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Year 3 MedEd > Cardio3 > Flashcards

Flashcards in Cardio3 Deck (25)
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1
Q

What are your systolic murmurs?

A

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

2
Q

What are your diastolic murmurs?

A

Aortic regurgitation
Mitral stenosis

ARMS- 2 of them aka di-astolic [di=2]

3
Q

What are the causes of systolic murmurs?

A
Age-related cacification (AS)
Congenital bi-cuspid aortic valve (AS)
Infective endocarditis (TR- think IVDU)
Rheumatic HD (Commonly MR)
Connective tissue disorders (Marfan, EDS, osteogenesis imperfecta)
4
Q

What is the epidemiology of systolic murmurs?

A

3% of 75 yr olds

M>F

5
Q

What are the symptoms of systolic murmurs?

A
Dyspnoea
Syncope on exertion
Angina
HF symptoms
Palpitations
6
Q

What are the signs of aortic stenosis?

A

Narrow pulse pressure
Slow rising pulse
Thrill

7
Q

What are the signs of mitral regurgitation?

A

Normal/irregularly irregular pulse

Laterally displaced apex beat

8
Q

What are the signs of tricuspid regurgitation?

A

Raised JVP
Parasternal heave
Signs of RHF
(pleural effusion, hepatomegaly, ascites, pitting oedema)

9
Q

Where does an aortic stenosis murmur radiate to?

A

The right carotid artery

10
Q

Where does a mitral murmur radiate to?

A

The left axilla

11
Q

What murmur is accentuated upon expiration and leaning forwards?

A

Aortic regurgitation

12
Q

What murmur is accentuated upon expiration and leaning to the left?

A

Mitral stenosis and regurgitation

13
Q

What murmurs are accentuated upon inspiration?

A

Tricuspid and pulmonary murmurs

14
Q

Which murmur would be present if a CXR showed aortic valve calcification?

A

Aortic stenosis

15
Q

Which murmur would be present if a CXR showed right sided enlargement?

A

Tricuspid regurgitation

16
Q

Which murmur would be present if a CXR showed cardiomegaly calcification?

A

Mitral regurgitation

17
Q

What can cause diastolic murmurs?

A

Infection (RhHD, IE)
Congenital (bicuspid aortic valve)
Aortic dilation (aortitis, HTN)
CTD

18
Q

Rheumatic heart disease characteristically causes which valvular defect?

A

Mitral stenosis

19
Q

What are the symptoms of AR/MS?

A
Dyspnoea
Syncope on exertion
Angina
HF signs
Palpitations
Orthopnoea
20
Q

What would you see on examination of a Pt with AR?

A

Wide pulse pressure
Water hammer pulse
Displaced apex beat

21
Q

What would you see on examination of a Pt with MS?

A

Malar flush
Thready/irregularly irregular pulse
Tapping apex, parasternal heave

22
Q

Which is the early diastolic and which is the mid diastolic murmur?

A

Early diastolic- aortic regurgitation

Mid diastolic- mitral stenosis

23
Q

A 49-year-old woman presents with increasing shortness of breath on exertion developing over the past three months. She has no chest pain or cough, and has noticed no ankle swelling. On examination, blood pressure is 158/61mmHg, pulse is regular at 88 beats per minute and there are crackles at both lung bases. There is a decrescendo diastolic murmur at the left sternal edge. What is the most likely diagnosis?

A. Aortic regurgitation
B. Aortic stenosis 
C. Mitral regurgitation 
D. Mitral stenosis 
E. Tricuspid regurgitation
A

A. Aortic regurgitation

Note the wide pulse pressure, the lung base crackles, and the decrescendo diastolic murmur on the LEFT sternal edge (AS is heard at the right sternal edge)

24
Q

You see a 57-year-old woman who presents with worsening shortness of breath coupled with decreased exercise tolerance. She had rheumatic fever in her adolescence and suffers from essential hypertension. On examination, she has a mid-diastolic murmur heard loudest over the mitral area. Which of the following is not a clinical sign associated with this particular diagnosis?

A. Malar flush 
B. Atrial fibrillation 
C. Pan-systolic murmur which radiates to axilla 
D. Tapping, un-displaced apex beat 
E. Right ventricular heave
A

C. Pan-systolic murmur which radiates to axilla

Note the Rheumatic heart disease, and murmur loud at the mitral area indicates mitral stenosis, which is a mid-diastolic murmur.

25
Q

An 8 year old boy comes to the GP with his mother for a check-up. You find the child to be extremely sociable and friendly, with some mild learning difficulties. You also note distinct facial features including broad forehead, short nose and full cheeks. On auscultation of his chest, you detect a murmur in the right 2nd intercostal space, loudest on expiration. What is the most likely diagnosis?

A. Hypertrophic obstructive cardiomyopathy
B. Infective endocarditis 
C. Aortic stenosis
D. Aortic regurgitation
E. Mitral stenosis
A

C. Aortic stenosis

There were no indications of infx, or HOCM. Mitral stenosis tends to develop with Rheumatic heart disease, which the child did not have. Aortic regurgitation is heard louder on the left sternal border.