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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

Where would you auscultate for aortic regurgitation?

Primary Site: Left sternal angle | Radiates to: Down the left sternal edge towards apex.

26
What is right ventricular heave indicative of? (2)
1. Mitral Stenosis | 2. Mitral Regurgitation.
27
Medical intervention for mitral regurgitation (2)
1. Mitral valve apparatus or repair | 2. Mitral valve replacement.
28

Give 4 differential diagnoses for a loud first heart sound

1. Hyper-dynamic circulation - fever, exercise 2. Mitral stenosis 3. Atrial myxoma - rare. 4. Severe Aortic regurgitation.

29

Describe 4 features of the limb of a patient with peripheral vascular disease:

1. Cold 2. White 3. Painful 4. Pulseless.

30

Give 3 differential diagnoses for a loud aortic component of the second heart sound

1. Systemic hypertension 2. Dilated aortic root 3. Severe mitral regurgitation.

31
Clinical Manifestations of Mitral Stenosis:
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.
32
How is the P wave affected in Mitral Regurgitation?
1. P > 0.12
33

How can you diagnose chronic stable angina?

Cardiac catheterisation.

34

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

ST segment depression, indicative of stable angina. - using ETT.

35
Describe the heart sound for: Aortic Regurgitation (5)
1. Early Diastolic 2. Descrescendo 3. Soft mumur Sound 1: Normal Sound 2: Normal
36

Myocardial perfusion disadvantages:

expensive, invovles radioactivity; depdends on availability.

37
What is head at the apex upon auscultation in mitral stenosis?
1. Tapping apex | 2. Diastolic Thrill
38
What are 5 signs of mitral regurgitation?
1. Pulmonary hypertension 2. Atrial Fibrillation. 3. Pulmonary oedema 4. Cardiogenic Shock 5. Right heart failure.
39

What may embolisms to multiple sites be the first clue of?

Cardiac disease called Atrial Myxoma.

40

Where would you auscultate for mitral regurgitation?

Primary Site: Apex | Radiates to: Left axilla, beneath the scapula.

41

Describe 6 signs/symptoms associated with Chronic Heart Failure:

1. Fatigue on minimal exertion 2. Exertional dyspnoea 3. Peripheral oedema (bilateral) 4. Abdominal discomfort (hepatic distension) 5. Nocturia 6. Weight loss and cachexia.

42

Describe 5 Signs of Stable Angina

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

43
Describe an characteristic feature of the right ventricle in aortic stenosis, mitral regurgitation, mitral stenosis, but not aortic regurgitation? 1
1. Right Ventricle Heave.
44
Describe the pulse (2) and pulse pressure (1) typical with aortic regurgitation:
``` Pulse: (Corrigan Sign) 1. Large 2. Collapsing Pulse pressure: 1. Wide ```
45

Where would you auscultate for ventricular septal defect?

Primary Site: Left sternal edge | Radiates to: All over pericardium

46
Reduced Left Atrium compliance and pulmonary vasculature remodelling is associated with which sign and which valve pathology?
Sign: Pulmonary hypertension | Valve Pathology: Mitral Regurgitation
47

Give 3 signs of of hyperlipidaemia:

1. Corneal arcus (white ring around colour of eye) 2. Tendon xanthomata 3. Xanthelasma.

48
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
49

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

Claudication - intermittent - i.e. pain arises when walking and goes away at rest.

50
Describe the JVP of a patient with Aortic Stenosis: 2
1. Prominent if RH failure | 2. Presents with low blood pressure.
51
What are two dangerous patterns of coronary artery disease? 2
1. Left main stem stenosis | 2. 3 vessel coronary artery disease
52

What are 3 treatments for angina to reduce disease progress.

1. Statins 2. ACE inhibitors 3. Aspirin.

53

Exercise Tolerance Test can be used to diagnose: (1)

Stable Angina

54

Mitral Stenosis

Primary Site: Apex | Radiates to: XXX ! Does Not Radiate ! XXX

55
What are -- symptoms of mitral regurgitation?
1. breathlessness (due to pulmonary oedema and cardiogenic shock, and AF) 2. Fatigue, right heart failure 3. Palpitations (AF)
56

What can a computed tomography coronary angiography be used to diagnose?

1. Stable Angina 2. Unstable Angina 3. Coronary Heart Disease

57

Blood investigations around Angina: (6)

1. FBC 2. Lipid profile 3. Fasting glucose 4. Electrolytes 5. Liver function 6. Thyroid function

58

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

Multiple coronary vessels affected

59

Where would you auscultate for aortic stenosis?

Primary Site: Apex | Radiates to: Towards upper right sternal edge, over carotids.

60
Describe the heart sound for: Aortic Stenosis (6)
1. Late peaking 2. loud at bases 3. harsh 4. radiating to carotids Sound 1: Normal Sound 2: Less audible A2
61

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

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

62
Describe the pulse of a patient with Aortic Stenosis: 2
1. Small volume | 2. Slowly rising.
63

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

Heart failure = bilateral leg oedema | DVT, Blood Clot, PE = unilateral leg oedema.

64

Where would you auscultate for pulmonary stenosis?

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

65
What might an echocardiography show in mitral stenosis?
1. Thickening/scaring of valve leaflets | 2. Fusion of commissures.
66

Arterial atheroma is often what in nature?

1. Eccentric

67

Patholigical Q-waves from an echocardiogram indicate: (2)

1. prior myocardial infarction | 2. LVH = high voltages, lateral ST-segment depression or "strain pattern".

68
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?
1. Chest X-Ray | 2. Left Atrium Hypertrophy.
69
Describe the heart sound for: Mitral Stenosis (1)
Mid diastolic murmur
70

Explain the principles of myocardial perfusion

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.

71
Describe the heart sound for: Mitral Regurgitation (7)
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
Describe the Apex beat of a patient with Aortic Stenosis: 2
1. Vigorous | 2. Sustained
73
Name 4 leaflet causes of aortic regurgitation:
1. Bicuspid aortic valve 2. Rheumatic heart disease 3. Endocarditis 4. Myxomatous degeneration.
74

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

Sacrum.

75
How does the medical treatment for aortic stenosis differ compared to other valvular diseases? 1 What can patients receive? 1
1. Medical treatment is limited to those who develop heart failure. 2. Patients can receive medical intervention: Aortic valve replacement or repair.
76
Name two aortic causes of aortic regurgitation:
1. Dilated aorta (Marfans & Hypertension) | 2. Connective tissue disorders
77
What should the ejection fraction be for a patient to be deemed ideal for coronary artery bypass grafting (CABG)? 1
1. Greater than 20%
78

What can amend coronary artery stenosis?

1. An Angioplasty

79

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

1. Pulmonary Oedema

80

Give 2 differential diagnoses for a varied intensity of the first heart sound

1. Atrial fibrillation 2. Complete heart block. 3. Mild mitral regurgitation.

81

In heart failure where would oedema occur in a relatively mobile patient?

Bilaterally occurs in legs - as a result of increased venous pressure.

82
Would the pulse in a patient with mitral valve defects change?
No, only reduced if | they proceed to heart failure.

Signs, Symptoms, Investigations (1 decks)

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