Cardiology Flashcards
(42 cards)
Peripheral signs infective endocarditis
- splinter haemorrhages
- oslers nodes (finger pulp, tender)
- Janeway lesions (palm)
- Roth spots (retina)
- splenomegaly
- haematuria
Aortic stenosis Vs sclerosis
AS - radiation to carotids, may have slow rising pulse
Sclerosis - murmur only
Aortic stenosis causes
- Age/calcification
- Congenital (bicuspid) +/- coarctation
- Rheumatic/streptococcal
Dukes criteria
MAJOR
- BCs with typical org
- Echo evidence - abscess/vegetation/dehiscence
MINOR
- Fever >38
- Suggestive echo
- Predisposition e.g. prosthesis
- Embolic phenomena
- Vasculitic phenomena e.g. ESR
- Atypical org on BC
AS signs besides murmur
- Slow rising pulse
- Narrow pulse pressure
- => “parvus et tardus” carotid = weak/slow
- Delayed A2
AS replacement indications
- Symptoms
- LVEF <50%
Or consider if: - Flow >4m/s
- Gradient >40mmHg
- Valve area <1cm2
AS intervention options
- SAVR (surgical aortic valve replacement) - metallic vs bioprosthetic. Preferred for young, fit. Can be midline or minimally invasive sternotomy.
- TAVI (transcatheter/femoral aortic valve intervention/replacement). Preferred for elderly.
- Discussion with patient! & MDT - anaesthetics, interventional cardio, cardiothoracics, geriatrician.
Balloon valvuloplasty can be used as a stopgap
Aortic Regurg peripheral signs
- Quinkes - nail bed pulsation
- Corrigan - vegorous neck pulsatioi
- De Mussets - head nodding
- “Pistol shot” femoral pulse sounds
- Collapsing/waterhammer pulse
- Wide pulse pressure
AR causes
Acute valve:
- Endocarditis
Chronic valve:
- Rheumatic fever
Acute root:
- Type A dissection
- Trauma
Chronic root:
- Marfan’s -dilation
- HTN - dilation
- Syphilis - aortitis
- Ank spond - aortitis
- Vasculitis
AR valve replacement criteria
- Acute
- pulse pressure>100
- LVEF<50%
- ECG changes
Reason for wide S2 splitting in MR
Aortic valve shuts sooner as it empties rapidly
Causes MR
Primary
- CTDs (ED, Marfan’s, OI)
- Degenerative
- Infective endocarditis
- (Rheumatic heart disease)
Secondary
- Dilated cardiomyopathy
- Ischaemic cardiomyopathy
JVP waves
A wave - atrial systole
C - tricuspid closure
X descent - ventricular systole
V wave - atrial filling
Y descent - Tricuspid opening
https://gramproject.com/wp-content/uploads/2021/01/JVP-waveform.png
AS medical management
If symptoms, replace.
Follow up:
- Echo every 6/12, 1 year, or 3 years dep on severity
Medications:
- Statins
- BP control, avoiding ACE if haemodynamically significant disease. Avoid vasodilators.
- BB good option in heart failure
Clinical features severe AS
Any symptoms.
Or:
- Slow rising, low volume pulse
- Narrow pulse pressure
- Quiet/absent S2
- High pitch, long duration murmur
- LV heave
- S4 in LVH
Mitral stenosis causes
- Rheumatic fever most common
Rarer: - Congenital
- Carcinoid syndrome
- SLE
- Amyloid
HCM inheritance
Usually AD
MYH7 (B myosin) or MYBPC3 (myosin binding protein chain)
Young cardio patient syncope
HCM
Channelopathies (LQT, brugada, WPW)
Other congenital cardiac conditions
Broad categories congenital heart disease
1 - L-R shunts (acyanotic)
2 - R-L shunts (cyanotic)
3 - Obstructive
Eisenmenger’s syndrome
- Any congenital L-R shunt
-> Increase pulmonary vascular resistance
-> Pulmonary hypertension
-> Pulmonary/right heart remodelling
-> R pressure > L
-> Shunt reversal and cyanosis, polycythaemia
Usually around age 20-40
Congenital L-R in order of prevalence
- VSD (outlet, inlet, perimembranous, muscular)
- ASD (sinus venosus, ostium primum, o secundum, unroofed coronary sinus)
- Patent ductus arteriosus (aorta-pulm circ, bypasses pulm circ as maternal blood entering RA -> lower body cyanosis, machinery murmur)
- APVC (anomolous pulmonary venous connection) Rare.
Causes of VSD
- Congenital (most common CHD)
- Ischaemic
VSD signs
Pansystolic murmur LLSE. Loud 2nd HS if pulm HTN
ASD signs
Systolic murmur at L upper sternal edge
Fixed S2 splitting
