High Yield Cardio

Question 1

Mitral Stenosis Valve Area

Answer 1

Normal 4-6cm2, Severe <1cm2

Question 2

Mitral Stenosis: Causes

Answer 2

Rheumatic (Women > Men)
Severe Mitral Annular Calcification (Can be associated with hypercalcaemia/high PTH)
After mitral valve repair for MR
Congenital Parachute Valve

Question 3

Mitral Stenosis: Signs of Severity

Answer 3

Small Pulse Pressure
Soft First Heart Sound
Early-opening Snap
Length of mid-diastolic rumbling murmur
Diastolic Thrill at the Apex (rare)

Question 4

Mitral Stenosis: Murmur

Answer 4

Apex
Low Pitched
Middle and Late Diastolic
Pre-systolic accentuation in sinus
Left Lateral Position
Exercise

Question 5

Signs of pulmonary Hypertension

Answer 5

Prominent A wave in JVP (If in sinus rhythm)
Right Ventricular Impulse
Loud P2, or palpable P2
Pulmonary Regurgitation
Tricuspid Regurgitation

Question 6

Mitral Regurgitation: Murmur

Answer 6

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)

Question 7

Mitral Regurgitation: Causes of Chronic

Answer 7

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

Question 8

Mitral Regurgitation: Causes of Acute

Answer 8

Infective Endocarditis - perf of anterior leaflet, rupture of myxomatous cord
Myocardial Infarction
Trauma

Question 9

Mitral Regurgitation: Signs of Severity

Answer 9

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)

Question 10

Mitral Valve Prolapse

Answer 10

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

Question 11

Aortic Regurgitation: Causes

Answer 11

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

Question 12

Aortic Regurgitation: Signs of Severity

Answer 12

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

Question 13

Aortic Regurgitation: Murmur

Answer 13

Early diastolic murmur in aortic area
Radiating to lower left sternal edge
Decrescendo
More on accentuation or leaning patient forward

Question 14

Aortic Regurgitation: Clinical Signs

Answer 14

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

Question 15

Mitral Regurgitation: Clinical Signs

Answer 15

Displaced Apex Beat
Pansystolic apical thrill

Question 16

Mitral Stenosis: Clinical signs

Answer 16

Mitral facies
Peripheral cyanosis
Tapping quality of apex beat

Question 17

Aortic Stenosis: Causes

Answer 17

Valve area <1cm2, less than 0.7cm2 in critical aortic stenosis

Degenerative senile calcific aortic Stenosis
Rheumatic (rarely isolated)
Calcific Bicuspid Valve

Question 18

Aortic Stenosis: Clinical Signs of Severity

Answer 18

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

Question 19

Aortic Stenosis: Murmur

Answer 19

Ejection systolic radiating to carotids
Louder on expiration

Question 20

Aortic Stenosis: General Signs

Answer 20

Plateau or anacrotic pulse -> may be late peaking and small volume
Hyperdynamic and slightly displaced apex beat
Systolic thrill at aortic area

Question 21

Tricuspid regurgitation: Clinical Signs

Answer 21

Large v waves
Right ventricular heave
Pulsatile/large/tender liver
Dilated, pulsatile veins

Question 22

Tricuspid Regurgitation: Murmur

Answer 22

Lower left and right sternal edge
Pansystolic murmur increasing with inspiration
Multiple systolic clicks - Ebstein’s anomaly

Question 23

Tricuspid Regurgitation: Causes

Answer 23

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)

Question 24

Tricuspid Regurgitation: Severity

Answer 24

Right ventricular failure - Elevated JVP, peripheral oedema, ascites