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PACES - Final Week Revision > Cardiology > Flashcards

Cardiology Flashcards

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
Q

HOCM findings

A

Ejection-systolic loudest at left sternal edge
Murmur louder on Vasalva manoeuvre
Implantable cardiac defibrillator in place

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26
Q

HOCM associations

A

Atrial fibrillation
Friedrich’s ataxia
Myotonic dystrophy
Wolff-Parkinson-White syndrome

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27
Q

Aortic stenosis associations

A

Coarctation of the aorta
Heyde’s syndrome (AS + angiodysplasia)

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28
Q

Clinical indicators of severe aortic stenosis

A

Narrow BP
quiet S2
S4
Palpable thrill / heaving apex
Bibasal crepitations

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29
Q

Causes of dilated cardiomyopathy

A

Ischaemic heart disease
Valvular disease
Alcohol
Amyloidosis
Viral
Autoimmune

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30
Q

Signs of mitral valve prolapse

A

Pansystolic murmur
Quieter on squatting
Louder on standing

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31
Q

Causes of mitral valve prolapse

A

Acute:
Infective endocarditis
Rupture of chordae tendinae (post-MI),

Chronic:
Idiopathic
Marfan syndrome, Ehler Diablos syndrome

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32
Q

Clinical signs of Pulmonary hypertension

A

Right ventricular heave
Heaving apex
Loud P2
S4 sound

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33
Q

Symptoms of Mitral regurgitation

A

Dyspnoea
Reduced exercice tolerance
Symptoms of heart failure

34
Q

Causes of S3 sound

A

Also known as ventricular gallop
Normal variant up to age 40y

  • Aortic and Mitral regurgitation
  • Systolic heart failure
35
Q

Describe the JVP waveform

A

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
Q

Management of aortic stenosis

A

Digoxin, furosemide
AVR or TAVI
Statin
Caution with beta blockers
Nitrates contra-indicated

37
Q

Causes of Aortic stenosis

A

Age-related calcification
Bicuspid valve
Congenital
Rheumatic heart disease

Aortic sclerosis is a differential

38
Q

Clinical indicators of severe aortic regurgitation

A

Wide BP
Collapsing pulse
S3 sound
Heart failure
Austin Flint murmur (mid-diastolic)

39
Q

Associations of Mitral valve prolapse

A

Turner syndrome
Poly cystic kidney disease
Marfan & Ehler Danlos syndromes
Osteogenesis imperfecta

40
Q

Differences between S3 and S4

A
41
Q

PPM Right atrial lead only

A

Sino-atrial disease in young person

42
Q

PPM Right ventricular lead only

A

Pacing whilst in permanent atrial fibrillation

43
Q

Indications for an implantable defibrillator

A

Primary prevention: familial cardiac conditions, previous MI with symptomatic HF
Secondary prevention: Survivors of VT or VF with no treatable cause identified

44
Q

Infective endocarditis organisms

A

Staph Aureus (esp prosthetic valves and IVDU)
Streptococci, enterococci
HACEK organisms
Candida

45
Q

Clinical signs of infective endocarditis

A

Splinter haemorrhages
Osler nodes (painful finger nodules)
Janeway lesions (painless palmar macules)
Clubbing
(Roth spots on retina)
Then use Duke’s criteria

46
Q

Differentials for infective endocarditis

A

SLE - Libman-Sachs (aseptic) endocarditis
Antiphospholipid syndrome -thromboemboli & valve disease
Tuberculosis

47
Q

Infective endocarditis criteria

A

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
Q

Complications of infective endocarditis

A

Septic emboli to lungs or brain
Heart failure
Sepsis
Aortic root abscess

49
Q

Aortic regurgitation associations

A

Osteogenesis imperfecta
Marfan & Ehler Danlos syndrome
Ankylosing spondylitis
SLE

50
Q

Causes and Associations of pulmonary stenosis

A

Congenital
Tetralogy of Fallot
Carcinoid syndrome

Williams syndrome
Noonan syndrome

51
Q

Apical beat

A

Displaced & thrusting —> MR/AR
Undisplaced & heaving —> AS / LVH
Tapping —> MS

52
Q

Indications for ASD or VSD closure

A

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
Q

Management of aortic regurgitation / aortic root dilatation

A

ACE inhibitors to control blood pressure
Beta blockers to slow dilatation
CCB,
Diuretics
Statins

54
Q

Management of pulmonary hypertension

A

Treat the cause
Ambrisentan
Sildenafil
Iloprost

55
Q

Mitral valve prolapse

A

Most common cause of MR
Mid-systolic click
Late-systolic murmur

RF: Marfan, Ehlers-Danlos, Osteogenesis Imperfecta, Pseudoxanthoma Elasticum

56
Q

Symptoms of aortic stenosis

A

Angina
Exertional dyspnoea
Syncope

57
Q

Symptoms of mitral regurgitation

A

Dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
Palpitations

58
Q

Symptom of mitral valve prolapse

A

Atypical chest pain

59
Q

Symptoms of tricuspid regurgitation

A

Fatigue
Hepatic pain on exertion
Ascites
Peripheral oedema

60
Q

Difference between MR and MVP on examination

A

Pansystolic vs mid-systolic click
MVP will have normal S1 then gap before murmur

61
Q

Symptoms of mitral stenosis

A

Dyspnoea
Fatigue
Haemoptysis
Chest pain

62
Q

Examination findings for TR

A

Giant V wave in JVP
Loud P2
No evidence of pulmonary congestion
Peripheral oedema

63
Q

Causes of tricuspid regurgitation (3)

A

Pulmonary hypertension from lung disease of left heart disease
Rheumatic heart disease
Infective endocarditis

64
Q

How to identify which valve replaced?

A

Abnormal S1 - mitral metallic
Abnormal S2 - aortic metallic

Systolic murmur normal in AVR

65
Q

Valve replacement examination

A

Systolic flow murmur
?regurgitation of replaced valve
?heart failure —> unlikely
?infective endocarditis
?over anticoagulation
?atrial fibrillation

66
Q

Treatment of Mitral stenosis

A

Balloon valvuloplasty

67
Q

When to use tissue valve rather than mechanical?

A

Older people (because might need replacing in 10-15y, metallic valves last up to 30y)
Women who want children
Contra-indications to warfarin

68
Q

Indications for pacemaker

A

Mobitz type 2 second degree heart block
Complete heart block
Symptomatic bradycardia (sick sinus syndrome)
Symptomatic pauses >3s
Trifascicular block with syncope

69
Q

HOCM examination

A

Pacemaker/ICD
Jerky pulse
Double apex beat
Ejection systolic murmur
S4

70
Q

Types of mechanical valves

A

Ball and cage
Single tilting disc
Double tilting disc

71
Q

Types of tissue valves

A

Xenograft (porcine)
Homograft (cadaveric)

72
Q

Types of VSD

A

Membranous
Muscular
Infundibular
Posterior

73
Q

Conditions associated with VSD

A

Turner syndrome
Down syndrome
Tetralogy of Fallot
Myocardial infarction

74
Q

Complications of VSD

A

Infective endocarditis
Aortic regurgitation
Pulmonary hypertension
Congestive cardiac failure
Eisenmenger’s complex

75
Q

Tetralogy of Fallot repair surgery

A

Blalock-Taussig shunt

76
Q

Blalock-Taussig shunt

A

Surgical repair of Tetralogy of Fallot
Anastomosis connecting the left subclavian artery with the left pulmonary artery

77
Q

Complications of Tetralogy of Fallot

A

Endocarditis
Paradoxical embolus
Polycythaemia
Eisenmenger’s syndrome

78
Q

Eisenmenger’s syndrome

A

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
Q

Examination findings HOCM

A

Prominent A wave in JVP
Pacemaker
Double apical impulse
Left sternal thrill
S4
ESM + PSM radiating to axilla

80
Q

Management of HOCM

A

Propranolol
Verapamil
Dual chamber pacemaker
Septal ablation
Treat complications
Genetic counselling for family

81
Q

Valve complications

A

Failure
Infection
Bleeding
Anaemia
Thromboembolism

PACES - Final Week Revision (7 decks)

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