Physical exam/general cardio/imaging/CAD

Question 1

DX when see Bisferiens pulse of carotids?

Answer 1

Severe AI

Question 2

Dx even see Parvis En Tardus carotid pulse?

Answer 2

Severe AS

Question 3

Dx when see Bifid wave in carotid pulse?

Answer 3

HOCM

Question 4

Dx when see pulse alternans in carotid pulse?

Answer 4

CHF. Very poor sign

See strong then weak pulse

Question 5

Jvp tracing:

What does the a, x, v and y represent?

Answer 5

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)

Question 6

What do you see in JVP tracing when have construction?

Answer 6

Very prominent x and y decents. High pressures. Good a wave because no myocardial problem (intact atrial contraction).

Question 7

What do you see in JVP tracing of tamponade?

Answer 7

High pressures with good a wave (myocardium intact) and good x decent but y decent is blunted (no room to fill RV).

Question 8

What do you see in JVP tracing in Restrictive CM?

Answer 8

Myocardial problem do not great a and decrease in x decent but intact/rapid y decent

Question 9

What do you see in JVP tracing of severe TR?

Answer 9

Blunted a and absent x decent with a VERY + V wave -> ventricularizarion of right atrium -> Monophysite wave

Question 10

Which right sided valve disease decreases with inspiration?

Answer 10

Pulm Stenosis

Question 11

What are the following Dx:

1. Paradoxical splitting of S2?
2. Persistent but some variation is splitting of S2?
3. Fixed S2?

Answer 11

1. LBBB, AS, pump failure (delay if pressure change in LV so tight closes before left)
2. RBBB or PHTN
3. ASD

Question 12

When you hear a loud P2 what Dx should you think about?

Answer 12

PHTN or MS or PR

Question 13

What does handgrip do to MR, AS, HOCM murmurs?

Answer 13

Increases MR, decreases AS, decreases HOCM because you are increasing afterload.
-similar with a squat

Question 14

What happens to MR, AS and HOCM murmurs when valsalva?

Answer 14

Decreasing Preload

MR and AS go down but HOCM increases.

Question 15

How to calculate ABIs.

What shows PAD and what is severe values?

Answer 15

ABI = foot / highest of both arms
+ if < or = 0.9
Severe if < 0.5

Question 16

What do you see with Osler-Weber-Rendo syndrome?

Answer 16

PHTN, shunts, telangictadias on tongue/mouth

Question 17

What facial features do you see with Amyloid?

Answer 17

Raccoon eyes, scalloping tongue, macroglocia

Question 18

Equation for Duke Treadmjll score.

What score is low, intermediate vs high risk?

Answer 18

= duration (mins) -[5x ST changes in mm] - [ 4x angina index of 0,1,2]
Low = > or = 5
Intermediate = -10 to +4
High = < -10

Question 19

What values do you look at that indicate diastolic dysfunction on TTE?

Answer 19

1. Mitral annular e’: lateral <10 and septal <7
2. Mitral E wave/e’: > 14
3. LA index > 34 ml/m2
4. TR max: 2.8m/s

Question 20

How do you determine the Grade of diastolic dysfunction on TTE?

Answer 20

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>

Question 21

Normal basal diameter of RV on TTE.

Answer 21

41 mm

Question 22

What is the next step in treatment/evaluation when identify a retro aortic LCx on LHC?

Answer 22

Nothing. This is a benign anomalous coronary, no need to even get a CT

Question 23

If there is a lot of artifact on TTE or TEE from mechanical valve and worries about endocarditis what can you do?

Answer 23

Check CT. There is not much artifact on Cardiac CT from mechanical valve.

Question 24

If I’m CTA see 60% stenosis in coronaries what should the next step be?

Answer 24

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)