Year 4 Flashcards
What does the S1 heart sound represent?
Closure of the tricuspid and mitral valves, alongside the systolic contraction of the ventricles.
What causes the production of an S3 heart sound?
Chordae tendineae stretching to their maximum, twinging.
May be due to rapid filling, or stiff, weak ventricles.
Can S3 be physiological?
Yes, in those under 40 only.
What occurs in S1?
AV valves close, meaning blood flows into ventricles and cannot return to atria.
What occurs in S2?
Blood leaves hart, with closure of semilunar valves preventing backflow of blood into the ventricles.
Is S4 normal?
No, this is always abnormal.
What does S4 indicate?
A stiff/hypertrophied ventricle - atria struggles to pass blood downwards.
Where can aortic valve be auscultated?
2nd ICS RHS of sternum
Where can pulmonary valve be auscultated?
2nd ICS LHS of sternum
Where can tricuspid valve be auscultated?
5th ICS LHS of sternum
Where can mitral valve be auscultated?
5th ICS LHS at mid-clavicular line
What is Erb’s point?
The best place to listen to all heart sounds.
3rd ICS LHS of sternim
How does mitral stenosis affect the left atrium?
Causes hypertrophy due to increased pressure to push blood through.
How does aortic stenosis affect the left ventricle?
Causes hypertrophy.
How does valvular regurgitation affect the preceding heart chamber?
The leakage of blood results in stretching of chamber due to increased volume.
Over time results in dilatation.
What are the 2 main causes of mitral stenosis?
Rheumatic heart disease
Infective endocarditis
Which murmur may be described as a mid-diastolic, low-pitched, rumble?
Mitral stenosis
Why does mitral stenosis cause a loud S1?
As thick valves require high systolic force to shut.
Why does mitral stenosis cause malar flush?
Due to backlog of blood in pulmonary circulation - as valve is stenotic. Thus, patient will have raised CO2 and will therefore vasodilate to compensate.
Why does mitral regurgitation cause a pan-systolic murmur?
As valvular incompetence may mean a backlog of blood in left side of heart, producing strain - chorda tympani stretch as much as possible.
What is the most common heart valve disease?
Aortic stenosis
Which murmur radiates to the carotids?
Aortic stenosis
What is a collapsing pulse associated with?
Aortic regurgitation
Which murmur radiates to the left axilla?
Mitral regurgitation
How does hypercalcaemia affect an ECG?
Shortened QT interval
Which pattern of inheritance is seen in HOCM?
Autosomal dominant
How can diabetes contribute to postural hypotension?
Can cause autonomic nerve dysfunction.
Does isosorbide mononitrate reduce mortality?
No, it is a long-acting nitrate.
Provides symptomatic relief only.
How long should DOAC therapy be continued in an unprovoked PE/DVT?
6 months
Also applies to those developed in context of malignancy due to ongoing hypercoaguable state.
What is the only CCB licenced for use in heart failure?
Amlodipine
Consider use carefully - ACEi and Beta blockers are first-line.
What triad of symptoms are seen in right heart failure?
Raised JVP
Ankle oedema
Hepatomegaly
What is the mechanism of BNP release in heart disease?
Strain of left ventricle triggers release.
High levels within blood are associated with a poor prognosis.
Is raised BNP specific to heart failure?
No, may be due to a myriad of causes.
What are the 2 pathologies through which chronic heart failure can develop?
Impaired LV contraction (systolic failure)
Impaired LV relaxation (diastolic failure)
What is orthopnoea?
Shortness of breath which worsens when lying flat.
How should heart failure be managed medically?
Think ‘ABAL’
ACE inhibitor
Beta blocker
Aldosterone antagonist
Loop diuretic
When should ACE inhibitors be avoided in the context of cardiac pathology?
Valvular heart disease
Causes reduced perfusion of cardiac muscle.
Which side-effect is seen in both ACE inhibitors and aldosterone antagonists?
Hyperkalaemia
What should be monitored regularly in heart failure?
Urea and electrolytes
Due to side-effect profile of the medications used.
What is an important cause to exclude in pyrexia of unknown origin?
Infective endocarditis
What form of medication is eplerenone?
Aldosterone antagonist
Same drug class as spironolactone.
Do loop diuretics improve prognosis in heart failure?
No, only improves symptoms.
How is orthostatic hypotension measured?
After 3 minutes of standing, check BP.
If >/= 20mmHg systolic drop or 10mmHg diastolic drop - this is diagnostic.
Think ‘3, 2, 1, drop!’
What should be carried out to screen for end-organ damage in BP> 180/120mmHg?
ECG
Urine dipstick
Bloods
How should bradycardia WITH signs of shock be managed?
IV atropine
What are ectopics?
Extra systolic beats.
Described like ‘‘one big thump’’ - these are very common.W
What % of SVT patients resolve with vasovagal manoeuvres?
Around 85%
How long should a QRS complex last?
<0.12s
Which electrolyte disturbances produces flattened T waves?
Hypokalaemia
How long should PR interval last?
0.12-0.2s
Delay suggests issue with AV node conduction.
What is meant by Wenckebach phenomenon?
Progressive prolongation of PR interval until a QRS is not produced.
Also called Mobitz I.
What leads are affected in lateral MI?
Leads I, aVL, V4-V6.
Circumflex artery is affected.
What leads are affected in an anteroseptal MI?
Leads V1-V3.
Left anterior descending artery affected.
What leads are affected in an inferior MI?
Leads II, III, aVF.
May also produce heart block.
Which valve is most commonly affected in infective endocarditis?
Mitral valve
How many positive blood cultures are needed to diagnose infective endocarditis?
Two - requires presence of typical causative organism.
OR
Three with atypical organism present.
What scoring system is used in endocarditis diagnosis?
Modified Duke’s criteria.
What is the most specific ECG change in pericarditis?
PR depression
Classically cause widespread saddle ST elevation.
What is Kussmaul’s sign?
A paradoxical rise in JVP seen during inspiration.
Common in constrictive pericarditis.
What is the first-line management of acute pericarditis?
NSAIDs and colchicine
In which condition are janeway lesions seen?
Staph. aureus
What form of medication is eplerenone?
Aldosterone antagonist - like spironolactone.
Do loop diuretics improve prognosis in heart failure?
No, only improve symptoms.
How is orthostatic hypotension measured?
After 3 minutes of standing, check BP.
If >20mmHg systolic drop or >10mmHg diastolic drop.
Think ‘3, 2, 1 drop’.
What should be carried out to screen for end-organ damage in BP > 180/120mmHg?
ECG
Urine dipstick
Bloods
How should bradycardia WITH signs of shock be managed?
IV atropine
What are ectopics?
Extra systolic beats.
Described as ‘‘one large thump’’.
What % of SVT patients resolve with vasovagal maneouvres?
Around 85%.
