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Block A > WCS5 Cardiology Fever and murmur > Flashcards

WCS5 Cardiology Fever and murmur Flashcards

1
Q

Valvular stenosis and regurgitation causes what kind of structural chamber changes

A

stenosis - hypertrophy of proximal chamber, dilation when chamber fails

regurgitation - dilation of chambers on either side of valve

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2
Q

what heart problem is progressive exertional dyspnea indicative of

A

LHF

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3
Q

what heart problem

is ankle edema, hepatic pain indicative of

A

RHF

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4
Q

CVS investigations

A
  • ECG
  • CXR
  • Echo
  • exercise testing
  • cardiac catheterisation
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5
Q

what does echo assess

A
  • valvular archi
  • chamber size
  • chamber function
  • doppler: valvular gradient, DSE to assess ischemia and contractile reserve
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6
Q

what does exercise testing assess

A

functional capacity

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7
Q

what does cardiac catheterization assess

A
  • CAD
  • pressure gradient
  • regurgitant lesions by contrast
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8
Q

chronic rheumatic disease commonest valve involvement

A

mitral
aortic + mitral
aortic tricuspid

MS> MR+MS> MR

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9
Q

causes of MS

A

95% rheumatic

5% congenital

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10
Q

complication of MS

A

PHT

RHF

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11
Q

predisposing structural factors for IE

A
  • valvular (MR>MS, AR>AS, prosthetic, normal in ivdu

- shunts (congenital, postsurgical for VSD, PDA, AV fistula

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12
Q

History of MS

A

respiratory symptoms (exertional dyspnea, PND)
RHF (edema, hepatic pain)
afib (palpitation, fatigue - cardiac decompensation)
systemic embolization (enlarged LA –> stasis)

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13
Q

why does MS cause afib

A

dilated LA

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14
Q

how does afib cause cardiac decompensation

A

afib –> reduced LV filling
afib –> increased ventricular systole (higher rate –> lower diastolic LV filling)
–> lower stroke volume and CO

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15
Q

signs of MS

A

General exam (RHF, LHF)

  • malar flush if PHT
  • ankle/sacral edema
  • small pulse volume, irregular pulse if afib
  • loss of venous a wave if afib
  • raised jvp if RHF

Precordium

  • nondisplaced tapping apex
  • parasternal heave (RVH/ PHT)
  • loud S1
  • loud P2 with opening snap if PHT
  • mid-diastolic rumble at apex best heard with exercise/ left lateral position

Complications

  • basal creps
  • cold extremities/ stroke (emboli)
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16
Q

Investigations for MS-

A
  • CXR (large LA - straight left heart border; pulmonary edema - Kerley A B lines)
  • ECG (P mitrale, AF, RVH)
  • Echo (thickened + dooming; parallel diastolic mvt of MV; size of MV opening)
  • Cardiac catheterization (CAD asso)
17
Q

parameters to assess MS severity

A
  • symptoms
  • presence of PHT
  • duration of murmur
  • interval between S2 and OS
18
Q

what is p mitrale

A

LA abnormality on ECG, (MS LA enlargement)
A. double humped p wave in II
B. wide and deep negative deflection in V1 p wave

19
Q

treatment for MS

A
  • diuretics
  • digoxin for Afib
  • anticoagulation for valvular afib or history of embolisation
  • valvuloplasty
  • valvotomy
  • MV replacement
20
Q

causes of acute cardiac decompensation in MS

A
  • afib (reduced ventricular filling and thus CO)
  • chest infection
  • pregnancy (increased intravascular volume)
21
Q

MR causes

A
  • rheumatic (50%) tgt with MS
  • MVP
  • ruptured chordae tendinae (degen, collagen disease, IE, active rheumatic heart)
  • papillary muscle dysfunction (MI)
  • LV dilation
22
Q

signs of MR

A

General

  • (ankle/sacral edema)
  • afib if tgt with MS
Precordial
- displaced apex
(- systolic thrill)
- parasternal heave if PHT (late/MS)
- Soft S1 
- pansystolic murmur best heard apex, radiating to axilla
- S2 buried in systolic murmur
- S3 present
- S4 if acute regurgitation (acute LV failure in ruptured tendinae --> no time for LV to adapt to increased volume)
23
Q

Investigations for MR

A
  • ECG (afib, LVH)
  • CXR (left heart enlargement, pulmonary edema)
  • echo (cause of MR)
  • Cardiac catheterization (severity of MR, CAD)
24
Q

MVP associated syndromes

A
  • secondary ASD
  • Turners
  • PDA
  • WPW
  • Marfans
  • osteogenesis imperfecta
25
Q

MVP signs

A
  • mid/late systolic click accentuated by standing/ Valsalva

- late systolic murmur best heard at apex accentuated by standing/ Valsalva

26
Q

complications of MVP

A
  • emboli

- Afib

Block A (11 decks)

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