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Y3(M) - Cardiology > Introduction And Valvular Disease > Flashcards

Introduction And Valvular Disease Flashcards

1
Q

What are some general examination findings that can be suggestive of an underlying cardiac pathology?

A

Turner’s syndrome
Down’s syndrome
Marfan’s syndrome

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2
Q

What are some visible features of Turner’s syndrome?

A

Neck webbing
Low set ears
Short
Wide spaced nipples/shield shaped chest

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3
Q

What is Turner’s syndrome?

A

45,XO karyotype caused by non dysjunction

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4
Q

What are the associated cardiac pathologies with Turner’s syndrome?

A

Bicuspid aortic valve + Aortic stenosis
Corarctation of the aorta
Atrial and ventricular septal defects

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5
Q

What are visible features of Down’s syndrome?

A

Flat facial profile
Short neck
Small head
Epicanthic folds (skin lines at inner corners of eyes)
Lower ears
Upward slanted eyes
Single palmar crease

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6
Q

What cardiac pathologies are associated with Down’s syndrome?

A

(All the S’s for septal defects)
Atrioventricular septal defect
Ventricular septal defect
Atrial septal defect
Patent ductus Arteriosus
Tetralogy of Fallot.

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7
Q

What are the visible signs of Marfan’s?

A

Tall
Arm span over 3cm there height
Long metacarpals (arachnodactyly)

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8
Q

What cardiac pathologies are associated with Marfan’s?

A

Aortic root dilation/aneurysm:
Aortic regurgitation
Mitral valve prolapse
Tricuspid valve prolapse

Left ventricular dilation

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9
Q

If you see a midline thoracic scared, what procedures are you thinking?

A

Valve replacemtn
Carotid bypass

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10
Q

What does a left sided S shape scar indicate on a patient?

A

Likely had an aortic coarctation repair
(Likely now has aortic valve disease)

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11
Q

What is special about patients aortic valve if they have aortic coarctation?

A

Everyone with aortic coarctation has a bicuspid aortic valve

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12
Q

What signs are you looking for on the hands of a patient if you think they might have cardiac pathology?

A

Long metacarpals (marfans)
Splinter haemorrhages
Janeaway lesions
Oslers nodes
Tendon Xanthomas
Single palmar crease

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13
Q

What condition do Splinter haemorrhages, Janeaway lesions and Oslers nodes indicate?

A

Infective endocarditis

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14
Q

What are tendon xanthomas indicative of?

A

High serum cholesterol

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15
Q

What is indicated by a single palmar crease?

A

Down syndrome or mosaic for down syndrome

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16
Q

What is a collapsing pulse?

What is it typically indicative of?

A

Forcefully appearing but rapidly disappearing pulse (felt at radial pulse)

Aortic regurgitation

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17
Q

Why do you get a collapsing pulse with aortic regurgitation?

How is pulse pressure affected?

A

Forceful pulse out of aortic valve via aorta but quickly dissapears due to regurgitation through the incompetent aortic valve

Wide/broad pulse pressure

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18
Q

What are you trying to determine by palpating the carotid artery?

A

Slow rising pulse? = aortic stenosis (pulse struggles to make it through stenosed valve to carotids )

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19
Q

When looking at the neck, what can indicate a tricuspid valve regurgitation and why?

A

V waves

See pulsation in the internal jugular vein due to blood leaking into the right atrium when the right ventricle contracts

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20
Q

What are some indications of cardiac pathology when looking at the face?

A

Malar flush
Conjunctival pallor
Central cyanosis
High arch

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21
Q

What is malar flush suggestive of a why?

A

Rheumatic mitral valve disease/stenosis

Back flow of blood into pulmonary circulation leads to elevated CO2 and Vasodilation of blood vessels

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22
Q

What anatomical areas do you listen to for the 4 heart valves?

A

Pulmonary valve = 2nd intercostal space right sternal border (semilunars at 2nd)
Aortic valve = 2nd intercostal space left sternal border (semilunars at 2nd)
Tricuspid valve = 5th intercostal space right sternal border (atrioventricular at 5th)
Mitral/bicuspid valve = 5th intercostal space left mid clavicular line (atrioventricular at 5th)

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23
Q

What is the name of the best point to listen to S1 and S2?

Where is it?

A

Erbs point

3rd intercostal space left sternal border

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24
Q

What creates the S1 and S2 heart sounds respectively?

A

Closing of the heart valves

S1 = closing of atrioventricular valves (tricuspid and mitral)

S2 = closing of semilunar valves (pulmonary and aortic valves)

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25
Q

What is the pathophysiology of a third heart sound S3?

A

Rapid ventricular filling causes chordae tendineae to fully stretch and pluck like a guitar string

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26
Q

When can a third heart sound be heard (S3)?
What can it indicate?

A

Normal in young healthy patients 15-40

Older patients may be indicative of heart failure (fluid overload and patients hearts less compliant due to age)

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27
Q

What kind of sound does S3 make?

A

Leads to galloping rhythm

S1 + S2 + S3

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28
Q

What is the pathophysiology of the fourth heart sound (S4)?

A

Stiff or hypertrophic ventricles
As atria contract the pushing off blood into the non compliant ventricle creates turbulent flow leading to a sound being heard before the atrioventricular valves close

S4, S1, S2

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29
Q

How can you listen for mitral valve stenosis?

A

5th intercostal space left mid clavicular line and patient rolls to left

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30
Q

What is it called if you place hand on left side of sternum and your palm lifts up?

A

Right ventricular heave

31
Q

What affect does a valve regurgitation have on the heart?

A

Leads to dilation of the chambers before it

32
Q

What affect does a valve stenosis have on the heart?

A

Hypertrophy of the chamber that has to push blood through it

33
Q

How can you tell the difference between a dilated ventricle (volume loaded) and a hypertrophic ventricle (pressure loaded) on palpation of the apex beat?

A

Volume loaded/dilate:
-displaced (laterally or inferior LH)
-hyper dynamic/diffuse
-brief impulse (weak due to dilation)
LARGE DIFFUSE AREA OF IMPULSE

Pressure loaded/hypertrophic:
-non-displaced (only displaced laterally in severe LV hypertrophy)
-well localised/heaving impulse
-sustained impulse
SMALL LOCALISED AREA OF IMPULSE

34
Q

What is the general appearance, pulse rate and rhythm of a patient with aortic stenosis and why?

A

Pale
Sweaty
Sinus tachycardia
Exertional syncope

Stenosis reduces the patients Stroke volume
Less blood can reach head

Therefore patients need a faster heart rate to maintain cardiac output

35
Q

What is the general appearance, pulse rate and rhythm of a patient with aortic stenosis and why?

A

Pale
Sweaty
Sinus tachycardia
Exertional syncope

Stenosis reduces the patients Stroke volume
Less blood can reach head

Therefore patients need a faster heart rate to maintain cardiac output

36
Q

What is the pulse volume and character of a patient with aortic stenosis?

A

Low volume
Narrow pulse pressure

Slow rising carotid pulse

37
Q

How is JVP and Apex beat affected in aortic stenosis?

Is there any palpable change?

A

JVP only raised in severe long standing disease

Non displaced well localised and sustained (unless severe)

Palpable thrill over aortic area

38
Q

What murmur can be heard on auscultation of an aortic stenosis?

Why does it sound like this?

A

Crescendo-decrescendo (diamond shaped sound)

An ejection systolic murmur which is high pitch due to high velocity of blood flow

Sound is quite then louder then quieter as LV contracts speed of blood increases to where its velocity peaks then decreases

39
Q

What are some causes of aortic stenosis?

A

Idiopathic age related calcification
Bicuspid aortic valve
Rheumatic heart disease

40
Q

What are the 3 characteristic signs of aortic regurgitation?

A

Corrigans sign
De-mussets sign
Quinke’s sign

41
Q

What is Corrigans sign?

A

Indicates aortic. Regurgitation
Bounding collapsing pulse seen in the carotids

42
Q

What is De-mussets sign?

A

Head bobbing at rest synchronous with the heart beating

43
Q

What is Quinke’s sign?

A

Capillary pulsation when compressing nail bed

44
Q

What is the pulse rate/rhythm and pulse pressure like with aortic regurgitation?

A

Sinus. Rhythm
Large pulse pressure difference

45
Q

What is the pulse volume and character like for aortic regurgitation?

A

High. Pulse volume

COLLAPSING PULSE

46
Q

How is JVP and apex beat affected with aortic regurgitation?

Any palpable changes?

A

JVP not affected

Apex beat = displaced, diffuse and non sustained (volume loaded)

Not normal alt any palpable changes

47
Q

What murmur can be heard/ausculated with aortic regurgitation?

Why is it like this?

A

Decrescendo = Early diastolic soft murmur

Heard after S2 , aortic valve has closed but blood flows back from the aorta through it into the LV during diastole

48
Q

What are some causes of aortic regurgitation?

A

Idiopathic age related weakness
Bicuspid aortic valve

CONNECTIVE TISSUE DISORDERS LIKE EHLOS DANLOS and MARFANS

49
Q

What complication can occur due to aortic regurgitation??

A

Heart failure -> pulmonary oedema

50
Q

What visible change can be seen with mitral valve stenosis?

A

Malar flush on cheeks

51
Q

What can happen to pulse rate and rhythm with mitral valve stenosis?

Why?

A

Atrial fibrillation

Left atrium contracts struggling to push blood through to LV, leads to electrical disturbance in LA as it tries to pump faster and harder

52
Q

How is pulse volume and character affected in mitral valve stenosis?

A

Normal

53
Q

How is JVP and the apex beat affected with mitral valve stenosis?

A

JVP can be raised if mitral valve stenosis causes right sided heart failure

Tapping apex beat

54
Q

What palpable thrill can you get with mitral valve stenosis and why?

A

Right ventricular heave due to RV enlargement (pulmonary hypertension)

55
Q

What murmur/sound can be heard with mitral valve stenosis and why?

A

Mid diastolic low pitch rumbling murmur (absence of silence in diastole)

Loud S1 due to thick stenosed valve closing
S2 happens then hear another opening snap as the stenosed mitral valve opens during diastole

Murmur heard as mitral valve opens and the left ventricle rapidly fills in diastole

56
Q

What are some causes of mitral valve stenosis?

A

Rheumatic heart disease
Infective endocarditis is

57
Q

What changes are seen with Mitral regurgitation in terms of:
1.) general appearance
2.) pulse rate and rhythm
3.) pulse vol + character
4.) JVP

A
  1. Normal
  2. Normal
  3. Normal
  4. Normal
58
Q

How is Apex beat affected with mitral valve regurgitation and why?

A

Displaced, diffuse and non sustained apex beat

Leads to left atrial dilation (volume loading) this increases pre load so volume of blood entering into left ventricle increases which leads to volume overload and dilation in the left ventricle

59
Q

How is Apex beat affected with mitral valve regurgitation and why?

A

Displaced, diffuse and non sustained apex beat

Leads to left atrial dilation (volume loading) this increases pre load so volume of blood entering into left ventricle increases which leads to volume overload and dilation in the left ventricle

(Reduced ejection fraction due to back flow during systole)

60
Q

What palpable change can be felt with mitral valve regurgitation?

A

Thrill at apex beat/mitral area

61
Q

What type of murmur/sound can be heard with mitral valve regurgitation and why?

A

Pan systolic murmur (high pitch whistling noise through entire systole)
The blood from the ventricles gets forced back through to the atria with high velocity

Can hear high velocity blood flowing through the mitral valve during systole

62
Q

What are some causes of mitral valve regurgitation?

A

Idiopathic age related weakness
Ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders like Ehrlers Danlos and Marfans

63
Q

What general changes/ issues can cause tricuspid valve regurgitation?

A

COPD
Respiratory issues
Both cause functional tricuspid valve regurgitation

64
Q

How is pulse rate + rhythm and pulse volume and character affected with tricuspid regurgitation?

A

Normal

65
Q

How is JVP affected with tricuspid valve regurgitation?

A

Can be ELEVATED and see V waves
Can be normal

66
Q

How is apex beat and palpation with tricuspid valve regurgitation?

A

Normal
Normal

67
Q

What murmur/sound can be heard with tricuspid regurgitation and why?

A

Pansystolic murmur

Blood flows past tricuspid valve back into right atrium during systole

68
Q

What are you considering if you have a patient that has just been involved in a RTC and is the driver if they have a new pansystolic murmur?

A

Traumatic rupture of tricuspid valve

Seatbelts for driver runs across this area

69
Q

What is the only abnormality associated with a SMALL ventricular septal defect on examination?

A

Thrill at lower left sternal edge

WITH VERY LOUD PANSYSTOLIC MURMUR

70
Q

What can cause tricuspid regurgitation?

A

Pulmonary hypertension/left sided heart failurer (FUNCTIONAL TRICUSPID REGURGITATION)

Infective endocarditis
Rheumatic heart disease
Connective tissue disorder (Marfans)
Carcinoid syndrome
Eebsteins anomaly

71
Q

What are some other signs of tricuspid regurgitation except for thrill over tricuspid area and Raised JVP / V waves?

A

Peripheral oedema
Ascites
Pulsatile liver (regurging into venous system)

72
Q

What are some signs of pulmonary valve stenosis?

A

Ejection systolic murmur
Thrill in pulmonary area
Raised JVP (hypertrophic RV)
Peripheral oedema
Ascites

73
Q

What is a congenital syndrome where pulmonary stenosis occurs?

A

Tetralogy of fallot

74
Q

What are the 4 pathologies in tetralogy of fallot?

A

Ventricular septal defect
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

Y3(M) - Cardiology (3 decks)

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