Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PACES > Cardiology > Flashcards

Cardiology Flashcards

(106 cards)

Start Studying
1
Q

What are clinical signs of aortic stenosis? (6)

A

Slow rising, low volume pulse
Narrow pulse pressure
Heaving apex beat
Thrill in aortic area
Ejection systolic murmur in aortic area
Radiation to carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are features of the murmur in severe aortic stenosis? (6)

A

Soft and delayed/absent S2
Delayed ESM
S4 sound
Narrow pulse pressure
Systolic thrill and heaving apex
CCF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are examination features of endocarditis ? (8)

A

Splinter haemorrhages
Oslers nodes (finger pulp)
Janeway lesions (palms)
Roth spots (retina)
Temperature
Splenomegaly
Haematuria
New murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are complications of aortic stenosis? (3)

A

Endocarditis
LVSD
Conduction problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are differentials for aortic stenosis? (6)

A

HOCM
VSD
Aortic sclerosis: normal pulse character, no radiation
Aortic flow murmur: high output states - pregnancy or anaemia
Pulmonary stenosis
Supravalvular AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are causes of aortic stenosis? (3)

A

Congenital: bicuspid
Age: senile degeneration and calcification
Rheumatic: streptococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some associations of aortic stenosis? (2)

A

Coarctation and bicuspid aortic valve
Angiodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are mortality rates associated with symptoms of Aortic stenosis?

A

Angina: 50% mortality at 5 years
Syncope: 50% at 3 years
Breathlessness: 50% at 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some investigations and findings on them for aortic stenosis? (5)

A

Bloods: FBC, U&Es, LFTs
ECG: LVH, conduction defect
CXR: calcified valve, HF changes
Echo: mean gradient >40 Hg
Catheter: invasive transvalvular gradient and coronary angio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is management for aortic stenosis?

A

Asymptomatic: good dental health, regular review with echo to assess gradient and LV function
Symptomatic: surgical valve replacement +/- CABG, balloon aortic valvuloplasty, TAVI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is dukes criteria for endocarditis?

A

Major: typical organism on 2 blood cultures, echo vegetation, abscess or dehiscence
Minor: pyrexia, echo suggestive, prosthetic valve, embolic phenomena, vasculitic phenomena, atypical organism
Diagnose if 2 major, 1 major and 2 minor or 5 minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are signs of aortic regurgitation? (10)

A

Collapsing pulse
Wide pulse pressure
Apex beat hyperkinetic and displaced laterally
Thrill in aortic area
Early diastolic murmur at left lower sternal edge with patient sat forwards in expiration
Corrigans: visible neck pulsation
Quinckes: nail bed pulsation
De mussets: head nodding
Duroziezs: diastolic murmur proximal to femoral artery compression
Traubes: pistol shot sound over femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are causes of aortic regurgitation? (13)

A

Congenital: bicuspid aortic valve, peri membranous VSD
Valve leaflet: endocarditis, rheumatic fever, pergolide, slimming agents
Aortic root: type A dissection, trauma, marfans, HTN, syphilis, ank spond, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are causes of a collapsing pulse? (6)

A

Aortic regurgitation
Pregnancy
Patent ductus arteriosus
Paget’s disease
Anaemia
Thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some investigations for aortic regurgitation? (4)

A

ECG: lateral t wave inversion (LV strain)
CXR: cardiomegaly, wide mediastinum, pulmonary oedema
Echo: LVEF, root size, jet width, dissection flap or vegetation
Cardiac catheterisation: grade severity aortogram and coronary patency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are management steps for aortic regurgitation? (4)

A

ACE inhibitors / ARB reduce after load
Regular echo’s
Acute; Surgery for dissection, aortic root abscess, endocarditis
Chronic: surgery if symptomatic, pulse pressure >100, ECG changes, LV enlargement >5.5cm or EF <50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is an Austin flint murmur?

A

Mid diastolic, low pitch rumble murmur heard best at the apex with the patient leaning forward and breathing out
Due to regurgitant flow impeding mitral opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is prognosis for aortic regurgitation?

A

Asymptomatic with EF >50% - 1% mortality at 5 years
Symptomatic and 3 criteria met (PP >100, ECG changes, LV enlargement/ EF <50%) - 65% mortality at 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are clinical signs of mitral stenosis? (6)

A

Malar flush
Irregular pulse
Tapping apex
Left parasternal heave
Loud first heart sound, opening snap
Mid diastolic murmur at apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are features of haemodynamic significance in mitral stenosis? (3)

A

Pulmonary HTN: functional TR, right ventricular heave, loud p2
LV failure: pulmonary oedema
RVF: sacral and pedal oedema, raised JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are causes of mitral stenosis? (5)

A

Congenital
Rheumatic (most common)
Senile degeneration
Endocarditis
RA/SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are differentials of mitral stenosis murmur? (2)

A

Left atrial myxoma
Austin flint murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are investigations of mitral stenosis? (3)

A

ECG: p mitrale, AF
CXR: enlarged left atrium, calcified valve, pulmonary oedema
Echo: valve area <1cm severe, cusp mobility, calcification, left atrial thrombus, RV failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is management of mitral stenosis? (4)

A

AF rate control and anticoagulation
Diuretics
Mitral valvuloplasty
Surgery: closed or open valvotomy, valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is mortality of mitral stenosis?
Latent asymptomatic phase 15-20 years NYHA >II - 50% mortality at 5 years
26
What causes valve disease in rheumatic fever?
Immunological cross reactivity between group a beta haemolytic strep (pyogenes) and valve tissue
27
What is duckett jones criteria for rheumatic fever?
Proven beta haemolytic strep - throat swab, rapid antigen detection test, ASOT or clinical scarlet fever Plus 2 major and 2 minor Major: chorea, erythema marginatum, subcutaneous nodules, polyarthritis, carditis Minor: raised ESR, raised WCC, arthralgia, previous rheumatic fever, pyrexia, prolonged PR interval
28
What is treatment for rheumatic fever? (3)
Rest High dose aspirin Penicillin
29
What is prophylaxis for rheumatic fever?
Primary prevention: pen V or clinda for 10 days Secondary prevention: pen V for 5-10 years
30
What are signs of mitral incompetence? (5)
Pulse: AF, small volume Apex: displaced and volume loaded Thrill at apex Pan systolic murmur at apex radiating to axilla Wide splitting of a2p2
31
What are causes of mitral incompetence? (10)
Congenital - cleft mitral valve with primum ASD Endocarditis Mitral prolapse Rheumatic fever Connective tissue disease Fibrosis from pergolide Functional MR from dilated cardiomyopathy Calcification Amyloid Chord/ papilla rupture
32
What are investigations for mitral incompetence? (3)
ECG: p mitrale, AF, previous infarction CXR: cardiomegaly, left atrial enlargement, pulmonary oedema Echo: density of MR jet, LV dilation, reduced EF, prolapse, vegetations
33
What are treatments for mitral incompetence?
Anticoagulation for AF Diuretics Beta blocker ACE inhibitors Mitral clip - palliative Surgical: repair or replacement
34
Who gets mitral prolapse? (5)
Young tall women Connective tissue disease - marfans, EDS, pseudoxanthoma elasticum, SLE HOCM PKD Muscular dystrophy
35
How does mitral prolapse present? (3)
Chest pain Syncope Palpitations
36
What does mitral prolapse sound like?
Mid systolic ejection click Pan systolic murmur gets louder up to a2 Accentuated by valsalva
37
What are clinical signs of tricuspid incompetence ? (7)
Raised JVP with giant CV waves Thrill left sternal edge Pulsatile liver, Ascites, peripheral oedema Pan systolic murmur loudest at left lower sternal edge in inspiration Reverse split second heart sound S3 If pulmonary HTN: RV heave and loud p2
38
What are causes of tricuspid incompetence? (5)
Ebsteins anomaly: atrialisation of right ventricle with TR Endocarditis Functional TR Rheumatic fever Carcinoid syndrome
39
What are investigations of tricuspid incompetence? (3)
ECG: p pulmonale and RVH CXR: double right heart border from enlarged right atrium Echo: TR jet, RV dilation
40
What is management of TR? (4)
Diuretics Beta blockers ACE inhibitors Surgical: valve repair/annuloplasty
41
What are signs of pulmonary stenosis? (6)
Raised JVP with giant a waves Left parasternal heave Thrill in pulmonary area Ejection systolic murmur in pulmonary area in inspiration Widely split second heart sound Right heart failure - Ascites, oedema
42
What are some associated syndromes with pulmonary stenosis? (2)
Tetralogy of fallot: PS, VSD, overriding aorta, RVH - will have sternotomy scar Noonans syndrome: PS, male, wide forehead, low set ears, wideset nipples, webbed neck, small chin
43
What are investigations of tricuspid incompetence? (3)
ECG; p pulmonale, RVH, RBBB CXR: oligaemic lung fields, large right atrium Echo: pressure gradient for severity, RV function
44
What is the management of pulmonary stenosis? (3)
Pulmonary valvotomy if gradient >70 or RV failure Percutaneous pulmonary valve implantation Surgical repair/replacement
45
How does carcinoid syndrome link to heart valve issues?
Gut primary with liver mets secrete 5-HT into blood stream Diarrhoea, wheeze and flushing Secreted mediators cause right sided valve fibrosis - TR or PS Treatment is octreotide or surgical resection
46
What are signs of prosthetic heart valves? (3)
Audible prosthetic clicks Scars Signs of anticoagulation - bruising/anaemia
47
What cardiac scars might you see and what do they mean? (5)
Midline sternotomy: CABG, AVR, MVR Lateral Thoracotomy: MVR, mitral valvotomy, coarctation repair, BT shunt Subclavicular: PPM, ICD Anticubital fossa/ wrist: angiography Saphenous vein harvest scar
48
What are late complications of heart valve replacements? (6)
Thromboembolism despite warfarin Bleeding on warfarin Bioprosthetic dysfunction and LVF Haemolysis Endocarditis AF especially mitral
49
What are clinical signs of implantable cardiac devices? (4)
Incisional scar in infraclavicular position Palpable pacemaker Signs of heart failure - JVP, crackles, oedema Medic alert bracelet
50
What are primary prevention indications for an ICD? (3)
MI > 4 weeks ago with LVEF <35% and non sustained VT with positive EP MI > 4 weeks ago with LVEF <30% and QRS >120 ms Familial condition with high risk sudden cardiac death: LQTS, ARVD, brugada, HCM, complex congenital heart disease
51
What are secondary prevention indications for an ICD? (3)
Cardiac arrest due to VT or VF Haemodynamically compromising VT VT with LVEF <35%
52
What are criteria for CRT pacemaker? (3)
LVEF <35% NYHA II-IV on optimal medical therapy Sinus rhythm and QRS >150 or LBBB >120
53
What are features of constrictive pericarditis? (5)
Right heart failure Kussmauls sign: paradoxical increase in JVP on inspiration Pulsus paradoxus: >10mmhg drop in systolic pressure in inspiration Pericardial knock Congestive hepatomegaly
54
What are causes of constrictive pericarditis? (6)
TB Trauma or surgery Post MI Tumour Radiotherapy Connective tissue disease
55
What are investigations for constrictive pericarditis? (4)
CXR: pericardial calcification, old TB, sternotomy wires Echo: high signal from pericardium, septal bounce Cardiac catheterisation - pressures CT: thickened pericardium
56
What is the pathophysiology of constrictive pericarditis?
Thickened fibrous capsule reduces ventricular filling and insulates heart from intrathoracic pressure changes leading to ventricular interdependence- filling of one ventricle reduces size and filling of the other
57
What is treatment for constrictive pericarditis? (3)
Diuretics Fluid restriction Pericardial stripping
58
What are signs of ASD? (6)
Raised JVP Pulmonary area thrill Fixed split second heart sounds that do not changed with respiration Pulmonary ESM and mid diastolic flow murmur Pulmonary HTN: RV heave and loud P2 Eisenmengers: cyanosis and clubbing, right to left shunt
59
What are types of ASD? (2)
Primum: associated with AVSD and cleft mitral valve in Down’s syndrome Secundum: commonest
60
What are complications of ASD? (3)
Paradoxical embolus Atrial arrhythmias RV dilatation
61
What are investigations of ASD? (4)
ECG: RBBB, LAD (primum), RAD (secundum), AF CXR: small aortic knuckle, pulmonary plethora, double heart border from enlarged RA Echo: site, size, shunt calculation Right heart catheter: shunt calculation
62
What are the indications for closure of ASD? (3)
paradoxical embolism breathlessness Significant shunt with RV dilatation
63
What are contraindications for closure of ASD? (2)
Severe pulmonary HTN Eisenmengers syndrome
64
How can an ASD be closed? (2)
Percutaneous: secundum only Surgical patch repair
65
What are signs of VSD? (2)
Thrill at left lower sternal edge Systolic murmur at left sternal edge with no radiation
66
What other lesions can be associated with a VSD? (4)
AR PDA Tetralogy of fallot Coarctation of aorta
67
What is tetralogy of fallot? (4)
ventricular septal defect overriding aorta pulmonary stenosis right ventricular hypertrophy
68
What are features of coarctation of aorta? (6)
HTN in upper limbs Prominent upper limb pulses Weak pulses in lower limbs Radiofemoral delay Heaving pressure loaded apex Continuous murmur radiating to back, loud a2 May be other murmurs associated from other lesions
69
What are causes of VSD? (2)
Congenital Acquired: traumatic, post op, post MI
70
What are investigations of VSD? (4)
ECG: conduction defect, BBB CXR: pulmonary plethora Echo: site, size, shunt calculation Cardiac catheterisation: consideration of closure
71
What are management options for VSD? (2)
Surgical: pericardial patch Percutaneous amplatzer device
72
What is a bhalock taussig shunt?
Partially corrects fallots tetralogy by anastamosing the subclavian artery to the pulmonary artery Causes absent radial pulse and scar
73
What are causes of an absent radial pulse? (6)
Embolism Aortic dissection Trauma eg radial artery sheath Atherosclerosis Coarctation Takayasus arteritis
74
What is coarctation of aorta?
Congenital narrowing of aortic arch usually distal to left subclavian artery
75
What are some associations of coarctation of aorta? (5)
VSD Bicuspid aortic valve PDA Turner’s syndrome Berry aneurysms
76
What are investigations of coarctation of aorta? (2)
ECG: LVH and RBBB CXR: rib notching, double aortic knuckle - post stenotic dilatation
77
What are management options for coarctation of aorta? (4)
Percutaneous endovascular aortic repair Surgical: Dacron patch aortoplasty Long term anti hypertensive therapy Surveillance with MRA for aneurysms and recoarctation
78
What is PDA?
Continuity between aorta and pulmonary trunk with left to right shunt
79
What are risk factors for PDA? (4)
Rubella during pregnancy Prematurity FH congenital heart disease Smoking during pregnancy
80
What are signs of PDA? (4)
Collapsing pulse Thrill second left intercostal space Thrusting apex Loud continuous machinery murmur below left clavicle, loudest in systole
81
What are complications of PDA? (2)
Eiesenmengers syndrome Endocarditis
82
What is management of PDA?
Closure surgically or percutaneously
83
What are signs of hypertrophic cardiomyopathy? (6)
Jerky pulse character Double apical impulse Thrill at left lower sternal edge ESM at left lower sternal edge radiates throughout precordium accentuated by valsalva 4th heart sound Maybe be associated MVP
84
Which conditions are associated with hypertrophic cardiomyopathy ? (2)
Friedreichs ataxia Myotonic dystrophy
85
What investigations should be done for hypertrophic cardiomyopathy? (6)
ECG: LVH with strain CXR: normal Echo: asymmetrical septal hypertrophy and systolic anterior motion of mitral leaflet across LVOT, LVOT gradient Cardiac MR: apical HCM Cardiac catheterisation: gradient accentuated by ventricular ectopic or pharmacological stress Genetic testing: sarcomeric protein mutation
86
What is the management for hypertrophic cardiomyopathy? (5)
Asymptomatic: avoid strenuous exercise, dehydration and vasodilators Symptomatic and LVOT gradient >30: beta blockers, PPM, alcohol septal ablation, surgical myomectomy Rhythm disturbance/high risk SCD: ICD Refractory: cardiac transplant Genetic counselling of first degree relatives (autosomal dominant)
87
What are poor prognosis factors in hypertrophic cardiomyopathy? (4)
Young age at diagnosis Syncope Family history sudden death Septal thickness >3cm
88
What are features of severity in MR? (4)
Larger left ventricle - displaced heaving apex S3 sound AF LV failure
89
How do you accentuate an AR murmur?
Sit patient forwards Auscultate with breath held at end of inspiration Early diastolic high pitched murmur at left sternal edge
90
What are signs of severity in AR? (6)
Wide pulse pressure Soft second heart sound Duration of murmur Presence of 3rd heart sound Austin flint murmur LV failure
91
How do you differentiate aortic stenosis from aortic sclerosis?
Sclerosis: pulse normal volume, apex not shifted, murmur localised
92
What is a 3rd heart sound?
Ventricular gallop during passive left ventricular filling when blood strikes a compliant LV Sign of systolic heart failure
93
What is s4 sound?
atrial gallop results from the contraction of the atria pushing blood into a stiff or hypertrophic ventricle Sign of diastolic failure
94
How to differentiate between s3 and split s2?
S3 is a low-pitched sound; disappears when diaphragm used. Appreciated at apex S2 is high pitched. Disappears when bell used. Appreciated in pulmonary region
95
What is the inheritance of Marfans?
Autosomal dominant mutation of fibrillin gene which affects collagen formation
96
What are cardiac complications of marfans? (4)
Aortic root dilation Aortic dissection Aortic regurgitation Mitral valve replacement
97
What are indications for aortic root replacement in marfans? (3)
Dilation of 50mm at aortic root >45mm if family history of dissection If expanding >3mm per year
98
What are phenotypic features of noonans? (9)
Wide spaced nipples Pectus excavatum Cubitus valgus Webbed neck Short stature Ptosis Strabismus Widely spaced eyes Low set ears
99
Differentials for pulmonary stenosis (4)
Aortic stenosis Infra or supra valvular lesions ASD VSD
100
Findings of significant pulmonary stenosis (5)
Large A waves JVP RV heave PSM murmur from functional TR Right heart failure Widely split second heart sound with quiet P2
101
Cardiac issues in noonans (3)
Pulmonary stenosis (most common) HCM Septal defects
102
What numbers signify severity in pulmonary stenosis? (3)
Gradient >64mmHg Velocity >4m/sec Valve area <1cm2
103
What is the name of the finding of AS murmur radiating across whole chest into apex?
Gallavardin phenomenon
104
What are causes of restrictive cardiomyopathy? (7)
Primary: loefflers endocarditis Secondary: amyloid, sarcoidosis, iron overload, carcinoid, radiotherapy, scleroderma
105
What are causes of constrictive pericarditis? (6)
Viral TB Dresslers Post surgery Connective tissue disease Uraemia
106
What echo finding is suggestive of restrictive cardiomyopathy? (4)
Diastolic dysfunction biatrial dilatation hypertrophied ventricles with decreased compliance normal to depressed systolic function

PACES (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions