Station 3: Cardiology Flashcards
Causes of clubbing
ABDOMINAL: liver cirrhosis, primary biliary cirrhosis, inflammatory bowel disease
RESP: CF, bronchiectasis, lung cancer, fibrosis, abscess, empyema
CARDIO: infective endocarditis, congenital heart disease (cyanotic), atrial myxoma
OTHER: idiopathic, thyroid acropachy
Indications for permanent pacemaker
Bradyarrhythmias
- complete heart block
- Mobitz 2 heart block
- AV conduction block post MI
- trifasicular block with other concerning features e.g. syncope, episodes of complete heart block
Tachyarrhythmias
- sick sinus syndrome
- drug-resistant tachyarrhythmias
Clinical features of ASD
Ejection systolic murmur
Fixed split second heart sound
Left parasternal heave
ECG: right bundle branch block with either left OR right axis deviation and long PR interval
Ostium primum 15% (LEFT axis): childhood, associated with Downs, Klinefelters and Noonans, associated with MR/TR
Ostium secondum 70% (RIGHT axis): adulthood, mitral valve prolapse
PFO occurs in 25% of the population, paradoxical emboli
Clinical features of aortic stenosis
Slow rising pulse Narrow pulse pressure Heaving apex beat Ejection systolic murmur, loudest on expiration, radiating to carotids \+/- loss of S2 (indicator of severity)
Grading severity of aortic stenosis
MILD
area >1.5cm2
gradient <25mmHg
MODERATE
area >1-1.5cm2
gradient 25-50mmHg
SEVERE
area <1cm2
gradient >50mmHg
CRITICAL
area <0.7cm2
gradient >80mmHg
Clinical features of aortic regurgitation
Collapsing pulse Wide pulse pressure Thrusting apex Early diastolic murmur loudest sitting forwards on expiration \+/- mid diastolic murmur of aortic incompetence Pistol shot femorals Pulsating uvula, capillary nail beds Visible carotid pulsations Head bobbing
Causes of aortic regurgitation
Valve inflammation
- rheumatic fever
- infective endocarditis
- rheumatoid arthritis
- SLE
Aortic root problems
- dissection
- hypertension
- ankylosing spondylitis
Collagen disease
- marfan’s
- pseudoxanthoma elasticum
Causes of aortic stenosis
Bicuspid valve
Degeneration / calcification
Clinical features of coarctation
Symptoms
- headache
- epistaxis
- calf claudication
Clinical examination
- radio-radial delay
- midsystolic murmur in the left infraclavicular area
- left lateral thoracotomy scar
nb. surgical repair via left lateral thoracotomy scar to resect the coarctation segment and anastamose the two sections together, recoarctation is possible
Clinical features of patent ductus arteriosis
Symptoms
- development of pulmonary hypertension and Eisenmengers
Clinical examination
- machinery murmur
- wide collapsing pulse
- apical heave
Monitoring of a patient with Marfans
Annual ECHO to assess aortic valve and root
B blockade
Replace aortic root once >5cm
Ophthalmology follow up
DIfferential diagnosis for tall, aortic regurg, hypermobility
Marfans
Homocysteinuria (learning disability, autosomal recessive)
MASS (Mitral valve prolapse, mild non-progressive Aortic root dilatation, Skin and Skeletal manifestations)
Tell me about Marfan’s syndrome
Autosomal dominant
Defect in fibrillin
Presents with tall, slim phenotype, lens dislocation, chest wall deformities and scoliosis, pneumothorax
Cardiac manifestations such as aortic regurgitation, mitral valve, aortic root dilatation
Clinical features of mitral stenosis
Irregularly irregular pulse (AF)
Palmar erythema
Mitral facies (rosy cheeks with blueish tinge to the rest of the face)
Signs of pulmonary hypertension (RV heave, loud S2, functional tricuspid regurg)
Mid-diastolic murmur heard best at the apex
Loud S1 (opening snap)
Causes of mitral stenosis
Rheumatic fever
Degenerative mitral annular calcification
Congenital heart disease e.g. Shone’s syndrome
Infective endocarditis e.g. large vegetation
Atrial myxoma
