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PACES - Final Week Revision > Cardiology > Flashcards

Cardiology Flashcards

(81 cards)

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1
Q

Ejection systolic murmur

A

Aortic stenosis
Aortic sclerosis
Coarctation of the Aorta
Pulmonary stenosis
Atrial septal defect
HOCM

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2
Q

Pansystolic murmur

A

Mitral regurgitation
Mitral valve prolapse
Tricuspid regurgitation
Ventricular septal defect

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3
Q

Mid-Diastolic murmur

A

Mitral stenosis
Austin-Flint murmur (in severe aortic regurgitation)
Myxoma

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4
Q

Early Diastolic murmur

A

Aortic regurgitation
Pulmonary regurgitation
Graham-Steel murmur (in severe mitral regurgitation)

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5
Q

Difference between HOCM and AS on examination?

A

AS murmur louder
HOCM murmur increased by standing from squatting
AS murmur radiates to carotids

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6
Q

ALWAYS present Cardio features of:

A

Scars
Atrial fibrillation
Heart failure
Infective endocarditis
Bruises (anticoagulation)

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7
Q

Mitral stenosis examination

A

Malar flush
Atrial fibrillation
Palpable/loud S1
Signs of pulmonary hypertension
Rumbling mid-diastolic murmur loudest on expiration

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8
Q

Causes of mitral stenosis

A

** Rheumatic fever **
Carcinoid syndrome
Congenital

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9
Q

Clinical features of severe mitral stenosis?

A

Pulmonary hypertension
Right heart failure
Long murmur

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10
Q

Indications for MS valve surgery?

A

Pulmonary hypertension
Symptomatic heart failure
Undergoing a CABG anyway

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11
Q

Clinical features of Aortic regurgitation

A

Quincke’s nail sign
Collapsing pulse
De Musset head bobbing sign
Muller’s bobbing uvula
Corrigan’s prominent carotid pulsations
Displaced apex
!!!Austin Flint mid-diastolic murmur!!!

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12
Q

Causes of Aortic regurgitation

A

Acute:
IE, aortic dissection

Chronic:
Aortic root dilatation (age-related, hypertension)
Rheumatic fever
Connective tissue disorders - Marfan syndrome, Ank Spond

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13
Q

Features of severe aortic regurgitation

A

Wide pulse pressure
Quiet S2
Austin-flint murmur
Left-sided heart failure

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14
Q

Indications for aortic valve replacement?

A

Severe symptoms
EF <50%
Valve area <1cm2
Aortic root diameter >50mm
Aortic valve gradient >50mmHg
Undergoing a CABG anyway

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15
Q

Features of severe aortic stenosis on examination

A

Narrow BP
Quiet S2
S4
Palpable thrill
Heart failure

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16
Q

When would you hear Ejection systolic + pan-systolic murmur?

A

Gallaverdin phenomenon (dissociation of aortic stenosis murmur)
Co-existent mitral valve disease

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17
Q

Causes of mitral regurgitation

A

Acute:
Infective endocarditis
Papillary muscle rupture after MI

Chronic:
Mitral valve prolapse
Rheumatic fever
Congenital

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18
Q

Features of severe mitral regurgitation?

A

Graham Steel murmur (pulmonary regurgitation due to pulm HTN from MR)
S3
Heart failure

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19
Q

Description of a Murmur

A

Timing (to carotids)
Location
Grade 3+
Radiation
Louder on inspiration or expiration

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20
Q

HOCM exam

A

Ejection systolic murmur
Heaving apex
Double apical pulse
+/- ICD

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21
Q

HOCM echo

A

asymmetrical septal hypertrophy, systolic anterior motion of the mitral valve (SAM),
a small LV cavity

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22
Q

Causes of cyanotic heart patient

A

Tetralogy of Fallot
Shunt - ASD, VSD, PDA —> Eisenmenger syndrome

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23
Q

Ventricular Septal Defect murmur?

A

Pan-systolic murmur

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24
Q

Atrial septal defect

A

Loud systolic murmur in pulmonary area
Down syndrome
Risk of stroke

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25
HOCM findings
Ejection-systolic loudest at left sternal edge Murmur louder on Vasalva manoeuvre Implantable cardiac defibrillator in place
26
HOCM associations
Atrial fibrillation Friedrich’s ataxia Myotonic dystrophy Wolff-Parkinson-White syndrome
27
Aortic stenosis associations
Coarctation of the aorta Heyde’s syndrome (AS + angiodysplasia)
28
Clinical indicators of severe aortic stenosis
Narrow BP quiet S2 S4 Palpable thrill / heaving apex Bibasal crepitations
29
Causes of dilated cardiomyopathy
Ischaemic heart disease Valvular disease Alcohol Amyloidosis Viral Autoimmune
30
Signs of mitral valve prolapse
Pansystolic murmur Quieter on squatting Louder on standing
31
Causes of mitral valve prolapse
Acute: Infective endocarditis Rupture of chordae tendinae (post-MI), Chronic: Idiopathic Marfan syndrome, Ehler Diablos syndrome
32
Clinical signs of Pulmonary hypertension
Right ventricular heave Heaving apex Loud P2 S4 sound
33
Symptoms of Mitral regurgitation
Dyspnoea Reduced exercice tolerance Symptoms of heart failure
34
Causes of S3 sound
Also known as ventricular gallop Normal variant up to age 40y - Aortic and Mitral regurgitation - Systolic heart failure
35
Describe the JVP waveform
A wave - Right atrial (RA) contraction C wave - Tricuspid valve (TV) closure X descent - RA relaxation as ventricles contract V wave - RA filling Y descent - TV opens
36
Management of aortic stenosis
Digoxin, furosemide AVR or TAVI Statin Caution with beta blockers Nitrates contra-indicated
37
Causes of Aortic stenosis
Age-related calcification Bicuspid valve Congenital Rheumatic heart disease Aortic sclerosis is a differential
38
Clinical indicators of severe aortic regurgitation
Wide BP Collapsing pulse S3 sound Heart failure Austin Flint murmur (mid-diastolic)
39
Associations of Mitral valve prolapse
Turner syndrome Poly cystic kidney disease Marfan & Ehler Danlos syndromes Osteogenesis imperfecta
40
Differences between S3 and S4
41
PPM Right atrial lead only
Sino-atrial disease in young person
42
PPM Right ventricular lead only
Pacing whilst in permanent atrial fibrillation
43
Indications for an implantable defibrillator
Primary prevention: familial cardiac conditions, previous MI with symptomatic HF Secondary prevention: Survivors of VT or VF with no treatable cause identified
44
Infective endocarditis organisms
Staph Aureus (esp prosthetic valves and IVDU) Streptococci, enterococci HACEK organisms Candida
45
Clinical signs of infective endocarditis
Splinter haemorrhages Osler nodes (painful finger nodules) Janeway lesions (painless palmar macules) Clubbing (Roth spots on retina) Then use Duke’s criteria
46
Differentials for infective endocarditis
SLE - Libman-Sachs (aseptic) endocarditis Antiphospholipid syndrome -thromboemboli & valve disease Tuberculosis
47
Infective endocarditis criteria
Duke’s criteria Major: - positive cultures for typical organism - findings on echocardiogram Minor: - risk factors - fever - vascular phenomena: septic emboli, janeway lesions - immunological phenomena: Osler nodes, glomerulonephritis - microbiology: positive blood cultures that don’t meet the Major criteria
48
Complications of infective endocarditis
Septic emboli to lungs or brain Heart failure Sepsis Aortic root abscess
49
Aortic regurgitation associations
Osteogenesis imperfecta Marfan & Ehler Danlos syndrome Ankylosing spondylitis SLE
50
Causes and Associations of pulmonary stenosis
Congenital Tetralogy of Fallot Carcinoid syndrome Williams syndrome Noonan syndrome
51
Apical beat
Displaced & thrusting —> MR/AR Undisplaced & heaving —> AS / LVH Tapping —> MS
52
Indications for ASD or VSD closure
Major right to left or left to right shunt including Eisenmenger syndrome Aortic regurgitation due to the defect Infective endocarditis Any cardiac surgery happening anyway
53
Management of aortic regurgitation / aortic root dilatation
ACE inhibitors to control blood pressure Beta blockers to slow dilatation CCB, Diuretics Statins
54
Management of pulmonary hypertension
Treat the cause Ambrisentan Sildenafil Iloprost
55
Mitral valve prolapse
Most common cause of MR Mid-systolic click Late-systolic murmur RF: Marfan, Ehlers-Danlos, Osteogenesis Imperfecta, Pseudoxanthoma Elasticum
56
Symptoms of aortic stenosis
Angina Exertional dyspnoea Syncope
57
Symptoms of mitral regurgitation
Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Palpitations
58
Symptom of mitral valve prolapse
Atypical chest pain
59
Symptoms of tricuspid regurgitation
Fatigue Hepatic pain on exertion Ascites Peripheral oedema
60
Difference between MR and MVP on examination
Pansystolic vs mid-systolic click MVP will have normal S1 then gap before murmur
61
Symptoms of mitral stenosis
Dyspnoea Fatigue Haemoptysis Chest pain
62
Examination findings for TR
Giant V wave in JVP Loud P2 No evidence of pulmonary congestion Peripheral oedema
63
Causes of tricuspid regurgitation (3)
Pulmonary hypertension from lung disease of left heart disease Rheumatic heart disease Infective endocarditis
64
How to identify which valve replaced?
Abnormal S1 - mitral metallic Abnormal S2 - aortic metallic Systolic murmur normal in AVR
65
Valve replacement examination
Systolic flow murmur ?regurgitation of replaced valve ?heart failure —> unlikely ?infective endocarditis ?over anticoagulation ?atrial fibrillation
66
Treatment of Mitral stenosis
Balloon valvuloplasty
67
When to use tissue valve rather than mechanical?
Older people (because might need replacing in 10-15y, metallic valves last up to 30y) Women who want children Contra-indications to warfarin
68
Indications for pacemaker
Mobitz type 2 second degree heart block Complete heart block Symptomatic bradycardia (sick sinus syndrome) Symptomatic pauses >3s Trifascicular block with syncope
69
HOCM examination
Pacemaker/ICD Jerky pulse Double apex beat Ejection systolic murmur S4
70
Types of mechanical valves
Ball and cage Single tilting disc Double tilting disc
71
Types of tissue valves
Xenograft (porcine) Homograft (cadaveric)
72
Types of VSD
Membranous Muscular Infundibular Posterior
73
Conditions associated with VSD
Turner syndrome Down syndrome Tetralogy of Fallot Myocardial infarction
74
Complications of VSD
Infective endocarditis Aortic regurgitation Pulmonary hypertension Congestive cardiac failure Eisenmenger’s complex
75
Tetralogy of Fallot repair surgery
Blalock-Taussig shunt
76
Blalock-Taussig shunt
Surgical repair of Tetralogy of Fallot Anastomosis connecting the left subclavian artery with the left pulmonary artery
77
Complications of Tetralogy of Fallot
Endocarditis Paradoxical embolus Polycythaemia Eisenmenger’s syndrome
78
Eisenmenger’s syndrome
Progressive process by which a longstanding R to L shunt from a congenital cardiac defect causes pulmonary hypertension and eventual reversal of the shunt into a Cyanotic L to R shunt
79
Examination findings HOCM
Prominent A wave in JVP Pacemaker Double apical impulse Left sternal thrill S4 ESM + PSM radiating to axilla
80
Management of HOCM
Propranolol Verapamil Dual chamber pacemaker Septal ablation Treat complications Genetic counselling for family
81
Valve complications
Failure Infection Bleeding Anaemia Thromboembolism

PACES - Final Week Revision (7 decks)

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