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Flashcards in Cardio Deck (22):
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Causes of aortic stenosis

Rheumatic fever
Degenerative calcification
Congenital bifid valve
IE
Paget's disease of the bone

2

DDx for ejection systolic murmur loudest on expiration

Aortic stenosis
Hypertrophic obstructive cardiomyopathy
Supravalvular aortic stenosis

3

How do you classify aortic stenosis severity?

valve area
normal 3-4 cm squared. mild >1.5, mod 1.5-1, severe 50mmHg

4

What are the clinical signs of severe AS?

slow rising, low volume pulse
ejection systolic murmur radiating to carotids
aortic thrill at aortic area
heaving apex
reversed splitting of S2
soft or absent aortic component of S2

5

complications of aortic stenosis?

LVF
AF and VT
pulmonary hypertension
heart block (calcification of conduction system)
IE
haemolytic anaemia

6

Indications for aortic valve replacement?

symptomatic severe stenosis (mean gradient >50mmHg)
asymptomatic:
mod/severe AS pt having CABG/other valve surgery
severe AS and VT/LV sys dysfunction/valve area <0.6

7

Features of pulmonary hypertension on cardiac exam

loud pulmonary component of S2,
pansystolic murmur loudest on inspiration of tricuspid regurg
large v waves of JVP
parasternal heave (RVH)

8

features of mitral stenosis on examination

tapping apex beat (palpable S1)
loud S1 (could be soft if leaflets are calcified and immobile - not an indicator of severity)
opening snap in early diastole followed by a mid diastolic rumbling murmur
+/- malar flush

9

Causes of mitral stenosis

rheumatic fever (most common)
congenital
rheumatoid arthritis
SLE

10

DDx for mid-diastolic rumbling murmur

mitral stenosis
left atrial myxoma or thrombus

11

Causes of mitral regurgitation

leaflets - rheumatic, CT, fibrosis
valve annulus - LV dilatation, calcification
chordae/papillae rupture - infiltration (amyloidosis), fibrosis

12

signs of tricuspid regurg

PSM
raised JVP with cannon v waves
pulsatile hepatomegaly
peripheral oedema and ascites

13

Causes of tricuspid regurgitation

pulmonary hypertension
IE
rheumatic fever
carcinoid syn (increased 5-HT from gut primary -> R side scarring and thickening -> TR +/- pulmonary stenosis

14

complications of valve replacement

prosthesis dysfunction and LVH
haemolysis
warfarin - bleeding
thromboembolism (despite warfarin)
infective endocarditis (staph if post-op, strep viridans if late)

15

Indications for implantable cardioverter defibrillator (ICD)

survived MI due to VF/VT
sustained VT causing syncope/haemodynamic compromise
familial condition (LQTS,Brugada, HCM, ARVD)
LFEF

16

Indications for cardiac resynchronisation therapy (CRT) biventricular pacemakers (BiV)

LVEF 150
SR and QRS >120 and dyssynchrony on echo

17

Signs of constrictive pericarditis

right heart failure
raised JVP
Kussmaul's sign (JVP raises on inspiration)
pericardial knock (S3 - ventricular filling into a stiff pericardial sac)
peripheral oedema/ascites/hepatomegaly

18

Causes of constrictive pericarditis

post MI (Dressler's syn)
TB
Trauma (surgery)
radioTherapy
connective Tissue disease (RA, SLE)

19

Signs of a VSD

ESM or PSM localised to the left sternal edge, no radiation

20

associations with a VSD

Tetralogy of Fallot (overriding aorta, RVH, VSD, pulmonary stenosis)
coarctation of the aorta
PDA

21

Management of HOCM patient

rhythm disturbance - ICD
LVOT gradient >30 and Sx (SOB, syn/pre-syn/angina):
-B-Blockers
-pacemaker
-percutaneous alcohol septal ablation
-surgical septal myomectomy
-avoid strenuous sport
-family counselling and screening (AD inheritance)

22

poor prognosis factors for HOCM

young age at diagnosis
syncope
family history of sudden death
septal thickness >3cm