Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Exam PREP > Cardiology > Flashcards

Cardiology Flashcards

Master the art of cardiology (70 cards)

Start Studying
1
Q

Loud S1

Closure of mitral and tricuspid valve

A

Mitral stenosis
Tricuspid stenosis
Tachycardia
Hyperdynamic circulation

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

Soft S1

A

Mitral Regurgitation
Calcified mitral valve
LBBB
1st degree AV block

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

A2 part of S2 (loud and soft)

A

Loud:
Aortic stenosis
Hypertension

Soft:
Aortic regurgitation
Calcified aortic valve

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

P2 part of S2 (loud and soft)

A

Loud:
Pulmonary hypertension

Soft:
Pulmonary stenosis

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

Splitting of S2 (increased normal, reverse and fixed)

A 
Increased normal splitting (wider on inspiration):
RBBB
Pulmonary stenosis
VSD 
MR 
Reverse splitting:
AS (severity sign) 
LBBB 
Coarctation of aorta
Large PDA

Fixed splitting:
ASD

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

S3 (tightening of mitral or tricuspid cusps at the end of rapid diastolic filling)
Left and right

A 
Left S3 - louder at apex on expiration:
Left ventricular failure
Aortic regurgitation 
Mitral regurgitation 
VSD

Right S3 - louder at LSE and on inspiration:
Right heart failure
Constriction pericarditis

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

S4 (high atrial pressure wave is reflected back from a poorly conpliant ventricle)
ALWAYS ABNORMAL, left and right

A 
Left S4:
Aortic stenosis 
Hypertension
Acute mitral regurgitation
HOCM

Right S4:
Pulmonary hypertension
Pulmonary stenosis

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

Signs of pulmonary hypertension

A

JVP - prominent a wave
Prominent v wave if developed functional TR
RV parasternal heave
Palpable / loud P2
Signs of right heart failure: raised JVP, pulsatile liver, ascites, sacral and peripheral oedema

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

ECG findings of pHTN

A

P pulmonale

  • right atrial enlargement
  • peaked p wave in lead II
  • upright p in V1

Atrial fibrillation

Right ventricular hypertrophy

diagnostic:
- right axis deviation
- dominant R wave in V1
- dominant S wave in V6
- QRS < 120ms

Supporting:

  • p pulmonale
  • right ventricular strain: t wave inversion / ST depression in V1-4 and II, III avF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Signs of tricuspid regurgitation

A

Elevated JVP
Dominant V waves
Right ventricular heave
Pansystolic murmur loudest at LLSE on inspiration
Multiple systolic clicks (if Ebatein’s anomaly)
Pulsatile liver, ascites, oedema

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

Causes of tricuspid regurgitation

A 
Functional (most common) - hence must look for causes of left and right heart failure 
Rheumatic disease 
Infective endocarditis
Congential (ebstein’s anonaly)
Tricuspid valve prolapse 
Right ventricular muscle infarction 
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs of pulmonary stenosis

A 
Peripheral cyanosis (in R-L shunt and increased R atrial pressure through ASD, PFO) 
Low volume pulse 
Giant A wave JVP 
RV heave 
Thrill over the pulmonary area 
Ejection systolic murmur
Splitting of S2
S4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Severity signs of PS

A

S4
Absence of ejection click (burried in S1)
Length of murmur and late peaking
Signs of right heart failure

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

Causes of PS

A

Congenital

  • Tetralogy of Fallot
  • Noonan syndrome
  • congenital rubella syndrome

Carcinoid syndrome

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

*7 Signs of Severity of Aortic Stenosis

A
  • Plateau pulse
  • Narrow pulse pressure
  • Aortic thrill
  • Length, harshness and lateness of the peak of systolic murmur
  • S4
  • Paradoxical splitting of S2
  • Signs of LVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common cause of AS

A
  • Young - Bicuspid valve
  • Old - Degenerative Calcification

Rheumatic heart disease

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

Differential diagnosis of AS

A
  • HOCM

- William Syndrome

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

AS severity on TTE

A
  • > 40mmHg
  • Area < 1.0cm
  • Velocity D.I. <0.25
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Difference between Stenosis and Sclerosis?

A

Sclerosis:

  • Doesn’t have reverse splitting of S2
  • Normal pulse and character
  • No displaced apex beat
  • Doesn’t radiate to the carotids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

*8 Complications of AS

A
  • Complete Heart Block
  • LVF
  • Thromboembolism
  • Infective Endocarditis
  • Pulmonary HTN
  • Heyde’s
  • Sudden Cardiac Death
  • Arrhythmias - AF, VT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Worst Prognostic Factor of AS

A

***Dyspnoea

Others include: Angina, Syncope

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

ECG (2) and CXR (6) findings suggestive of AS

A

ECG:

  • L) BBB
  • L) axis deviation

CXR:

  • Rib notching
  • Post stenotic dilatation of ascending aorta
  • Pulmonary congestion
  • Valve calcification
  • Cardiomegaly
  • Pul HTN/prominent pulmonary arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Indications for surgery for AS

A
  • Gradient >40mmHg
  • Symptomatic LVF
  • VT
  • Valve area <0.6cm
  • Other planned surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What type of murmur is MS?

A
  • Mid-diastolic murmur (low frequency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
7 Signs of Severity of MS
- Early opening snap (d/t increased L) atrial pressure) - Low pulse pressure (decreased cardiac output) - Increased length of murmur - Pulmonary HTN (prominent a-wave, RV heave, P2 loud/palpable) - Pulmonary congestion - Pulmonary reguirgitation (Graham Steell) - TR
26
Best position to hear MS
- L) lateral position with bell
27
5 Causes of MS
1) Rheumatic heart disease 2) Mitral annular calcification 3) Post MVR for MR 4) Congenital parachute valve 5) Cardiac carcinoid, Fabry's, RA, SLE, Whipple's
28
Differential diagnosis of MS
- TS - Atrial myxoma - L) atrial thrombus - Severe MR causing a mid-diastolic murmur (functional MS)
29
4 Complications of MS
- Valvular AF - L) atrial thrombus formation - Pulmonary HTN - R) heart failure
30
ECG (2) and CXR (3) findings of MS
ECG: - p-mitrale (bifid p-waves) suggestive of L) atrial hypertrophy - AF CXR: - MAC - large pulmonary arteries suggestive of pul HTN - double R) heart border suggestive of L) atrial enlargement
31
4 Indications for surgery in MS
- Exertional dyspnoea - Pulmonary HTN - Pulmonary congestion - Recurrent thrombo-embolic events despite anticoagulation
32
8 Chronic causes of MR
1) MVP 2) Degenerative disease 3) Rheumatic heart disease 4) Papillary muscle dysfunction due to LVF/ischemia 5) CTD - RA, Ank Spond 6) Congenital 7) Marfan's 8) Libman–Sacks endocarditis - SLE
33
4 Acute causes of MR
1) Infective endocarditis 2) Myocardial infarction 3) Surgery 4) Trauma
34
8 Signs of Severity of MR
- Soft S1 - S3 - Early diastolic rumble - due to increased flow across MV (functional MS) - Displaced apex beat/enlarged LV - Wide-split S2 - aortic component A2 earlier - Precordial thrill - Pulmonary HTN - Pulmonary congestion/LVF
35
Differential diagnosis of MR
- VSD | - TR
36
ECG (3) and CXR (4) findings of MR
ECG: - p-mitrale - AF - R) axis deviation CXR: - Gigantic L) atrium - double-bordered R) heart - MAC - Increased LV size
37
Indications for surgery in MR
*Essentially if have symptoms of dyspnoea Chronic: - NYHA III/IV, LV dysfunction, EF <60% Acute: - haemodynamic compromise *If asymptomatic, 6-monthly TTE follow up
38
What type of murmur is AR?
- early diastolic murmur
39
Differential diagnosis of AR?
- PR
40
5 Chronic Causes of AR
- Rheumatic heart disease - Congenital - bicuspid (also consider aortic root dilatation, coarctation), VSD - Marfan's - RA, Ank Spond - Tertiary Syphilis
41
2 Acute Chronic Causes of AR
- Infective endocarditis | - Dissecting aortic root aneurysm
42
8 Signs of Severity of AR
- Collapsing pulse - Wide pulse pressure - Length of the decrescendo diastolic murmur - S3 - Soft component of A2 - LVF - Austin Flint Murmur - Functional MS - Pulmonary HTN
43
Corrigan's sign?
- Carotid pulsations
44
Quincke's sign?
- Capillary pulsations in finger nails
45
De Musset's sign?
- Head-nodding with each heart beat
46
Muller's sign?
- Systolic pulsations in uvula
47
Traube's sign?
- Pistol shot/booming sound whilst auscultation over femorals
48
ECG (1) and CXR (3) findings of AR
ECG: - LVH CXR: - LV dilatation - Aortic root dilatation/aneurysm - Valve calcification
49
Indications for surgery in AR
- Symptoms of heart failure or angina - LVEF < 50% - LV End-systolic diameter >55mm - LV End-diastolic diameter >75mm - Aortic root dilatation >50mm (CT)
50
4 causes of S3
- AR - MR - VSD - MVP
51
2 causes of S4
- AS | - HOCM
52
Most common cause of MVP
1) Primary 2) Secondary: - Marfan's - Ehlers Danlos Syndrome - SLE - PCKD - Osteogenesis imperfecta
53
6 Complications of MVP
- Stroke/infective endocarditis - Arrhythmia's - AF, ventricular ectopy - Sudden death - Severe MR - Chordal rupture - Cardiac necrosis
54
7 Signs of severity of MVP
- Displaced apex beat - Systolic thrill - Parasternal heave - Pulmonary HTN - Soft S1 - S3 - LVF
55
DDx of MVP
- AS - HOCM - PS - Trivial MR
56
Treatment of MVP (2)
1) Reassurance | 2) Surgery if severe MR
57
Classification of significant VSD
Large L --> R shunt with - Soft murmur - Displaced and thrusting apex - Presence of pulmonary HTN - Loud P2 Large R --> L shunt (Eisenmengers) with - Clubbing - Cyanosis - Displaced and thrusting apex - Pulmonary HTN signs - Single loud S2
58
DDx for the murmur of VSD
- TR | - MR
59
Causes of VSD
Maternal Factors - Maternal diabetes - Maternal phenyketonuria - Fetal alcohol syndrome (drunk mama) Aneuploid Syndromes - Down's (Trisomy 21) - Edwards (Trisomy 18) - Pataus (Trisomy 13) - Di George Syndrome (Del 22q11) - Deletions at 4q, 5p, 21 and 32 Acquired - Ischaemia - Iatrogenic (pacing wire through the septum)
60
Classifications of VSD
Perimembranous - Most common ~ 80% - Lie just below the aortic valve - Cause LV-RA defects (Gerbode defect) Supra-cristal - 5-8% of case - Lie beneath the pulmonary valve, tract leading to RV outflow tract Muscular - 5-20% of cases - Lie in the muscular septum Posterior - 8-10% cases - Posterior to the septal leaflet of the tricuspid valve
61
Complications of VSD
- IE - Pulmonary HTN - LV dysfunction - AR (with perimembranous and supra-cristal defects) - Ventricular arrhythmias - Eisenmenger's
62
Ix for VSD
- CXR: cardiomegaly, pulmonary congestion, enlarged LA - ECG: LVH, evidence of biventricular hypertrophy, LA hypertrophy (bifid p wave in lead II), LA enlargement (bifid p wave in lead V1) - Echo
63
Indications for VSD closure
- Increasing pulmonary:systemic blood flow (Qp: Qs > 2:1) - LV dysfunction - Recurrent endocarditis - Development of AR - Rupture of the IV septum
64
Contraindications for VSD closure
Irreversible severe pulmonary HTN
65
Classification of significant ASD
With L --> R shunt - Often in AF - ESM murmur - Systolic thrill - Tricuspid valve flow murmur - Pulmonary HTN - Fixed-split S2 with loud P2 With R --> L shunt - Clubbed - Cyanotic - Pulmonary HTN - Fixed split S2 with loud P2 NOTE - always will have a fixed split S2, the loud P2 adds to the significance
66
Types of ASD
Ostium secundum - Most common - Site is at the foramen ovale Ostium primum - Occurs at the anterior and inferior aspect of the septum often with involvement of the mitral and tricuspid valve Sinus venosus - Occurs at the upper atrial septum, just below the entrance of the SVC, other spot is the junction of the right atrium and IVC Coronary sinus - Self-explanatory - Rarest of the lot
67
Why do you get fixed widely split S2 in ASD
- Increased R) heart volumes from the shunt means it takes longer for the right heart to empty (later P2) - Less blood in the L) heart (earlier A2) - Equalisation of pressure in the L) and R) atria causes fixing
68
Difference between ASD and PFO
PFO - no equalisation of atrial pressure, hence no fixed split
69
What age does shunt reversal occur in ASD
~ 20 years of age
70
What may cause an ASD and mitral stenosis
- Lutembacher syndrome - ASD with acquired rheumatic mitral stenosis - Post mitral valvotomy

Clinical Exam PREP (8 decks)

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