Cardiology Flashcards
(47 cards)
What are the causes of aortic stenosis?
Degenerative calcification
Rheumatic heart disease
Congenital bicuspid aortic valve
What are the signs of severity of aortic stenosis?
Plateau/Anacrotic slow rising pulse Narrow pulse pressure Length of systolic murmur Loud S2 S4 LVF
What are the indications for surgery in Aortic Stenosis? (HK)
Symptoms of heart failure regardless of EF
Asymptomatic patients with Severe AS & EF<50%
Severe AS undergoing other cardiac surgery
Critical AS with valve are <0.7cm2
What are the types of surgery available in Aortic Stenosis?
> Surgerical Aortic Valve Replacement
- Surgical AVR indicated in patients who meet an indication for AVR with low-intermediate surgical risk
Transcatheter Aortic Valve Implantation
- TAVI indicated in patients who meet an indication for AVR who have a prohibitive surgical risk & predicted post-TAVI survival >12 months
- Contraindications to TAVI include i) Estimated life expectancy <1 year, ii)Inadequate annulus size, iii) Thrombus in LV, iv) Active endocarditis, v) Bicuspid aortic valve
What are the causes of Aortic Regurgitation?
> Acute
-Infective endocarditis
-Aortic root rupture or Dissecting aneurysm
-Trauma
-Prosthetic valve failure
Chronic
-Congenital bicuspid aortic valve
-Rheumatic heart disease
-Seronegative arthropathy (ankylosing spondylitis)
-Aortitis in seronegative arthropathies or tertiary syphilis
What are the signs of severity of Aortic Regurgitation?
- Collapsing water hammer pulse
- Wide pulse pressure
- Length of decrescendo diastolic murmur
- Soft S2
- LVF
- Austin Flint Murmur (low pitched rumbling mid diastolic murmur at apex)
What are the indications for surgery in Aortic Regurgitation?
- Symptoms of heart failure regardless of EF
- Asymptomatic patients with Severe AR & EF <50%
- Severe AR undergoing other cardiac surgery
- Aortic root dilatation >50mm
- Reduction in exercise EF >5%
- Concomitant angina
What are the causes of Mitral Stenosis?
- Rheumatic heart disease
- Post mitral valve repair for MR
- Severe mitral annular calcification
- Congenital
What are the signs of severity of MItral Stenosis?
- Narrow pulse pressure
- Length of rumbling mid diastolic murmur
- Diastolic thrill at apex
- Opening snap
- Loud S1
- Pulmonary hypertension
What are the indications for surgery in Mitral Stenosis?
- Percutaneous Mitral Balloon Commisurotomy (PMBC) is recommended for symptomatic severe MS (MVA <1.5cm2) & favourable valve morphology
- Mitral Valve Surgery is recommended for symptomatic severe MS (MVA <1.5cm2) who are not high risk for surgery & are not candidates for PMBC.
- Mitral Valve Surgery is recommended for severe MS undergoing other cardiac surgery.
What are the causes of Mitral Regurgitation?
>Acute -Infective endocarditis -Trauma -Myocardial infarction >Chronic -Rheumatic heart disease -Papillary muscle dysfunction -Connective tissue disease -Mitral valve proplapse -Degenerative disease -Congenital
What are the signs of severity of Mitral Regurgitation?
- Soft S1
- S3
- LVF, LVH
- Pulmonary hypertension
What are the indications for surgery in Mitral Regurgitation?
- Symptomatic Severe MR with LVEF >30%
- Chronic Severe MR undergoing other cardiac surgery
What are the causes of Tricuspid Regurgitation?
- Functional TR secondary to RVF or Pulmonary HTN
- Rheumatic heart disease
- Infective endocarditis
- Ebstein’s anomaly
What are the signs of severity of Tricuspid Regurgitation?
- Soft S1
- Elevated JVP with v waves
- Pulsatile tender liver
- Ascites
- Peripheral oedema
What are the indications for surgery in Tricuspid Regurgitation?
- Severe TR undergoing left sided valve surgery
- Symptomatic Severe TR unresponsive to medical therapy
What are the causes of:
i) Dominant ‘a’ wave
ii) Dominant ‘v’ wave
iii) Cannon ‘a’ wave
iv) Increased JVP
i) Dominant ‘a’ wave: TS, PS, Pulmonary HTN
ii) Dominant ‘v’ wave: TR
iii) Cannon ‘a’ wave: CHB
iv) Increased JVP: RVF, TR, Constrictive pericarditis
What are the causes of:
i) Anacrotic slow rising pulse
ii) Plateau slow rising pulse
iii) Collapsing water hammer pulse
i) Anacrotic slow rising pulse: AS
ii) Plateau slow rising pulse: AS
iii) Collapsing water hammer pulse: AR
What are the causes of:
i) Soft S1
ii) Loud S1
iii) Soft S2
iv) Loud S2
v) S3
vi) S4
i) Soft S1: MR, TR
ii) Loud S1: MS, TS
iii) Soft S2: AR, PR
iv) Loud S2: AS, PS
v) S3: AR, MR, VSD, PDA
vi) S4: AS, MS, PS, HOCM
* Heart sounds are soft in Regurgitation & Loud in stenosis. S3 due to regurgitation. S4 due to stenosis.
What are the differential diagnoses for:
i) Pansystolic murmur
ii) Ejection systolic murmur
iii) Early diastolic murmur
iv) Mid-diastolic murmur
v) Continuous murmur
i) Pansystolic murmur: MR, TR, VSD
ii) Ejection systolic murmur: AS, PS, HOCM, ASD
iii) Early diastolic murmur: AR, PR
iv) Mid-diastolic murmur: MS, TS
v) Continuous murmur: PDA, AVF
What is the effect of:
i) Inspiration
ii) Expiration
iii) Left lateral decubitus position
iv) Leaning forward & expiration
v) Valsalva manoeuvre
i) Inspiration: Increased right sided murmurs (T/P)
ii) Expiration: increases left sided murmurs (A/M)
iii) Left lateral decubitus position: Increases MS
iv) Leaning forward & expiration: Increases AR
v) Valsalva manoeuvre: Increases HOCM & MVP, Reduces AS
What are the causes of Pulmonary Stenosis?
- Congenital
- Carcinoid syndrome
What are the signs of severity of Pulmonary Stenosis?
- Length of systolic murmur
- Loud S2
- S4
- RVF, Increased JVP
- Peripheral cyanosis secondary to reduced cardiac output
What are thet clinical findings of Hypertrophic Obstructive Cardiomyopathy?
- Sharp jerky pulse
- Double/triple apical impulse
- Length of ESM over LLSE (increased with valsalva)
- S4
- MR murmur (pansystolic murmur radiating to axilla)
