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Signs, Symptoms, Investigations > Signs > Flashcards

Signs Flashcards

1
Q

Describe auscultation characteristics of aortic stenosis: 4

A
  1. Late peaking
  2. Loud at base
  3. Harsh
  4. Radiating to the carotids (bruits)
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2
Q

What chamber tends to fail in Aortic regurgitation? 1

What changes occur before this happens? 2

A
  1. Left ventricle failure.

2. Left ventricle Hypertrophy &Left ventricle Dilation

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3
Q

<p>Give 3 differential diagnoses for a soft first heart sound</p>

A

<p>1. Low cardiac output, rest, heart failure

2. Tachycardia
3. Mild Aortic Regurgitation</p>

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4
Q

What extra features will an echocardiogram tell us in mitral stenosis? (4)

A
  1. Dimensions
  2. Causes (leaflet, chordae, papillary muscles, annular disease)
  3. Severity of Myocardial regurgitation
  4. Accurate cardia volumetric determination.
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5
Q

What chamber is affected (i.e. undergoes a compensatory change) in mitral regurgitation? (4)

A
  1. Left Ventricle
  2. Hypertrophy
  3. Chronic disease stage
  4. EDV increases, and ESV returns to normal.
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6
Q

Describe Degenerative Aortic stenosis: (2)

A
  1. Liked with atherosclerosis
  2. Slow inflammatory process
  3. Thickening & calcification of cusps from base to free margins.
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7
Q

What can you assume from an enlarge P wave = P >0.12?
Anatomically (1)
Diagnoses (2)

A

Anatomically:
1. Left Atrium Hypertrophy

Diagnoses:

  1. Mitral stenosis
  2. Mitral regurgitation
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8
Q

<p>Name to Inherited risk factors of Coronary Artery Disease:</p>

A

<p>1. Familial hyperlipdaemia

| 2. High lipoprotein A.</p>

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9
Q

<p>What are 5 treatments for angina to reduce disease symptoms</p>

A 
<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>
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10
Q

<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>

A

<p>1. Invasive Angiography</p>

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11
Q

<p>Give 6 differential diagnoses for Raised Jugular Venous pressure</p>

A

<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>

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12
Q

How does Mitral Stenosis affect the left atrium and right ventrical:

A

Left atrium: hypertrophy (including left auricle)

Right ventricle: heave

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13
Q

<p>Name 5 Acquired risk factors of Coronary Artery Disease:</p>

A

<p>1. Smoking

2. Acquired hyperlipidaemia
3. Diabetes
4. Hypertension
5. Physical inactivity.</p>

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14
Q

What are the two pathological types of Aortic stenosis: (2)

A
  1. Rheumatic

2. Degenerative

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15
Q

What investigation can be used to check for Right ventricular Heave?

A
  1. Cardiac Catheterisation.
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16
Q

What can be lifesaving treatment in acute mitral regurgitation? (1)

A
  1. Preload and afterload reducing medications: Sodium Ntroprisside, Dobutamine, IABP.
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17
Q

Describe Rheumatic Aortic stenosis: (2)

A
  1. Adhesion and fusion of commissures

2. Retraction and stiffening of free cusp margins

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18
Q

<p>Give 3 differential diagnoses for Left Ventricular Hypertrophy</p>

A

<p>1. Hypertension

2. Aortic stenosis
3. Hypertrophic cardiomyopathy.</p>

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19
Q

<p>Myocardial Perfusion Imaging benefit and use:</p>

A

<p>Benefit: superior to ETT in detection of CAD, localisation of ischaemia and assessing the size of an affected area.</p>

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20
Q

An ECG showing a prominent R wave in the R precordial lead suggests what?
Anatomically/functionally: (1)
Diagnosis: (1)

A

Anatomically/functionally:
1. Right ventricular heave
Diagnosis:
1. Mitral regurgitation.

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21
Q

<p>Where would you auscultate for tricuspid regurgitation?</p>

A

<p>Primary Site: Lower left sternal edge

| Radiates to: Lower right sternal edge and liver.</p>

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22
Q

Increased marked atrial volume, with little changes to pulmonary vasculature can lead to what type of heart arrythmia, in which condition?

A

Arrhythmia: Atrial fibrillation
Condition: Mitral regurgitation.

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23
Q

Describe the apex beat of an individual with Mitral regurgitation: (2)

A
  1. Brisk

2. Hyperdynamic.

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24
Q

How is the P wave affected in Mitral Stenosis following ECG.

A
  1. P wave > 0.12 seconds
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25
Q

<p>Where would you auscultate for aortic regurgitation?</p>

A

<p>Primary Site: Left sternal angle

| Radiates to: Down the left sternal edge towards apex.</p>

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26
Q

What is right ventricular heave indicative of? (2)

A
  1. Mitral Stenosis

2. Mitral Regurgitation.

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27
Q

Medical intervention for mitral regurgitation (2)

A
  1. Mitral valve apparatus or repair

2. Mitral valve replacement.

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28
Q

<p>Give 4 differential diagnoses for a loud first heart sound</p>

A

<p>1. Hyper-dynamic circulation - fever, exercise

2. Mitral stenosis
3. Atrial myxoma - rare.
4. Severe Aortic regurgitation.</p>

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29
Q

<p>Describe 4 features of the limb of a patient with peripheral vascular disease:</p>

A

<p>1. Cold

2. White
3. Painful
4. Pulseless.</p>

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30
Q

<p>Give 3 differential diagnoses for a loud aortic component of the second heart sound</p>

A

<p>1. Systemic hypertension

2. Dilated aortic root
3. Severe mitral regurgitation.</p>

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31
Q

Clinical Manifestations of Mitral Stenosis:

A
  1. Dysponea
  2. Haemoptysis from venous reupture
  3. Systemic embolism
  4. Left Atrial and Auricle Hypertrophy
  5. Chest pain
  6. Hoarseness due to compression of left recurrent laryngeal nerve.
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32
Q

How is the P wave affected in Mitral Regurgitation?

A
  1. P > 0.12
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33
Q

<p>How can you diagnose chronic stable angina?</p>

A

<p>Cardiac catheterisation.</p>

34
Q

<p>Comparing ECG at rest to ECG on exertion with chest pain can help identify what sign of what condition?</p>

A

<p>ST segment depression, indicative of stable angina. - using ETT.</p>

35
Q

Describe the heart sound for: Aortic Regurgitation (5)

A
  1. Early Diastolic
  2. Descrescendo
  3. Soft mumur
    Sound 1: Normal
    Sound 2: Normal
36
Q

<p>Myocardial perfusion disadvantages:</p>

A

<p>expensive, invovles radioactivity; depdends on availability.</p>

37
Q

What is head at the apex upon auscultation in mitral stenosis?

A
  1. Tapping apex

2. Diastolic Thrill

38
Q

What are 5 signs of mitral regurgitation?

A
  1. Pulmonary hypertension
  2. Atrial Fibrillation.
  3. Pulmonary oedema
  4. Cardiogenic Shock
  5. Right heart failure.
39
Q

<p>What may embolisms to multiple sites be the first clue of?</p>

A

<p>Cardiac disease called Atrial Myxoma.</p>

40
Q

<p>Where would you auscultate for mitral regurgitation?</p>

A

<p>Primary Site: Apex

| Radiates to: Left axilla, beneath the scapula.</p>

41
Q

<p>Describe 6 signs/symptoms associated with Chronic Heart Failure:</p>

A

<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>

42
Q

<p>Describe 5 Signs of Stable Angina</p>

A

<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>

43
Q

Describe an characteristic feature of the right ventricle in aortic stenosis, mitral regurgitation, mitral stenosis, but not aortic regurgitation? 1

A
  1. Right Ventricle Heave.
44
Q

Describe the pulse (2) and pulse pressure (1) typical with aortic regurgitation:

A 
Pulse: (Corrigan Sign)
1. Large 
2. Collapsing 
Pulse pressure: 
1. Wide
45
Q

<p>Where would you auscultate for ventricular septal defect?</p>

A

<p>Primary Site: Left sternal edge

| Radiates to: All over pericardium</p>

46
Q

Reduced Left Atrium compliance and pulmonary vasculature remodelling is associated with which sign and which valve pathology?

A

Sign: Pulmonary hypertension

Valve Pathology: Mitral Regurgitation

47
Q

<p>Give 3 signs of of hyperlipidaemia:</p>

A

<p>1. Corneal arcus (white ring around colour of eye)

2. Tendon xanthomata
3. Xanthelasma.</p>

48
Q

Treatment options for mitral stenosis:
Medical (3)
Interventional (2)

A

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

49
Q

<p>What symptom may individuals with chronic arterial insufficiency/peripheral vascular disease present with other than oedema?</p>

A

<p>Claudication - intermittent - i.e. pain arises when walking and goes away at rest.</p>

50
Q

Describe the JVP of a patient with Aortic Stenosis: 2

A
  1. Prominent if RH failure

2. Presents with low blood pressure.

51
Q

What are two dangerous patterns of coronary artery disease? 2

A
  1. Left main stem stenosis

2. 3 vessel coronary artery disease

52
Q

<p>What are 3 treatments for angina to reduce disease progress.</p>

A

<p>1. Statins

2. ACE inhibitors
3. Aspirin.</p>

53
Q

<p>Exercise Tolerance Test can be used to diagnose: (1)</p>

A

<p>Stable Angina</p>

54
Q

<p>Mitral Stenosis</p>

A

<p>Primary Site: Apex

| Radiates to: XXX ! Does Not Radiate ! XXX</p>

55
Q

What are – symptoms of mitral regurgitation?

A
  1. breathlessness (due to pulmonary oedema and cardiogenic shock, and AF)
  2. Fatigue, right heart failure
  3. Palpitations (AF)
56
Q

<p>What can a computed tomography coronary angiography be used to diagnose?</p>

A

<p>1. Stable Angina

2. Unstable Angina
3. Coronary Heart Disease</p>

57
Q

<p>Blood investigations around Angina: (6)</p>

A

<p>1. FBC

2. Lipid profile
3. Fasting glucose
4. Electrolytes
5. Liver function
6. Thyroid function</p>

58
Q

<p>In terms of the level of vessels affected what does a strong EET (early) result suggest.</p>

A

<p>Multiple coronary vessels affected</p>

59
Q

<p>Where would you auscultate for aortic stenosis?</p>

A

<p>Primary Site: Apex

| Radiates to: Towards upper right sternal edge, over carotids.</p>

60
Q

Describe the heart sound for: Aortic Stenosis (6)

A
  1. Late peaking
  2. loud at bases
  3. harsh
  4. radiating to carotids
    Sound 1: Normal
    Sound 2: Less audible A2
61
Q

<p>If symptoms are not controlled, how might you treat an angina patient, after checking general measures, and attempting medical treatment?</p>

A

<p>1. Revascularisation = percutaneous coronary intervention PCT &amp;amp; coronary after bypass grafting CABG. mainly for symptom relief</p>

62
Q

Describe the pulse of a patient with Aortic Stenosis: 2

A
  1. Small volume

2. Slowly rising.

63
Q

<p>How can you differentiate between possible heart failure and deep vein thrombosis, a lower limb blood clot, or pulmonary embolism?</p>

A

<p>Heart failure = bilateral leg oedema

| DVT, Blood Clot, PE = unilateral leg oedema.</p>

64
Q

<p>Where would you auscultate for pulmonary stenosis?</p>

A

<p>Primary Site: Upper left sternal edge 2nd Intercostal Space
Radiates to: Towards left clavicle, beneath left scapula.</p>

65
Q

What might an echocardiography show in mitral stenosis?

A
  1. Thickening/scaring of valve leaflets

2. Fusion of commissures.

66
Q

<p>Arterial atheroma is often what in nature?</p>

A

<p>1. Eccentric</p>

67
Q

<p>Patholigical Q-waves from an echocardiogram indicate: (2)</p>

A

<p>1. prior myocardial infarction

| 2. LVH = high voltages, lateral ST-segment depression or "strain pattern".</p>

68
Q

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?

A
  1. Chest X-Ray

2. Left Atrium Hypertrophy.

69
Q

Describe the heart sound for: Mitral Stenosis (1)

A

Mid diastolic murmur

70
Q

<p>Explain the principles of myocardial perfusion</p>

A

<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>

71
Q

Describe the heart sound for: Mitral Regurgitation (7)

A
  1. Holosystolic
  2. Blowing
  3. Loud at apex
  4. radiating to axilla
  5. No relationship between intensity and severity
    Sound 1: Early A2
    Sound 2: Loud P2
72
Q

Describe the Apex beat of a patient with Aortic Stenosis: 2

A
  1. Vigorous

2. Sustained

73
Q

Name 4 leaflet causes of aortic regurgitation:

A
  1. Bicuspid aortic valve
  2. Rheumatic heart disease
  3. Endocarditis
  4. Myxomatous degeneration.
74
Q

<p>In heart failure where would oedema occur in a patient that has experienced prolonged bed rest?</p>

A

<p>Sacrum.</p>

75
Q

How does the medical treatment for aortic stenosis differ compared to other valvular diseases? 1
What can patients receive? 1

A
  1. Medical treatment is limited to those who develop heart failure.
  2. Patients can receive medical intervention: Aortic valve replacement or repair.
76
Q

Name two aortic causes of aortic regurgitation:

A
  1. Dilated aorta (Marfans & Hypertension)

2. Connective tissue disorders

77
Q

What should the ejection fraction be for a patient to be deemed ideal for coronary artery bypass grafting (CABG)? 1

A
  1. Greater than 20%
78
Q

<p>What can amend coronary artery stenosis?</p>

A

<p>1. An Angioplasty</p>

79
Q

<p>What might a chest X-ray show if a patient is suffering from angina-"like" chest pain? (1)</p>

A

<p>1. Pulmonary Oedema</p>

80
Q

<p>Give 2 differential diagnoses for a varied intensity of the first heart sound</p>

A

<p>1. Atrial fibrillation

2. Complete heart block.
3. Mild mitral regurgitation.</p>

81
Q

<p>In heart failure where would oedema occur in a relatively mobile patient?</p>

A

<p>Bilaterally occurs in legs - as a result of increased venous pressure.</p>

82
Q

Would the pulse in a patient with mitral valve defects change?

A

No, only reduced if

they proceed to heart failure.

Signs, Symptoms, Investigations (1 decks)

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