Physical exam/general cardio/imaging/CAD Flashcards
DX when see Bisferiens pulse of carotids?
Severe AI
Dx even see Parvis En Tardus carotid pulse?
Severe AS
Dx when see Bifid wave in carotid pulse?
HOCM
Dx when see pulse alternans in carotid pulse?
CHF. Very poor sign
See strong then weak pulse
Jvp tracing:
What does the a, x, v and y represent?
a wave = atrial contraction
x decent = atrial relaxation
v wave = atrial filling (just after LV contraction/systole)
y decent = early atrial emptying (before atrial contraction)
What do you see in JVP tracing when have construction?
Very prominent x and y decents. High pressures. Good a wave because no myocardial problem (intact atrial contraction).
What do you see in JVP tracing of tamponade?
High pressures with good a wave (myocardium intact) and good x decent but y decent is blunted (no room to fill RV).
What do you see in JVP tracing in Restrictive CM?
Myocardial problem do not great a and decrease in x decent but intact/rapid y decent
What do you see in JVP tracing of severe TR?
Blunted a and absent x decent with a VERY + V wave -> ventricularizarion of right atrium -> Monophysite wave
Which right sided valve disease decreases with inspiration?
Pulm Stenosis
What are the following Dx:
- Paradoxical splitting of S2?
- Persistent but some variation is splitting of S2?
- Fixed S2?
- LBBB, AS, pump failure (delay if pressure change in LV so tight closes before left)
- RBBB or PHTN
- ASD
When you hear a loud P2 what Dx should you think about?
PHTN or MS or PR
What does handgrip do to MR, AS, HOCM murmurs?
Increases MR, decreases AS, decreases HOCM because you are increasing afterload.
-similar with a squat
What happens to MR, AS and HOCM murmurs when valsalva?
Decreasing Preload
MR and AS go down but HOCM increases.
How to calculate ABIs.
What shows PAD and what is severe values?
ABI = foot / highest of both arms
+ if < or = 0.9
Severe if < 0.5
What do you see with Osler-Weber-Rendo syndrome?
PHTN, shunts, telangictadias on tongue/mouth
What facial features do you see with Amyloid?
Raccoon eyes, scalloping tongue, macroglocia
Equation for Duke Treadmjll score.
What score is low, intermediate vs high risk?
= duration (mins) -[5x ST changes in mm] - [ 4x angina index of 0,1,2]
Low = > or = 5
Intermediate = -10 to +4
High = < -10
What values do you look at that indicate diastolic dysfunction on TTE?
- Mitral annular e’: lateral <10 and septal <7
- Mitral E wave/e’: > 14
- LA index > 34 ml/m2
- TR max: 2.8m/s
How do you determine the Grade of diastolic dysfunction on TTE?
Look at mitral E/A and E wave:
If E/A > or = 2 then it’s Grade III
If E/A < or = 0.8 with E < or = 59cm/s then it’s Grade I
Can also look at CW at mitral tips and if E<a></a>
Normal basal diameter of RV on TTE.
41 mm
What is the next step in treatment/evaluation when identify a retro aortic LCx on LHC?
Nothing. This is a benign anomalous coronary, no need to even get a CT
If there is a lot of artifact on TTE or TEE from mechanical valve and worries about endocarditis what can you do?
Check CT. There is not much artifact on Cardiac CT from mechanical valve.
If I’m CTA see 60% stenosis in coronaries what should the next step be?
Functional testing (stress test). If see <50% just med Tx, if 50-70% do functional testing, if >70% do functional vs angio (if 3v do angio)
