Aortic Regurgitation: Signs of Severity
Collapsing pulse
Wide pulse pressure
Length of decrescendo diastolic murmur
Third heart sound (left ventricular)
Soft component of second heart sound (A2)
Austin flint murmur (diastolic rumble caused by limitation to mitral inflow by the regurgitation jet
Left ventricular failure
Aortic Regurgitation: Murmur
Early diastolic murmur in aortic area
Radiating to lower left sternal edge
Decrescendo
More on accentuation or leaning patient forward
Aortic Regurgitation: Clinical Signs
Signs of Marfan’s syndrome, ank spond or other seronegative arthropathy
Water Hammer pulse
Prominent Carotid Pulsation or bisferiens pulse
Displaced and hyperkinetic apex
Widened Pulse Pressure
Mitral Regurgitation: Clinical Signs
Displaced Apex Beat
Pansystolic apical thrill
Mitral Stenosis: Clinical signs
Mitral facies
Peripheral cyanosis
Tapping quality of apex beat
Aortic Stenosis: Causes
Valve area <1cm2, less than 0.7cm2 in critical aortic stenosis
Degenerative senile calcific aortic Stenosis
Rheumatic (rarely isolated)
Calcific Bicuspid Valve
Aortic Stenosis: Clinical Signs of Severity
Plateau Pulse
Aortic Thrill (severe stenosis)
Length, harshness and lateness of peak of systolic murmur
Fourth Heart Sound
Paradoxical splitting of second heart sound
Left Ventricular Failure
Aortic Stenosis: Murmur
Ejection systolic radiating to carotids
Louder on expiration
Aortic Stenosis: General Signs
Plateau or anacrotic pulse -> may be late peaking and small volume
Hyperdynamic and slightly displaced apex beat
Systolic thrill at aortic area
Tricuspid regurgitation: Clinical Signs
Large v waves
Right ventricular heave
Pulsatile/large/tender liver
Dilated, pulsatile veins
Tricuspid Regurgitation: Murmur
Lower left and right sternal edge
Pansystolic murmur increasing with inspiration
Multiple systolic clicks - Ebstein’s anomaly
Tricuspid Regurgitation: Causes
Functional - RVF
Rheumatic - Rarely alone, usually with MV disease
Congenital - Ebstein’s
Tricuspid Valve Prolapse
Right ventricular papillary muscle infarction
Pacemaker lead
Trauma (steering Wheel injury)
Tricuspid Regurgitation: Severity
Right ventricular failure - Elevated JVP, peripheral oedema, ascites
