Cardiology Flashcards
(79 cards)
1
Q
Murmur - pansystolic
A
MR
TR
VSD
AP shunts
2
Q
Murmur - mid-systolic
A
AS
PS
HOCM
ASD (pulmonary flow)
3
Q
Murmur - early systolic
A
VSD
MR (acute)
TR
4
Q
Murmur - late systolic
A
MV prolapse
Papillary muscle dysfunction (eg. HOCM)
5
Q
Murmur - early diastolic
A
AR
PR
6
Q
Murmur - mid-diastolic
A
MS TS Atrial myxoma AR (Austin Flint) Rheumatic fever (Carey Coombs)
7
Q
Murmur - pre-systolic
A
MS
TS
Atrial myxoma
8
Q
Murmur - continuous
A
PDA AV fistula Venous hum Sinus of Valsalva rupture AP connection Mammary souffle
9
Q
JVP - dominant a wave
A
TS
PS
Pulmonary HTN
10
Q
JVP - dominant v wave
A
TR
11
Q
JVP - cannon a wave
A
Complete heart block
Paroxysmal nodal tachycardia (with retrograde atrial conduction)
VT (with retrograde atrial conduction, or AV dissociation)
12
Q
JVP - elevated CVP
A
RV failure TS or TR Pericardial effusion Constrictive pericarditis SVC obstruction Fluid overload Hyperdynamic circulation
13
Q
Hyperdynamic circulation - causes
A
Fever Anaemia Thyrotoxicosis AV fistula Pregnancy Exercise Beri beri Hypoxia Hypercapnia
14
Q
Pulse - anacrotic
A
AS
small volume, slow upstroke, a wave on upstroke
15
Q
Pulse - plateau
A
AS
slow upstroke
16
Q
Pulse - bisferiens
A
AS plus AR
anacrotic plus collapsing
17
Q
Pulse - collapsing (waterhammer)
A
AR PDA Hyperdynamic circulation Arteriosclerotic aorta Peripheral AV aneurysm
18
Q
Pulse - small volume
A
AS
Pericardial effusion
19
Q
Pulse - alternans
A
LV failure
alternating strong and weak beats
20
Q
Apex - pressure-loaded
A
AS
HTN
(hyperdynamic, systolic overloaded)
(forceful, sustained impulse)
21
Q
Apex - volume-loaded
A
MR
AR
(hyperkinetic, diastolic overloaded)
(forceful, unsustained impulse)
22
Q
Apex - tapping beat
A
MS
palpable 1st heart sound
23
Q
Apex - double/triple impulse
A
HOCM
24
Q
Apex - dyskinetic
A
Previous large MI
25
Heart sounds - loud S1
MS
TS
Tachycardia
Hyperdynamic circulation
26
Heart sounds - soft S1
MR
Calcified mitral valve
LBBB
1st degree HB
27
Heart sounds - loud A2
Congenital AS
| Systemic HTN
28
Heart sounds - soft A2
AR
| Calcified aortic valve
29
Heart sounds - loud P2
Pulmonary HTN
30
Heart sounds - soft P2
PS
31
Heart sounds - S2 increased splitting on inspiration
RBBB
PS
VSD
MR
32
Heart sounds - S2 fixed splitting
ASD
33
Heart sounds - S2 reversed splitting
| P2 first
LBBB
AS
Coarctation of aorta
PDA (large)
34
Heart sounds - LV S3
| louder at apex, on expiration
```
Physiological
LV failure
AR
MR
VSD
PDA
```
35
Heart sounds - RV S3
| louder left sternal edge, on inspiration
RV failure
| Constrictive pericarditis
36
Heart sounds - LV S4
| louder at apex, on expiration
```
AS
MR (acute)
HTN
IHD
HOCM
```
37
Heart sounds - RV S4
| louder left sternal edge, on inspiration
Pulmonary HTN
| PS
38
Pulmonary hypertension - signs
```
Prominent a wave JVP
RV impulse
Loud P2
PR
TR
```
39
Mitral stenosis - causes
Rheumatic
| Congenital (rare)
40
Mitral stenosis - signs of severity
```
Small pulse pressure
Diastolic thrill at apex
Pulmonary HTN
Early opening snap
Long mid-diastolic rumbling murmur
```
41
Mitral stenosis - ECG
P mitrale (in SR)
AF
RV systolic overload
RAD
42
Mitral stenosis - CXR
Mitral valve calcification
Large LA - double LA shadow, displaced left main bronchus, big left atrial appendage
Pulmonary HTN - large central pulmonary arteries, pruned peripheral artery tree
Cardiac failure signs
43
Mitral stenosis - surgical indications
Not responding to medical therapy
- Progressive dyspnoea
- Pulmonary oedema
- Major haemoptysis
Valve area ≤1cm
44
Mitral regurgitation - causes (chronic)
Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction (LV failure, ischaemia)
Connective tissue disease (RA, ank spond)
Congenital (ASD, parachute valve, corrected transposition)
45
Mitral regurgitation - causes (acute)
Infective endocarditis
MI
Surgery
Trauma
46
Mitral regurgitation - signs of severity
```
Small volume pulse
Enlarged LV
Pulmonary HTN
Soft S1
Early A2
S3
Early diastolic rumble
LV failure
```
47
Mitral regurgitation - ECG
P mitrale
AF
LV diastolic overload
RAD
48
Mitral regurgitation - CXR
Large LA
Large LV size
Mitral annular calcification
Pulmonary HTN
49
Mitral regurgitation - surgical indications
Class III or IV symptoms
LV dysfunction
Progressive LV dimension increase
50
Mitral valve prolapse - signs
Systolic click
- Valsalva (murmur longer, click earlier)
- Handgrip (murmur shorter)
51
Mitral valve prolapse - associations
Marfans
ASD
Anorexia nervosa
52
Aortic regurgitation - causes (chronic)
```
Rheumatic
Congenital
Seronegative arthropathy
Marfans
Aortitis
Dissecting aneurysm
Old age
```
53
Aortic regurgitation - causes (acute)
Infective endocarditis
Marfans
HTN
Dissecting aneurysm
54
Aortic regurgitation - signs of severity
```
Collapsing pulse
Wide pulse pressure
S3
Soft A2
Decrescendo diastolic murmur length
Austin Flint murmur
LV failure
```
55
Aortic regurgitation - ECG
LV hypertrophy
56
Aortic regurgitation - CXR
LV dilation
Aortic root dilatation / aneurysm
Valve calcification
57
Aortic regurgitation - surgical indications
Symptoms (dyspnoea on exertion)
LV function (low EF)
Progressive LV dilatation (LVESD more than 5.5 cm)
58
Aortic stenosis - causes
Degenerative (senile, calcific)
Rheumatic (rare in isolation)
Calcific bicuspid valve
59
Aortic stenosis - signs of severity
```
Plateau pulse
Aortic thrill
Paradoxical splitting S2
S4
Systolic murmur (long, late, harsh peak)
LV failure
```
60
Aortic stenosis - ECG
LV hypertrophy
61
Aortic stenosis - CXR
LV hypertrophy
| Valve calcification
62
Aortic stenosis - surgical indications
```
Symptoms (exertional angina, dyspnoea, syncope)
Critical obstruction (area less than 0.7 cm²/m², or valve gradient less than 70 mmHg)
```
63
Tricuspid regurgitation - causes
```
Functional (RV failure)
Rheumatic
Infective endocarditis
Congenital (Ebstein's anomaly)
Tricuspid valve prolapse
RV papillary muscle infarction
Trauma
```
64
Tricuspid regurgitation - signs of severity
```
JVP dominant v wave
RV heave
Pansystolic murmur (lower sternum, inspiration)
Pulsatile liver
Oedema, ascites, pleural effusion
```
65
Tricuspid regurgitation - CXR
RV or biventricular enlargement
| Box-shaped heart, narrow cardiac base (Ebstein's anomaly)
66
Pulmonary stenosis - causes
Congenital
| Carcinoid syndrome
67
Pulmonary stenosis - clinical signs
```
Peripheral cyanosis
Reduced pulse
JVP dominant a wave, elevated
RV heave
Thrill (pulmonary area)
S4
Ejection systolic murmur (pulmonary area, inspiration louder)
Pulsatile liver (presystolic)
```
```
(Signs of severity:
Late peaking ESM
Absence of ejection click
S4
RV failure)
```
68
Constrictive pericarditis - clinical signs
```
Low BP
Pulsus paradoxus
JVP (raised, Kussmaul's sign, prominent x and y descent)
Apex beat impalpable
S3
Hepatosplenomegaly
Oedema/ascites
```
69
Hypertrophic cardiomyopathy - clinical signs
```
Pulse (sharp, jerky)
JVP prominent a wave
Apex double/triple impulse
S4
Late ESM (left sternal edge)
PSM (apex due to MR)
Valsalva (louder murmur)
```
70
Hypertrophic cardiomyopathy - ECG
LV hypertrophy
Lateral ST segment / T wave changes
Deep Q waves
Conduction defects
71
Hypertrophic cardiomyopathy - CXR
LV enlarged, hump along border
| No valve calcification
72
Atrial septal defect - clinical signs
Fixed splitting S2
Pulmonary ESM (louder inspiration)
Pulmonary HTN
73
Atrial septal defect - ECG
RAD
RBBB
RV hypertrophy
74
Atrial septal defect - CXR
Increased pulmonary vasculature
Enlarged RA and RV
dilated pulmonary artery
Small aortic knob
75
Atrial septal defect - surgical indications
Left to right shunt 1.5 to 1
76
Ventricular septal defect - clinical signs
```
Pansystolic murmur (left sternal edge, louder expiration)
MR
```
(associated Down syndrome)
77
Ventricular septal defect - ECG
LV hypertrophy
78
Ventricular septal defect - CXR
LV hypertrophy
Increased pulmonary vasculature
Enlarge RV
79
Ventricular septal defect - surgical indications
Left to right shunt more than 1.5 to 1
