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BPT Clinical Exam Prep > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Ankylosing spondylitis is associated with what valvular dysfunction?

A

Aortic regurgitation

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2
Q

What is an argyll robertson pupil? What is its significance in cardiovascular disease?

A

Bilaterally small pupils that do not constrict when exposed to bright light, but do constrict when focussed on a neaby object. This finding is highly specific for tertiary syphyilis. The cardiac features of tertiary syphylis are aortic aneurysm aortic regurgitation.

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3
Q

What is the rash?

A

Janeway’s lesions

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4
Q

What is the ‘a’ wave in a JVP waveform? Why might you see large a waves or cannon a waves?

A

Atrial contraction just prior to S1. If there is complete heart block, then you may see cannon a waves as the atrium contracts against a closed tricuspid valve. A dominant or large a wave will be seen during tricuspid stenosis or anything that causes raised right ventricular pressure (e.g. pulmonary stenosis, pulmonary hypertension)

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5
Q

What is the x descent in the JVP waveform?

A

Atrial relaxation allowing filling from the jugular vein, with blood dropping down into atrium.

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6
Q

What is the v wave in the JVP?

A

Atrial filling during systole. When there is tricuspid regurgitation, the V wave is very large as the last part of systole uses ventricular force to pass blood into the internal jugular vein up the neck.

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7
Q

Differentials for a raised JVP?

A

RV failure, tricuspid stenosis, tricuspid regurgitation, pericardial effusion or constrictive pericarditis, superior vena caval obstruction, fluid overload, hyperdynamic circulation (beri, beri, fever, anaemia, thyrotoxixosis, AV fistular, pregnancy, hypoxia, hypercapnia).

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8
Q

What is an anacrotic carotid pulse and what is associated with?

A

Anacrotic pulse is small volume with a slow upstroke. It is associated with aortic stenosis.

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9
Q

What is a plateu carotid pulse and what pathology is it associated with?

A

A plateau pulse is one with a slow upstroke but normal volume. Aortic stenosis.

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10
Q

What is a bisferiens carotid pulse and what pathology is it associated with?

A

A bisferiens pulse is an anacrotic pulse (slow upstroke and small volume) PLUS collapsing. Mixed AS and AR.

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11
Q

What is a collapsing carotid pulse, and what pathology is it associatecd with?

A

A collapsing pulse is on that rapidly drains away leading to a tapping sensation on palpation. Usually also felt in the forearm (waterhammer pulse). It is associated with aortic regurgitation, hyperdynamic circulation, arteriosclerotic aorta (in elderly patients), patent ductus arteriosis or peripheral AV aneuysm.

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12
Q

What are the causes of a small volume carotid pulse?

A

AS or pericardial effusion

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13
Q

What is an alternans carotid pulse and what pathology is it associated with?

A

Alternating weak and strong pulsation. This is associated with left ventricular failure.

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14
Q

What type of valve pathology leads to a tapping apex beat?

A

Mitral stenosis

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15
Q

What are the causes of a loud S1?

A

Mitral stensois
Tricuspid stensosis
Tachycardia
Hyperdynamic circulation

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16
Q

What are the causes of a soft S1?

A

Mitral regurgitation
Calcified mitral valve
LBBB
First degree heart block

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17
Q

What are the causes of a loud A2?

A

Systemic hypertension

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18
Q

What are the causes of a soft A2?

A

Calcified aortic valve
Aortic stenosis
Aortic regurgitation

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19
Q

What is the causes of a loud P2?

A

Pulmonary hypertension

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20
Q

What is the cause of a soft P2?

A

Pulomonary stenosis

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21
Q

Increased normal S2 splitting?

A

RBBB
Pulmonary stenosis
VSD
MR

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22
Q

Fixed S2 splitting?

A

ASD

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23
Q

Reversed S2 splitting?

A

LBBB
Severe AS
Coarctation of aorta
PDA

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24
Q

Causes of a 3rd heart sound?

A

Physiological in fit people under 40 or pregnant people, LV failure, AR, MR, VSD, PDA

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25
Q

Causes of 4th heart sound?

A

LV failure, that may be associated with AS, MR, HTN, IHD or HCM

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26
Q

What are the differential diagnoses for a pansystolic murmur?

A

MR
TR
VSD
Aortopulmonary shunts

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27
Q

What are the differentials for a midsystolic murmur?

A

AS, PS, HCM, ASD

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28
Q

What are the differentials for a pre-systolic murmur?

A

Mitral stenosis, tricuspid stenosis, atrial myxoma

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29
Q

What are the differentials for a continuous murmur?

A

Patent ductus arteriosus, AV fistula, venous hum, rupture of a sinus of valsalva into the right atrium or ventricle, arotopulmonary connection, mammory souffle (pregnancy murmur). Note that a combination of a systolic and diastolic murmur might be confused with a continuous murmur.

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30
Q

What is the normal mitral valve area?

A

4-6cm squared

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31
Q

What valve area is considered severe for mitral stenosis?

A

<1cm squared

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32
Q

What are the causes of mitral stenosis?

A

Rheumatic heart disease
Congenital
Rheumatoid arthritis
SLE
Carcinoid syndrome
Whipples disease
Fabry’s disdase
Severe mitral annular calcification (occasionally associated with hypercalcaemia and hyperparathyroidism)
After mitral valve repair for mitral regurgitation

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33
Q

What are the signs of severity for a mitral stenosis murmur?

A

Small pulse pressure (due to low LV volumes)
Early-opening snap (due to raised LA pressure)
Length of the mid-diastolic rumbling murmur (persists as long as there is a gradient)
Diastolic thrill at the apex
Presence of pulmonary hypertension
- prominent a wave in the JVP
- right ventricular impulse
- loud P2, more so if palpable P2
- pulmonary regurgitation
- tricuspid regurgitation

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34
Q

What ECG findings do you expect to see in patients with mitral stenosis?

A

P mitrale - notched, enlarged P-wave - due to left atrial enlargement
Atrial fibrillation
Right ventricular systolic overload (severe disease)
Right axis deviation (severe disease)

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35
Q

Which leads should you use to accurately assess for axis deviation?

A

First, lead 1 and aVF (or lead III). If aVF (or III) has majority negative QRS complex, and therefore left access deviation is suspected, lead II can be used to confirm this. If lead II is negative, pathological left axis deviation is confirmed.

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36
Q

What can cause right axis deviation?

A

Right ventricular hypertrophy
Acute right ventricular strain (e.g. secondary to a pulmonary embolus)
Lateral MI
COPD
Pulmonary hypertension (and things that can lead to this like Mitral stenosis)
Hyperkalaemia
Sodium channel blockade (e.g. TCA poisoning)
Wolf-Parkinson White Syndrome
Dextrocardia
Ventricular ectopy
Secundum ASD
Normal paeds ECG
Left posterior fascicular block
Vertically orientated heart

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37
Q

What can cause left axis deviation?

A

Left ventricular hypertrophy
Left bundle brance block
Inferior MI
Ventricular pacing
Wolf Parkinson White Syndrome
Primum ASD
Left anterior fasciular block
Horizontally orientated heart

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38
Q

What might you seen on XR in mitral stenosis?

A

Enlarged left atrium (large left atrial appendeage, double left atrial shadow, displaced left main bronchus), signs of pulmonary hypertension (dilateted pulmonary arteries and/or pruned peripheral arterial tree), enlarged right ventricle (more easily seen on the lateral) and signs of cardiac failure. You may also see mitral valve calcification.

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39
Q

What are the indications for surgery in mitral stenosis?

A

Exertional dyspnoea and falling valve area (especially when it falls to around 1 cm squared). Surgery should be done before pulmonary oedma becomes an issue.

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40
Q

What are the chronic causes of mitral regurgitation?

A

Degenerative disease
Mitral valve prolapse
Rheumatic heart disease
Rheumatoid arthritis
SLE (libman-achs endocarditis)
Cardiomyopathy
Papillary muscle dysfunction secondary to HF or ischaemia
Connective tissue disease (particularly RA or ank spond or Marfan’s syndrome or EDS
Congenital defects

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41
Q

What are the acute causes of mitral regurgitation?

A

Infective endocarditis
Myocardial infarction
Trauma

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42
Q

What are the signs of severity of mitral regurgitation?

A

Enlarged left ventricle
Pulmonary hypertension
Third heart sound
Early diastolic rumble
Soft first heart sound
Aortic component of second heart sound is earlier than it should be
Small volume pulses
LV failure

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43
Q

What is seen on ECG in patients with mitral regurgitation?

A

(similar to MS)
P mitrale (enlarged and notched P wave)
AF
Right axis deviation

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44
Q

What is seen on chest XR in patients with mitral regurgitation?

A

Large left atriu
Increased LV size
Mitral annular calcification
Pulmonary hypertension (must less common than in MS)

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45
Q

If a TTE reports a thickened mitral valve leaflet and MR - what is the likely aetiology of the MR and thickening?

A

Rheumatic heart disease.

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46
Q

If a TTE reports calcification of the mitral annulus and mitral regurgitation, what is the likely aetiology the MR and the calcification?

A

Degenerative disease in an elderly patient

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47
Q

What are the indciations for sugery in a patient with mitral regurgitation?

A

NYHA class III or IV symptoms, or if there is LV dysfunction on TTE or if the LV dimensions have increased progressively. If the MR occurs acutely with haemodynamic collapse, this is also an indication to operate.

Repair is done in preference to replacement. If valve replacement is required, then a metal valve is typically used as the lifespan of tissue mitral valves is 5-7 years.

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48
Q

What are the new york heart association classes of symptomatic heart disease?

A

NYHA I - no symptoms of the disease. No limitation to daily activities.
NYHA II - mild symptoms, occasional swelling, sometimes limited ability to exercise or do other strenuous activities. No symptoms at rest.
NYHA III - noticeable limitation to exercise or participate in mildly strenuous activities. Comfortable at rest.
NYHA IV - Unable to do any physical activity without discomfort. Symptoms occur at rest.

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49
Q

What is the most common murmur in the community?

A

Mitral valve prolapse - systolic click-murmur syndrome. 3% of adults. More common in women. If seen in men, more likely to progress to regurgitation.

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50
Q

What does the valsalva manoeuvre do with regard to cardiac exam?

A

Reduces preload to the heart and decreases the systolic volume of the ventricles. This leads to accentuation of outflow tract murmurs that are louder with a narrower ventricle (e.g. HOCM). It quietens murmurs that rely on preload like MS or MR.

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51
Q

What does the handgrip manoeuvre do with regard to cardiac examination?

A

Increased cardiac afterload which enlarges the ventricles due to increased resistance to systole. This quietens murmurs that are ventricle diameter dependent (e.g. HOCM) and loudens most other systolic murmurs. It may sligtly soften an AS murmur due to the slowly flow rate across the aortic valve against higher resistance.

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52
Q

What murmurs are most commonly associated with Marfan’s disease?

A

Mitral prolapse and aortic regurgitation

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53
Q

What septal defect is associated with mitral prolapse?

A

ASD (secundum)

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54
Q

What complications can occur with a mitral prolapse?

A

Mitral regurgitation and infective endocarditis

55
Q

Chronic AR causes?

A

Caused by either problems with the valve itself, or with the aortic root.

Valve issues:
Rheumatic heart disease
Congetnital (i.e. as the result of a bicuspid valve, or in combination with a VSD)
Seronegative arthropathy - especially ankylosing spondylitis

Aortic root issues:
Dilatation secondary to Marfan’s syndrome
Aortitis (secondary to seronegative arthropathy, tertiary syphils RA)
Dissecting aneurysms
Old age

56
Q

Causes of acute aortic regurgitation?

A

Again, can be thought of as secondary to a valvular problem or an aortic root issue:

Valvular
- infective endocarditis

Aortic root
- Marfan’s related
- HTN
- Dissecting aneurysms

57
Q

Signs of severity in chronic aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Legnth of the decrescendo diastolic murmur
Third heart sound
Sorft aortic component of the seocnd heart sound
Austin Flint murmur (a diastolic rumble caused by limitation of mitral inflow by the regurgitation jet from the AR)
Left ventricular failure

58
Q

What is the typical finding on ECG for aortic regurgitation?

A

Left ventricular hypertrophy

59
Q

What might be seen on CXR for aortic regurgitation?

A

Left ventricle dilatation, aortic root dilatation, valve calcification

60
Q

What are the indications for surgery in aortic regurgitation?

A

Dyspnoea on exertion
Worsening LV function and reducing EF
Progressive LV dilatation on serial TTE - LV end-systolic dimensions of >5.5cm isthe figure of significance

61
Q

What are the TTE criteria for severe aortic stenosis?

A

Mean gradient of >40mmHg, peak aortic velocity of >4m/s and aortic valve area of <1cm squared.

62
Q

What are the causes of aortic stenosis?

A

Degenerative senile calcific aortic stenosis (by far the most common in the elderly)
Rheumatic heart disease
Calcific bicuspid valve

63
Q

What are the signs of severity in aortic stenosis?

A

Plateau pulse
Aortic thrill
Length, harshness and lateness of the peak of the systolic murmur
Fourth heart sound
Paradoxical splitting of the second heart sound (aortic valve closes after the pulmonary valve)
LV failure

64
Q

What ECG findings are typical of patients with chronic AS?

A

LV hypertrophy

65
Q

What CXR findings are typical of people with aortic stenosis?

A

LV hypertrophy and valve calcification

66
Q

What are the indications for surgery in patients with aortic stenosis?

A

Symptoms are the main driver for surgery
- exertional angina, exertional dyspnoea, and especially if there is the presence of exertional syncope.

67
Q

Where is an aortic regurgitation murmur heard loudest? What is it’s character?

A

Decrescendo blowing diastolic murmur heard best at the left sternal edge.

68
Q

Where is a tricuspid regurgitation murmur heard best?

A

Pan-systolic murmur heard best at the left sternal edge. Louder on inspiration.

69
Q

What are the non-auscultatory signs of tricuspid regurgitation?

A

Large V waves in the JVP, pulsatile liver, tender liver, right ventricular heave, ascites, peripheral oedema, pleural effusions.

70
Q

What are the causes of tricuspid regurgitation?

A

Functional secondary to RV failure
Rheumatic heard disease. Very rarely occurs alone.
Infective endocardititis - esp IVDU
Congential - Ebsteins anomaly (can be heard as a series of systolic clicks sometimes)
Tricuspid valve prolapse
RV papillary muscle infarction
Pacemaker or defib lead related
Trauma (often a steering wheel injury to the sternum)

71
Q

What are the peripheral and abdominal signs of pulmonary valve stenosis?

A

Peripheral cyanosis, normal or reduced pulse, giant a waves because of RV hypertrophy, pulsatile liver if TR present too, and signs of right heart failure if severe.

72
Q

What are the praecordium signs of pulmonary stenosis?

A

Heave over the left sternal edge to RV hypertrophy, thrill over the pulmonary valve (2nd intercostal space, left of sterum ) due to stenosis. Auscultation reveals harsh ejection systolic murmur (+/- click) maximal in the pulmonary area (+/- an RV S4).

73
Q

What are the signs of severity in tricuspid regurgitation?

A

Ejection systolic murmur peaking late in systole, absence of a an ejection click, presence of an S4, signs of right ventricular failure.

74
Q

What are the causes of pulmonary stenosis?

A

Congenital
Carcinoid syndrome

75
Q

Chronic constrictive peridcarditis has what general inspection features?

A

Cachexia and ascities typically

76
Q

What should be done if constrictive peridcarditis is suspected?

A

Blood pressure - low BP and presence of pulsus paradoxus
JVP is usually raised
Apex beat will be impalpable
Heart sounds - distant +/- a third heart sound with a pericardial knock as the rapidly filling ventricle hits the stiff pericardium
Hepatosplenomagaly, ascites and peripheral oedema are common.

77
Q

What is the differential diagnosis for constrictive peridcarditis?

A

Radiatiotherapy to the area
Malignancy to the pericardium
Post surgical constrictive pericardial scarring
Tuberculosis
Connective tissues diseases such system sclerosis
Chronic renal faiure
Trauma

78
Q

What is the classic carotid pulse in hypertrophic cardiomyopathy?

A

Sharp and strong early, with jerky nature as the outflow tract obstruction reduces the pulse volume.

79
Q

What is the JVP doing in hypertrophic cardiomyopathy?

A

Prominant a wave due to forceful atrial contrction against a non-compliant hypertrophied ventricle.

80
Q

What is special about the apex beat of hypertrophic cardiomyopathy?

A

Often a double apex beat owing to the expansion of the large ventricle from the powerful atrial contraction against the non-compliant ventricle.

81
Q

What is the typical murmur of hypertrophic cardiomyopathy? What other murmur is it often associated with? What added heart sound is it associated with?

A

Late systolic ejection murur heard maximally at the left sternal edge. It is often associated with mitral regurgitation due to the hypertrophic left ventricle leading to complicated overlying pansystolic murmur in the mitral area. There is usually a fourth heart sound. The murmur at the left sternal edge will be louder with the valsalva maneouver and quieter with handgrip.

82
Q

What ECG findings are consistent with hypertrophic cardiomyopathy?

A

Left ventricular hypertophy and lateral ST segment and T wave changes (pseudo infarct)
Deep Q waves
Conduction defects (e.g. RBBB or LBBB)

83
Q

What CXR findings are consistent with HCM?

A

Large LV without evidence of calcification

84
Q

What cardiac findings are associated with acromegaly?

A

Acromgalic cardiomyopathy. May have displaced apex beat, character would be of a sustained pressure loaded hypertrophic apex beat (non-displaced). Hypertension and associated mitral or aortic valve disease. Eventually, evidence of biventricular failure may become evident.

85
Q

What might you look in the eyes in a cardiac exam?

A

If suspicious of infective endocarditis, findings of Roth or cotton wool spots might be seen at the fundus. Silver wiring might be seen in severe hypertension.

86
Q

What are the non-cyanotic congential heart diseases?

A

Atrial septal defect (ostium secundum and ostium primum), ventricular septal defect, patent ductus arteriosus and coarctation of the aorta.

87
Q

What are the cyanotic heart diseases?

A

Eisenmenger’s syndrome - secondary to pulmonary hypertension plus a large communication between left and right heart. Tetrology of fallot. Rare and complex causes - univentricular heart, Ebstein’s anomaly with an associated ASD and a right->left shunt.

88
Q

What is an ostium secundum ASD?

A

It is the most common type of ASD to persist into adulthood. It is a defect that forms near to the IVC entrance to tha atrium, and is in place of the fossa ovalis (normal closed structure).

89
Q

What is an ostium primum atrial septal defect?

A

It is the second most common type of ASD following the ostium secondum. It is a defect that forms just superior to the tricuspid and mitral valves and is almost always associated with a cleft in the nterior leaflet in the mitral valve.

90
Q

What is a sinus venosus defect ASD?

A

It is the rarest type of congenital atrial septal defect and is found in the supeiror portion of the septum near the entry to atrium of the SVC. It is often associated with anomalous drainage of the right superior pulmonary veins.

91
Q

What is found on auscultation of the praecordium of a patient with ostium secundum ASD?

A
  1. Fixed splitting of second heart sound (but not always)
  2. Pulmonary systolic ejection murmur (louder on inspiration)
  3. Pulmonary hypertension
92
Q

What is found on the ECG of a patient with an ostium secundum ASD?

A

Right axis deviation, right bundle branch block and right ventricular hypertrophy.

93
Q

What might be seen on the chest XR of a patient with an ASD?

A

Increased pulmonary vasculature
Enlarged right atrium and ventricle
Dilated main pulmonary artery
Small aortic knob

94
Q

What might be seen on TTE for a patient with an ASD?

A

RV dilatation
Paradoxical septal motion
Echo dropout in the atrial septum
Doppler detection of a shunt at the atrial level
Bubble study shun ting with agitated saline
Easy to see on a TOE

95
Q

When should you operate on an ASD?

A

All ASDs need to be closed once RV dilatation has occurred. This can be done surgically or percutaneously. A strong shunt is also an indication for surgery. A nuclear medicine study may help to estimate shunt size.

96
Q

How do the ostium primum ASD findings on chest auscultation differ to those of ostium secondum?

A

The addition of mitral regurgitation or tricuspid regurgitation given its close relationship to these valves. An associated VSD of often also present.

97
Q

How does the ECG of a patient with an ostium primum ASD differ the ECG of a patient with ostium secundum ECG?

A

And ostium primum ASD will often cause left axis deviation (opposed to right axis deviation with ostium secundum ASDs) and sometimes prolonged PR interval.

98
Q

What syndromes are classically associated with ASDs?

A

Down syndrome and Holt Oram syndrome.

99
Q

What is Holt-Oram syndrome?

A

Also called ‘heart-hand’ sydnrome.
Autosomal dominant
TBX5 mutations - important for upper limb and heart embryogenesis
Patients present with - upper limb malformation, congenital heart malformations, cardiac conduction disease, and family hisotyr of a congential heart defects.

Upper limb findings - carpal bones, thenar bones and radial bones absent or malformed. Unilateral/bilateral symmetric/asymmetric all possible - however most common is left arm abnormalities.

Heart malformations are present in 75% of people. Most commonly ostium secundum ASD, primum ASD or VSD. Conduction abnormalities are also common - sinus bradycardia or heart block are common. Atrial fibrillation is also often seen.

100
Q

What the praecordium palpation and auscultation findings for a ventral septal defect?

A

Thrill and harsh pansystolic murmur confined to the left sternal edge.

101
Q

What congential syndromes are associated with VSD?

A

Down syndrome, Holt-Oram Syndrome

102
Q

What is seen on the CXR of patient with a long standing ventricular septal defect?

A

Left ventricular hypertrophy, increased pulmonary vasculature, enlarged right ventricle.

103
Q

What will be seen on the TTE of a patient with a ventricular septal defect?

A

Visible defect, shunt (left to right).

104
Q

When should a septal defect be closed?

A

When the left to right shunt is moderate to large with pumonary-to-systemic flow ratio is between 1.5 and 1. The presence of RV dilatation is taken as a sign that the shunt is large.

105
Q

What clinical findings suggest a patent ductus arteriosis?

A

Continuous murmur heard under the left clavicle. If the shunt is reversed (from pulmonary artery to aorta) - peripheral cyanosis affecting the toes. Note that the PDA occurs in line with or just distal to the branches of the brachiocephalic artery and left subclavian artery, so the upper limbs aren’t typically affected by a patent ductus arteriosus.

106
Q

What is seen on the CXR for a patient with a patent ductus arteriosus?

A

Increased pulmonary vasculature. Calcification of the duct (trumpet-shaped calcification). An enlarged left ventricle.

107
Q

What is seen on the ECG for a patient with a patent ductus arteriosus?

A

Left ventricular hypertrophy

108
Q

What are the indications for closure of a patent ductus arteriosus?

A

Evidence of more than a trivial shunt, or concurrent pulmonary hypertension.

109
Q

What are the clinical findings for a patient with coarctation of the aorta?

A

Better developed upper body
Radiofemoral delay
Hypertension only impacting the arms
Chest collateral vessels
A midsystolic murmur over the praecordium and back
Changes consistent with hypertension seen in the fundi

110
Q

What congenital syndrome is associated with aortic coarctation?

A

Turner syndrome

111
Q

What might be seen on the CXR of a patient with coarctation of the aorta?

A

Enalrged left ventricle
Enlarge left subclavian artery
Dilated ascending aorta
Aortic indentation
Aortic pre and post stenosis dilatation
Rib notching of the second - six ribs on their inferior border.

112
Q

What clinical findings might suggest an Eisenmenger’s syndrome?

A

It is a cyanotic heart disease, so central cyanosis
Signs of ASD
Signs of pulmonary hypetension

113
Q

In patients with Eisenmenger’s syndrome, what might be seen on ECG?

A

RV hypertrophy and P pulmonale

114
Q

What ECG findings are consistent with left ventricular hypertrophy?

A

Requires meeting voltage and non-voltage criteria.

LVH voltage criteria in left sided leads
–S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm
LVH non-volatage criteria
–peak R wave time (from R wave start to peak) of >50ms (small box is 40ms) in leads V5-6
–Left ventricular strain pattern- ST depression or T wave inversion in left sided leads.

Other supportive findings:
LV axis deviation
Reciprocal ST segment changes in right sided changes
Prominent U waves

115
Q

What ECG findings are consistent with right ventricular hypertrophy?

A

Diagnostic criteria:
Right axis deviation of >110 degrees
Dominant R wave in V1
Dominant S wave in V5/V6
QRS < 120ms

Supporting criteria
Right atrial enlargement (P pulmonale)
Right ventricular strain pattern: ST depression/T wave inversion in the right precordial (V1-4) and inferior (II, III, aVF) leads.

116
Q

What might be seen on the CXR for a patient with Eisenmenger syndrome?

A

RV and atrial enlargement
Pulmonary artery prominence
Increased hilar vascular markings with attenuated peripheral vessels
NOT a boot heart.

117
Q

What are the four features of tetralogy of fallot?

A

Ventral septal defect
Right ventricular outflow obstruction (this determines severity)
Overriding aorta
Right ventricular hypertrophy

118
Q

What physicial signs are seen in patients with tetrology of fallow?

A

Cyanosis
Clubbing
Polycythaemia
Right ventricular heave and thrill at LSE due to right ventricular hypertrophy
No cardiomegaly
Auscultation reveals a single second heart sound and a short pulmonary ejection murmur (outflow murmur)
- this is due to the right outflow tract obstruction
Often coexistant AR

119
Q

What is seen on the ECG of patients with tetralogy of fallow?

A

Right ventricular hypertrophy and right axis deviation

120
Q

What is seen on the CXR of patients with tetralogy of fallow?

A

Normal sized heart with a boot shape
RV enlargement
Decreased vascularity of lung vessels
Right sided aortic knob and descening aorta in 25% of cases.

121
Q

What defines grade I hypertensive retinopathy?

A

Silver wiring

122
Q

What defines grade II hypertensive retinopathy?

A

Silver wiring and arteriovenous ‘nipping’

123
Q

What defines grade III hypertensive retinopathy?

A

Silver wiring, AV nipping and haemorrhages. Characteristically flame-shaped with exudates: soft exudates (also called cotton wool spots) due to ischaemia and hard exudates due to lipid residues from leaky vessels.

124
Q

What defines grade IV hypertensive retinopathy?

A

Silver wiring, AV nipping, haemorrhages, cotton-wool spots, lipids residues AND papilloedema.

125
Q

What differentiates aortic sclerosis from aortic stenosis?

A

Doesn’t radiate to the carotids
Pulse volume remains full
Murmur always loudest at the aortic area
Undisplaced apex beat

126
Q

How do you find the 5th intercostal space?

A

2nd rib connects at the angle of louis
Below this rib is the 2nd intercostal space
Count down from there

127
Q

What valvulopathies can cause a crescendo decrescendo murmur?

A

AS
HOCM
Supravalvular AS

128
Q

How does Heyde’s syndrome work?

A

AS related upper GI angiodysplasia caused by acquired von Willebrand disease.

129
Q

What valve problem does this person have?

A

Mitral stenosis

130
Q

What is the pathophysiology of mitral facies in mitral stenosis?

A

Occurs with advanced disease and severe pulmonary hypertension
Low cardiac output state leads to flushing

131
Q

What are the peripheral signs of AR on inspection?

A

Corrigan’s sign (visible pulsations in the neck)
Quinke’s sign (cap pulsations in fingernails)
De Musset’s sign (head nodding with each heart beat)
Muller’s sign (systolic pulsations of the uvula

132
Q

How do you tell the difference between an AR Austin Flint murmur and mitral stenosis?

A

In theory, you should be able to hear an opening snap with an Mitral Stenosis murmur that isn’t present in an Austin Flint murmur

133
Q

What is the most common other cardiac valve problem associated with coarctation of the aorta?

A

Bicuspid aortic valve

134
Q

What are the causes of tetrology of fallot?

A

Fetal hydantoin syndrome
Fetal carbamazepine syndrome
Fetal alcohol syndrome
Maternal phenylketonuria
Alagille syndrome
CATCH 22 malformations (associated wtih Di George syndrome)

BPT Clinical Exam Prep (8 decks)

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