Signs Flashcards
Describe auscultation characteristics of aortic stenosis: 4
- Late peaking
- Loud at base
- Harsh
- Radiating to the carotids (bruits)
What chamber tends to fail in Aortic regurgitation? 1
What changes occur before this happens? 2
- Left ventricle failure.
2. Left ventricle Hypertrophy &Left ventricle Dilation
<p>Give 3 differential diagnoses for a soft first heart sound</p>
<p>1. Low cardiac output, rest, heart failure
2. Tachycardia
3. Mild Aortic Regurgitation</p>
What extra features will an echocardiogram tell us in mitral stenosis? (4)
- Dimensions
- Causes (leaflet, chordae, papillary muscles, annular disease)
- Severity of Myocardial regurgitation
- Accurate cardia volumetric determination.
What chamber is affected (i.e. undergoes a compensatory change) in mitral regurgitation? (4)
- Left Ventricle
- Hypertrophy
- Chronic disease stage
- EDV increases, and ESV returns to normal.
Describe Degenerative Aortic stenosis: (2)
- Liked with atherosclerosis
- Slow inflammatory process
- Thickening & calcification of cusps from base to free margins.
What can you assume from an enlarge P wave = P >0.12?
Anatomically (1)
Diagnoses (2)
Anatomically:
1. Left Atrium Hypertrophy
Diagnoses:
- Mitral stenosis
- Mitral regurgitation
<p>Name to Inherited risk factors of Coronary Artery Disease:</p>
<p>1. Familial hyperlipdaemia
| 2. High lipoprotein A.</p>
<p>What are 5 treatments for angina to reduce disease symptoms</p>
<p>1. Beta-blockers 2. Calcium channel blockers 3. Ik channel blockers = All achieve heart rate below 60 bpm. 4. Nitrates 5. Potassium channel blockers.</p>
<p>What might be required if a CT Coronary Angiography is not clearly providing a diagnosis, or a patient presents with strong ETT results.</p>
<p>1. Invasive Angiography</p>
<p>Give 6 differential diagnoses for Raised Jugular Venous pressure</p>
<p>1. Congestive or right-sided heart failure
2. Tricuspid regurgitation
3. Pericardial tamponade
4. Pulmonary embolism
5. Iatrogenic fluid overload
6. Superior vena cava obstruction.</p>
How does Mitral Stenosis affect the left atrium and right ventrical:
Left atrium: hypertrophy (including left auricle)
Right ventricle: heave
<p>Name 5 Acquired risk factors of Coronary Artery Disease:</p>
<p>1. Smoking
2. Acquired hyperlipidaemia
3. Diabetes
4. Hypertension
5. Physical inactivity.</p>
What are the two pathological types of Aortic stenosis: (2)
- Rheumatic
2. Degenerative
What investigation can be used to check for Right ventricular Heave?
- Cardiac Catheterisation.
What can be lifesaving treatment in acute mitral regurgitation? (1)
- Preload and afterload reducing medications: Sodium Ntroprisside, Dobutamine, IABP.
Describe Rheumatic Aortic stenosis: (2)
- Adhesion and fusion of commissures
2. Retraction and stiffening of free cusp margins
<p>Give 3 differential diagnoses for Left Ventricular Hypertrophy</p>
<p>1. Hypertension
2. Aortic stenosis
3. Hypertrophic cardiomyopathy.</p>
<p>Myocardial Perfusion Imaging benefit and use:</p>
<p>Benefit: superior to ETT in detection of CAD, localisation of ischaemia and assessing the size of an affected area.</p>
An ECG showing a prominent R wave in the R precordial lead suggests what?
Anatomically/functionally: (1)
Diagnosis: (1)
Anatomically/functionally:
1. Right ventricular heave
Diagnosis:
1. Mitral regurgitation.
<p>Where would you auscultate for tricuspid regurgitation?</p>
<p>Primary Site: Lower left sternal edge
| Radiates to: Lower right sternal edge and liver.</p>
Increased marked atrial volume, with little changes to pulmonary vasculature can lead to what type of heart arrythmia, in which condition?
Arrhythmia: Atrial fibrillation
Condition: Mitral regurgitation.
Describe the apex beat of an individual with Mitral regurgitation: (2)
- Brisk
2. Hyperdynamic.
How is the P wave affected in Mitral Stenosis following ECG.
- P wave > 0.12 seconds
<p>Where would you auscultate for aortic regurgitation?</p>
<p>Primary Site: Left sternal angle
| Radiates to: Down the left sternal edge towards apex.</p>
What is right ventricular heave indicative of? (2)
- Mitral Stenosis
2. Mitral Regurgitation.
Medical intervention for mitral regurgitation (2)
- Mitral valve apparatus or repair
2. Mitral valve replacement.
<p>Give 4 differential diagnoses for a loud first heart sound</p>
<p>1. Hyper-dynamic circulation - fever, exercise
2. Mitral stenosis
3. Atrial myxoma - rare.
4. Severe Aortic regurgitation.</p>
<p>Describe 4 features of the limb of a patient with peripheral vascular disease:</p>
<p>1. Cold
2. White
3. Painful
4. Pulseless.</p>
<p>Give 3 differential diagnoses for a loud aortic component of the second heart sound</p>
<p>1. Systemic hypertension
2. Dilated aortic root
3. Severe mitral regurgitation.</p>
Clinical Manifestations of Mitral Stenosis:
- Dysponea
- Haemoptysis from venous reupture
- Systemic embolism
- Left Atrial and Auricle Hypertrophy
- Chest pain
- Hoarseness due to compression of left recurrent laryngeal nerve.
How is the P wave affected in Mitral Regurgitation?
- P > 0.12
<p>How can you diagnose chronic stable angina?</p>
<p>Cardiac catheterisation.</p>
<p>Comparing ECG at rest to ECG on exertion with chest pain can help identify what sign of what condition?</p>
<p>ST segment depression, indicative of stable angina. - using ETT.</p>
Describe the heart sound for: Aortic Regurgitation (5)
- Early Diastolic
- Descrescendo
- Soft mumur
Sound 1: Normal
Sound 2: Normal
<p>Myocardial perfusion disadvantages:</p>
<p>expensive, invovles radioactivity; depdends on availability.</p>
What is head at the apex upon auscultation in mitral stenosis?
- Tapping apex
2. Diastolic Thrill
What are 5 signs of mitral regurgitation?
- Pulmonary hypertension
- Atrial Fibrillation.
- Pulmonary oedema
- Cardiogenic Shock
- Right heart failure.
<p>What may embolisms to multiple sites be the first clue of?</p>
<p>Cardiac disease called Atrial Myxoma.</p>
<p>Where would you auscultate for mitral regurgitation?</p>
<p>Primary Site: Apex
| Radiates to: Left axilla, beneath the scapula.</p>
<p>Describe 6 signs/symptoms associated with Chronic Heart Failure:</p>
<p>1. Fatigue on minimal exertion
2. Exertional dyspnoea
3. Peripheral oedema (bilateral)
4. Abdominal discomfort (hepatic distension)
5. Nocturia
6. Weight loss and cachexia.</p>
<p>Describe 5 Signs of Stable Angina</p>
<p>1. Pallor of anaemia
2. Tachycardia, tremor, hyper-reflexia of hyperthyroidism
3. Ejection systolic murmur, plateau pulse of aortic stenosis
4. Pan-systolic murmur of mitral regurgitation
5. Signs of heart failure: basal crackles, elevated JVP, bi-lateral peripheral oedema</p>
Describe an characteristic feature of the right ventricle in aortic stenosis, mitral regurgitation, mitral stenosis, but not aortic regurgitation? 1
- Right Ventricle Heave.
Describe the pulse (2) and pulse pressure (1) typical with aortic regurgitation:
Pulse: (Corrigan Sign) 1. Large 2. Collapsing Pulse pressure: 1. Wide
<p>Where would you auscultate for ventricular septal defect?</p>
<p>Primary Site: Left sternal edge
| Radiates to: All over pericardium</p>
Reduced Left Atrium compliance and pulmonary vasculature remodelling is associated with which sign and which valve pathology?
Sign: Pulmonary hypertension
Valve Pathology: Mitral Regurgitation
<p>Give 3 signs of of hyperlipidaemia:</p>
<p>1. Corneal arcus (white ring around colour of eye)
2. Tendon xanthomata
3. Xanthelasma.</p>
Treatment options for mitral stenosis:
Medical (3)
Interventional (2)
Medical
1. Diuretics and restriction of Na intake
2. AF: SR restoration or ventricular rate control
3. Anticoagulation: all those with AF, detectable in (SR?)
Interventional
1. Valvotomy (balloon vs surgical)
2. MVR
<p>What symptom may individuals with chronic arterial insufficiency/peripheral vascular disease present with other than oedema?</p>
<p>Claudication - intermittent - i.e. pain arises when walking and goes away at rest.</p>
Describe the JVP of a patient with Aortic Stenosis: 2
- Prominent if RH failure
2. Presents with low blood pressure.
What are two dangerous patterns of coronary artery disease? 2
- Left main stem stenosis
2. 3 vessel coronary artery disease
<p>What are 3 treatments for angina to reduce disease progress.</p>
<p>1. Statins
2. ACE inhibitors
3. Aspirin.</p>
<p>Exercise Tolerance Test can be used to diagnose: (1)</p>
<p>Stable Angina</p>
<p>Mitral Stenosis</p>
<p>Primary Site: Apex
| Radiates to: XXX ! Does Not Radiate ! XXX</p>
What are – symptoms of mitral regurgitation?
- breathlessness (due to pulmonary oedema and cardiogenic shock, and AF)
- Fatigue, right heart failure
- Palpitations (AF)
<p>What can a computed tomography coronary angiography be used to diagnose?</p>
<p>1. Stable Angina
2. Unstable Angina
3. Coronary Heart Disease</p>
<p>Blood investigations around Angina: (6)</p>
<p>1. FBC
2. Lipid profile
3. Fasting glucose
4. Electrolytes
5. Liver function
6. Thyroid function</p>
<p>In terms of the level of vessels affected what does a strong EET (early) result suggest.</p>
<p>Multiple coronary vessels affected</p>
<p>Where would you auscultate for aortic stenosis?</p>
<p>Primary Site: Apex
| Radiates to: Towards upper right sternal edge, over carotids.</p>
Describe the heart sound for: Aortic Stenosis (6)
- Late peaking
- loud at bases
- harsh
- radiating to carotids
Sound 1: Normal
Sound 2: Less audible A2
<p>If symptoms are not controlled, how might you treat an angina patient, after checking general measures, and attempting medical treatment?</p>
<p>1. Revascularisation = percutaneous coronary intervention PCT &amp; coronary after bypass grafting CABG. mainly for symptom relief</p>
Describe the pulse of a patient with Aortic Stenosis: 2
- Small volume
2. Slowly rising.
<p>How can you differentiate between possible heart failure and deep vein thrombosis, a lower limb blood clot, or pulmonary embolism?</p>
<p>Heart failure = bilateral leg oedema
| DVT, Blood Clot, PE = unilateral leg oedema.</p>
<p>Where would you auscultate for pulmonary stenosis?</p>
<p>Primary Site: Upper left sternal edge 2nd Intercostal Space
Radiates to: Towards left clavicle, beneath left scapula.</p>
What might an echocardiography show in mitral stenosis?
- Thickening/scaring of valve leaflets
2. Fusion of commissures.
<p>Arterial atheroma is often what in nature?</p>
<p>1. Eccentric</p>
<p>Patholigical Q-waves from an echocardiogram indicate: (2)</p>
<p>1. prior myocardial infarction
| 2. LVH = high voltages, lateral ST-segment depression or "strain pattern".</p>
If you used radiography of a patient with valvular pathology, what type of radiography did you send for, and what would you expect to find in an individual with mitral stenosis?
- Chest X-Ray
2. Left Atrium Hypertrophy.
Describe the heart sound for: Mitral Stenosis (1)
Mid diastolic murmur
<p>Explain the principles of myocardial perfusion</p>
<p>1. Radio nucleotide tracer injected at rest and exercising. Compare images.
2. Tracer seen at rest but not after stress = Ischaemia
3. Tracer seen neither at rest, or after stress = infarction.</p>
Describe the heart sound for: Mitral Regurgitation (7)
- Holosystolic
- Blowing
- Loud at apex
- radiating to axilla
- No relationship between intensity and severity
Sound 1: Early A2
Sound 2: Loud P2
Describe the Apex beat of a patient with Aortic Stenosis: 2
- Vigorous
2. Sustained
Name 4 leaflet causes of aortic regurgitation:
- Bicuspid aortic valve
- Rheumatic heart disease
- Endocarditis
- Myxomatous degeneration.
<p>In heart failure where would oedema occur in a patient that has experienced prolonged bed rest?</p>
<p>Sacrum.</p>
How does the medical treatment for aortic stenosis differ compared to other valvular diseases? 1
What can patients receive? 1
- Medical treatment is limited to those who develop heart failure.
- Patients can receive medical intervention: Aortic valve replacement or repair.
Name two aortic causes of aortic regurgitation:
- Dilated aorta (Marfans & Hypertension)
2. Connective tissue disorders
What should the ejection fraction be for a patient to be deemed ideal for coronary artery bypass grafting (CABG)? 1
- Greater than 20%
<p>What can amend coronary artery stenosis?</p>
<p>1. An Angioplasty</p>
<p>What might a chest X-ray show if a patient is suffering from angina-"like" chest pain? (1)</p>
<p>1. Pulmonary Oedema</p>
<p>Give 2 differential diagnoses for a varied intensity of the first heart sound</p>
<p>1. Atrial fibrillation
2. Complete heart block.
3. Mild mitral regurgitation.</p>
<p>In heart failure where would oedema occur in a relatively mobile patient?</p>
<p>Bilaterally occurs in legs - as a result of increased venous pressure.</p>
Would the pulse in a patient with mitral valve defects change?
No, only reduced if
they proceed to heart failure.
