Valves (SBA medicine not clinically useful so focus on closer to exams)

Question 1

Signs of AS:
Pulse
Apex beat
HS

Answer 1

Slow rising pulse, narrow pulse pressure
Forceful/heaving non displaced apex
Quiet A2, S4, ejection click

Question 2

Difference between AS and aortic sclerosis

Answer 2

In sclerosis:
No radiation
Normal pulse
Valve thickening, no pressure gradient

Question 3

Diagnostic Ix for AS

Answer 3

Echo and doppler

Question 4

Indications for valve replacement in AS

Answer 4

Severe symptomatic

Asymptomatic + EF less than 50%

Question 5

Causes of AR

Answer 5

IE, dissection, rheumatic
Connective tissue
Ank spond, RA

Question 6

Indicator of severe AS

Answer 6

Quiet A2, S4, narrow pulse pressure, LVF

Question 7

Signs of AR
Pulse
Apex
HS

Answer 7

Collapsing pulse, wide pulse pressure
Displaced, thrusting apex
S3

Question 8

AR eponyms
Corrigan’s sign
De Mussets

Answer 8

C - Carotid pulsation

D - Head nodding

Question 9

AR eponyms
Quincke
Traube
Muller’s

Answer 9

Q - capillary pulsation in nail bed
T - pistol shot sound over femoral
M - bobbing of uvula

Question 10

AR eponyms
Austin flint murmur
Duroziez’s

Answer 10

A - mid diastolic murmur at apex, in severe AR

Systolic murmur over femoral artery

Question 11

Mx AR

Answer 11

Optimise cardiac med, valve replacement

Question 12

MS pulse and JVP features

Answer 12

AF, low pulse volume

JVP: prominent a wave (or absent if AF), large v wave

Question 13

MS apex, HS and murmur

Answer 13

Tapping apex
Loud S1, loud P2, early diastolic opening snap
MDM + Graham Steel murmur (Early DM, due to pulmonary HTN)

Question 14

Indicator severe MS

Answer 14

Mitral facies (malar flush)
Longer murmur
Opening snap closer to 2nd HS
RVF

Question 15

Complications of MS

Answer 15

Pulmonary HTN
Emboli
Hoarseness - recurrent laryngeal nerve palsy (Ortner’s syndrome)
Dysphagia, bronchial obstruction

Question 16

Mx MS

Answer 16

Optimised cardiac med, surgical (percutaneous balloon valvuloplasty)

Question 17

MR apex, HS, murmur

Answer 17

Apex - displaced, heave/hyperdynamic
HS - soft S1, loud P2, split S2
Murmur - PSM, radiate to axilla

Question 18

Mitral valve prolpase/Barlow syndrome murmur

Answer 18

Mid systolic click, late systolic murmur

Question 19

Double/jerky apex beat

Answer 19

HOCM

Question 20

Pulsus paradox seen in

Answer 20

Severe asthma and cardiac tamponade

Question 21

Pulsus alternans seen in

Answer 21

Severe LVF

Question 22

To increase HOCM and mitral valve prolapse murmur

Answer 22

Valsalva

Question 23

Hand grip does what to HOCM and mitral valve prolpase

Answer 23

Intensifies mitral valve prolapse

Question 24

Carey coombs murmur is… and seen in…

Answer 24

Short mid diastolic rumble

Due to thickened mitral valve

Question 25

JVP feature in AF

Answer 25

A wave absent

Question 26

JVP feature in cardiac tamponade and constrictive pericarditis

Answer 26

Large x descent

Question 27

JVP feature in tricuspid regurgitation

Answer 27

Large v wave (+ prominent y descent)

Question 28

JVP feature in complete heart block/venticular ectopics

Answer 28

Cannon a waves

Question 29

Large a waves in

Answer 29

Pulmonary hypertension/stenosis
Tricuspid stenosis
HOCM

Question 30

Steep y wave in

Answer 30

Constrictive pericarditis (+ tricuspid regurgitation)

Question 31

Tricuspid regurg murmur

Answer 31

Carvallo sign (louder during inspiration)