Cardiology Flashcards
(46 cards)
What are the features of the pulse in a patient with aortic stenosis?
Slow rising with narrow pulse pressure
What is the character of the murmur found in a patient with aortic stenosis?
Ejection systolic murmur, radiating to the carotids.
Loudest at aortic area and in expiration
What additional chest signs may be found in a patient with aortic stenosis?
Heaving apex beat
Palpable thrill over aortic area
What are the most common causes of aortic stenosis?
Calcification (more likely in older patient)
Congenital bicuspid valve
What are the indications for valve replacement in a patient with aortic stenosis?
Symptomatic patient with a gradient >50
Asymptomatic patient AND:
Mod/severe stenosis for CABG or
Severe AS with LVSD
or
Severe AS with abnormal BP response to exercise
or
VT
What are some differentials for a patient with an ejection systolic murmur?
Aortic stenosis
Aortic sclerosis
Pulmonary stenosis
Physiological flow murmur
Hypertrophic cardiomyopathy
Patient-prosthesis mismatch
Describe the murmur heard in aortic regurgitation
High-pitched early diastolic decrescendo murmur
Loudest at left sternal edge in fixed expiration
Other than a murmur, what signs may be found in a patient with aortic regurgitation?
Collapsing pulse
Wide pulse pressure
Head nodding
Dancing carotid
Pulsating nail beds
Murmur heard over femoral arteries
What are some causes of aortic regurgitation?
Acute - infective endocarditis, aortic dissection, prosthesis failure, rheumatic fever
Chronic - infective endocarditis, bicuspid aortic valve, marfan’s syndrome, syphilis, seronegative arthritides
What are the indications for surgical intervention in aortic regurgitation?
Moderate to severe acute regurgitation
Chronic AR with SOB or angina
Asymptomatic with significant root dilatation, LV dilatation and EF <50%
What are some manifestations of marfan’s syndrome?
Aortic regurgitation
Upwards lens dislocation
Arm span greater than height
Pectus excavatum
Joint laxity
Scoliosis
Pes planus
How often should aortic valve screening be done for patients with Marfan’s?
Echocardiogram annually to measure diameter of aorta
What is eisenmenger’s syndrome?
Reversal of a large left to right shunt due to increased pulmonary blood flow and pulmonary hypertension, leading to cyanotic heart disease
What are the causes of eisenmenger’s syndrome?
Large VSD
PDA
Atrioventricular septal defects
large systemic to pulmonary shunts for treatment of congenital heart disease
What are the potential complications of eisenmengers syndrome?
Secondary polycythaemia and hyperviscosity
Arrhythmias
Heart failure
Stroke
Haemoptysis
CKD
Gout
Hypertrophic osteoarthropathy
Sudden cardiac death
What is hypertrophic obstructive cardiomyopathy?
Septal hypertrophy, often causing left ventricular outflow tract obstruction
What heart sounds are present in a patient with HOCM?
Dynamic ejection systolic murmur radiating to apex. Murmur increases with valsalva manoeuvre and standing. Decreases with squatting
How can HOCM lead to mitral regurgitation?
Rapid blood flow at LV outflow tract causes systolic anterior motion of the mitral valve leaflets
What is the cause of HOCM?
Genetically inherited in 50%
Can occur de-novo
What may be seen on an ECG in someone with HoCM?
LVH
Deep q waves
ST elevation
Other than a murmur, what signs may be found in a patient with HOCM?
Jerky pulse
Low systolic blood pressure and narrow pulse pressure
Palpable thrill over aortic area
Heaving apex
Features of CCF
May be ICD present
MR murmur may be present
What information can be gained from a cardiac MRI in someone with HOCM?
Hypertrophic distribution
Wall fibrosis
LV function
How should HOCM be investigated?
ECG
Echo
Holter monitor for ?VT
Exercise tolerance test. Failure of BP to rise with exercise indicates worse LVOT obstruction
Consider genetic testing if appropriate
What are some risk factors for sudden cardiac death in a patient with HOCM?
Family history of sudden cardiac death
Episodes of ventricular arrhythmias
Abnormal BP response to exercise
High LV wall thickness
Unexplained syncope
