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Cardio Entrance > Integrated Evidence Based Approach to Specific Cardiac Disorders > Flashcards

Integrated Evidence Based Approach to Specific Cardiac Disorders Flashcards

1
Q

What is the Framingham criteria

A

used in HF diagnosis with reduced EF
only modest sensitivity and specificity

Compared to 3 or more symptoms of S3, tachycardia, elevated JVP, low pulse pressure, rales, ajr sign - 90%

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2
Q

when is HF most likely to be preserved

A

female, older, increased BMI

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3
Q

PP is determined by

A

stroke volume
vascular stiffness
(can be used to assess Cardiac output)

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4
Q

PP equation

A

(systolic -diastolic) / systolic

correlates well with cardiac index, stroke volume index, inverse systemic vascular resistance

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5
Q

if PP is lower than 25%, cardiac index is

A

less than 2.2 L/min/m2 in 91% of patients

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6
Q

if PP is greater than 25% , cardiac index is

A

greater than 2.2 L/min/m2 in 83% of patients

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7
Q

using oxygen as indicator, how to assess cardiac output?

A

a time from breath to hold to nadir of finger oximetry of greater than 34 seconds has been associated with Cardiac output < 4 L/min

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8
Q

TRUE or FALSE - Heart rate is also a powerful indicator of prognosis in HF

A

True , greater than 70 to 75 bpm is an independent predictor of mortality

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9
Q

Explain dysautonomia in HF

A

an attenuated HR increase with immediate standing (= 3 bpm); associated with death and Hospitalization;

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10
Q

simplest finding to elicit pleural effusion (LR 8.7)

A

Dullness to percussion

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11
Q

Absence of such makes pleural effusion less likely (LR 0.21)

A

Absence of reduced vocal fremitus

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12
Q

Signs suggesting severe mitral stenosis

A

1 long or holodiastolic murmur - indicating a persistent LA -LV gradient
2 short A2 OS interval -consistent with higher LA pressures
3 a loud P2 (or single S2) and or RV lift - suggestive of pulmonary hpn
4 elevated JVP with CV waves , hepatomegaly and lower ext edema - signs of right HF

xintensity of diastolic murmur
x presystolic accentuation

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13
Q

Findings that suggest chronic severe MR:

A

1 enlarged, displaced, but dynamic LV apex beat
2 apical systolic thrill (grade 4 or greater)
3 mid-diastolic filling complex comprising of S3 and a short, low-pitched murmur - accelerated and enhanced diastolic mitral inflow
4 wide but physiologic splitting of S2 caused by early aortic valve closure
5 loud P2 or RV lift

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14
Q

Findings with MVP

A

combination of non-ejection click and mid to late systolic murmur predicts MVP best (LR 2.43)

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15
Q

The following findings help gauge the severity of aortic stenosis

A

1 slowly rising carotid upstroke (pulsus tardus)
2 reduced carotid stroke amplitude (pulsus parvus)
3 reduced intensity of A2 and mid-to late peaking of the systolic murmur

x intensity of murmur

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16
Q

May independently predict outcome for severe aortic stenosis

A

reduced carotid upstroke amplitude

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17
Q

to differentiate with aortic sclerosis (older pxs with hypertension)

A

TTE

in aortic sclerosis - no valve dysfunction, carotid upstroke normal, A2 preserved, no LV hypertrophy

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18
Q

Differential diagnosis of systolic murmur related to LVOT obstruction

A

1 valvular aortic stenosis
2 hocm
3 DMSS
4 SVAS

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19
Q

Presence of ejection sound in systolic murmur

A

valvular cause

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20
Q

How can HOCM be distinguished with AS

A

Response of murmur to Valsalva and standing or squatting

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21
Q

Will usualy have a diastolic murmur indicative of AR but not an ejection sound

A

Discrete membranous subaortic stenosis

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22
Q

Right arm BP is more than 10 mmHg greater than the left arm BP

A

Supravalvular Aortic stenosis

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23
Q

Signs of Aortic Regurgitation

A

pulmonary edema and signs of low forward CO
Tachycardia invariably present
Systolic BP NOT elevated
PP not widened
S1 soft due to premature closure of mitral valve

24
Q

Symptoms of chronic, severe AR include

A

dyspnea, fatigue, chest discomfort and palpitations

25
Q

True or false. The absence of diastolic murmur significantly reduces the likelihood of moderate or greater AR.

A

True. LR 0.1

The presence of typical diastolic murmur increases the likelihood of moderate or greater AR (LR 4.0 to 8.3)

26
Q

T or F

The intensity of murmur correlates with the severity of the lesion in AR.

A

T

Grade 3 diastolic murmur has an LR of 4.5 (severe AR vs mild/moderate AR)

27
Q

Austin flint murmur on studies?

Hill sign?

A 
Data conflict regarding significance of Austin flint
Hill sign (Brachial popliteal systolic bp gradient >20 mmHg  has moderate sensitivity of 89% - although its supporting evidence base is also weak)
28
Q

Symptoms and signs suggesting Tricuspid stenosis

A

elevated JVP with delayed y descent
abdominal ascites
edema

29
Q

Symptoms and signs suggesting Tricuspid Regurgitation

A

elevated jvp with prominent CV waves, parasternal lift, pulsatilve liver, ascites and edema

30
Q

Explain Carvallo sign

A

the intensity in the holosystolic murmur of TR increases with inspiration

31
Q

Denotes severe obstruction in Pulmonic stenosis

A

Syncope

Other symptoms: fatigue, dyspnea, lightheadedness, chest discomfort (right ventricular angina)

32
Q

Describe the murmur in Pulmonic stenosis

A

it is a midsystolic murmur best heard at left 2nd ICS

33
Q

Signs of severe pulmonic stenosis

A

interval between S1 and pulmonic ejection sound narrows
murmur peaks late systole and may extend beyond A2;
P2 becomes inaudible

34
Q

Signs of significant RV pressure overload include

A

prominent jugular venous a wave and parasternal lift

35
Q

It occurs most often as a secondary manifestation of significant PA hypertension and annular dilatation.

A

Pulmonic regurgitation.

May also be primary valve disorder - congenital bicuspid valve) or as a complication of RVOT surgery

36
Q

Differentiate PR murmur with AR

A

The diastolic murmur secondary to PR (Graham steell) increases intensity with inspiration, it has a later onset (after A2 and with P2), it also has lower pitch

37
Q

Typical murmur of PR increases the likelihood by

A

LR 17 but the absecne of murmur does not exclude it`

38
Q

Differential diagnosis of functional limitation after valve replacement

A

prostethic valve dysfunction
arrhythmia
impaired ventricular dysfunction

39
Q

Causes of prostethic valve dysfunction

A

thrombosis
pannus ingrowth
infection
structural deterioration

40
Q

First clue suggesting valve dysfunction

A

change in quality of heart sounds or appearance of a new murmur

41
Q

murmur of bioprosthesis in the mitral position

A

mid systolic (from turbulence created by systolic flow across valve struts that project into LVOT) and soft mid diastolic murmur that occurs with normal LV filling (only heard in left lateral decubitus at the apex)

42
Q

A high-pitched or holosystolic apical murmur signifies

A

para-or transvalvular regurgitation that requires echocardiographic verification and careful ffup evaluation

43
Q

A bioprosthesis in the aortic position is invariably associated with what murmur

A

midsystolic murmur at base of grade 3 or less intensity

A diastolic murmur of AR is abnormal

44
Q

Indicates paravalvular regurgitation or prosthetic dysfunction in mitral/aortic prosthesis

A

mitral - high pitched apical systolic murmur
aortic - decrescendo diastolic murmur

signs of hemolysis should be sought

45
Q

signs of px with prosthetic valve thrombosis

A

shock, muffled heart sounds, soft murmurs

46
Q

Associated with increase in intensity of systolic murmur & other signs of prosthetic valve stenosis

A

Pannus ingrowth

47
Q

Clinical findings of high risk of short term death or MI in NSTEMI

A 
age older than 75
tachycardia
hypotension
signs of pulmonary congestion
new or worsening murmur of MR
48
Q

Radiation to trapezius ridge

A

Pericarditis

49
Q

T or F

A pericardial friction rub is almost 100% specific for pericarditis

A

T - specific

sensitivity not as high because the rub may wax and wane over the course of illness

50
Q

ECG changes in pericarditis

A

concave upward ST elevation
PR segment deviation
elevation in lead aVR, depression in lead II

51
Q

WHen does pericardial tamponade occur

A

when intrapericardial pressure equals or exceeds the RA pressure

52
Q

Most common associated symptom in pericardial tamponade

A

dyspnea (sensitivity 87-88%)

Hypotension (sensitivity 26%)
muffled heart sounds (sensitivity 28%)

Pulsus paradoxus greater than 12 mmHg in a px with large pericardial effusion predicts tamponade with sensi of 98% and specificity of 83%, LR 5.9

53
Q

Causes of constrictive pericarditis

A

Previous chest irradiation
cardiac or mediastinal surgery
chronic tuberculosis
malignancy

54
Q

CLinical presentation of constrictive pericarditis

A

Dyspnea, fatigue, weight gain, abdominal bloating , leg swelling

55
Q

Waveforms in constrictive pericarditis

A

classic M or W contour caused by prominent x and y descents

Kussmaul sign

Cardio Entrance (8 decks)

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