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RACP short cases > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the features of Marfans?

A

Tall with long limbs
High arched palate
Arachnodactyly
Positive wrist sign - when you wrap the hand aroud opposite wrist the fingers overlap
Positive thumb sign - when you make a fist with the thumb inside the fingers the end of the thumb sticks out
Scoliosis
Pes Planus - flat feet

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2
Q

What are the cardiac abnormalities that are seen in Marfans?

A

Aortic root dilatation
Aortic regurgitation
Bicuspid valve
Mitral valve prolapse

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3
Q

What are the features of Turners and what are the associated cardiac abnormalities?

A 
Short stature 
Delayed or absent pubertal development 
Neck webbing 
Low set malrotated ears 
Wide carrying angle 
Associated with aortic coarctation and bicuspid aortic valves
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4
Q

What causes an elevated JVP?

A 
Right heart failure 
Tricuspid stenosis or regurg 
Pericardial effusion or constrictive pericarditis 
SVC obstruction
Fluid overload
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5
Q

How can the arterial pulse character be described in AS (3)?

A

Anacrotic - slow volume, slow upstroke, plus a wave on upstroke
Plateau - Slow upstroke
Small volume

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6
Q

What is a tapping apex beat?

A

A palpable first heart sounds felt in mitral stenosis, especially felt in the left lateral position

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7
Q

When do you hear an S3?

A

Rapid diastolic filling - MR, AR, VSD

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8
Q

When do you hear an S4?

A

When the atrium contracts, forcing blood into a non-compliant ventricle - AS, HOCM, pulmonary hypertension

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9
Q

Differential diagnosis of a continuous murmur?

A

Patent ductus arteriosus

Dual pathology - AS with AR, MS with MR, AR and MR

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10
Q

What is hepatojugular reflux?

A

Push down on the right upper quadrant of the abdomen to increase right sided venous return. In normal people the jugular veins may distend and JVP may increase for a few seconds before going back to normal. In right sided heart failure, remains distended and elevated

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11
Q

What are the causes of mitral stenosis?

A

Rheumatic heart disease (by far most common), congenital, connective tissue disease (RA, SLE), carcinoid heart disease

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12
Q

Mitral Stenosis signs

A 
Murmur - mid-diastolic rumble
AF 
Small volume pulse (low output state if severe) with narrow pulse pressure 
Signs of pulmonary hypertension 
Signs of LV failure 
Malar flush 
Tapping apex beat 
Loud first heart sound with opening snap
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13
Q

How do you accentuate a mitral stenosis murmur?

A

Get the patient to exercise
Left lateral position
Expiration
Heard with bell

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14
Q

Signs of severity of mitral stenosis

A 
Length of the murmur 
Thrill 
Pulmonary hypertension 
Left ventricular failure 
Opening snap 
Small pulse pressure
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15
Q

Signs of pulmonary hypertension

A 
RV heave 
Loud P2 
Prominent v wave 
Elevated JVP 
TR murmur 
May have sacral and pedal oedema 
May have pulsatile liver 
Can sometimes get pulmonary regurg murmur if severe from dilatation of the pulmonary artery 
Other signs of connective tissue disease
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16
Q

What might you expect to see on ECG of mitral stenosis?

A

AF
P Mitrale if sinus
Right axis deviation

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17
Q

What is the indication for surgery in MS?

A

Valve area < 1cm squared with exertional dyspnoea

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18
Q

Why might you get a hoarse voice in valve pathology?

A

From an enlarged left atrium (as in MS), compressing the recurrent laryngeal nerve

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19
Q

What are the causes of mitral regurgitation?

A

Chronic - degenerative, mitral valve prolapse, Rheumatic (not usually the only murmur), papillary mm dysfunction (previous MI), connective tissue disease, congenital, functional (left ventricular dilatation)
Acute - AMI (chordae or papillary muscle involvement), infective endocarditis

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20
Q

What are the clinical signs of MR?

A 
Pansystolic murmur over apex radiating to axilla 
Soft S1
S3 
AF 
Thrill
Signs of LV failure 
Signs of pulmonary Hypertension 
Volume loaded apex beat
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21
Q

Mitral regurg signs of severity

A 
Displaced apex beat 
Soft S1 
Pulmonary HT 
LV failure 
Small volume pulse 
Thrill 
S3 and S4
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22
Q

Differentiating between TR and MR

A

TR - v waves, parasternal thrill, pulsatile liver, louder in inspiration, louder are left parasternal edge, parasternal heave
MR - radiation to axilla, louder in expiration, displaced apex beat, apical thrill

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23
Q

ECG in MR

A

AF, P mitrale, right axis deviation if severe

24
Q

Clinical features of mitral valve prolapse (without significant MR)

A

Mid systolic click followed by late systolic crescendo decrescendo murmur
Valsalva accentuates the click and murmur
Handgrip or squatting - murmur shorter

25
Q

Which conditions are associated with mitral valve prolapse?

A

Marfan’s, Ehlers Danlos, SLE, PKD, osteogenesis imperfecta

26
Q

Causes of aortic regurgitation

A

Chronic - rheumatic (rare to be only murmur), connective tissue (esp ank spon), congenital (eg - bicuspid valve, Marfan’s), HT, old age, syphilis
Acute - IE, dissection

27
Q

Clinical signs of AR

A 
Early diastolic decrescendo murmur heard loudest in left sternal edge leaning forwards and expiration
Collapsing pulse 
Corrigans pulse 
Displaced apex beat 
S3 
Wide pulse pressure 
Soft A2 
LVF
Volume loaded apex beat
28
Q

Aortic Regurgitation signs of severity

A 
LVF
Collapsing pulse 
Wide pulse pressure (esp > 100)
Length of the murmur 
Austin Flint murmur - a separate mid-diastolic murmur from the regurgitant jet hitting the mitral valve causing a functional mitral stenosis 
LVF and signs of PH
S3
Thrill in aortic region
29
Q

AR - what can you see on ECG

A

LVH from diastolic overload

30
Q

Causes of Aortic Stenosis

A

Degenerative
Rheumatic
Congenital
Calcific bicuspid valve

31
Q

Signs of aortic stenosis

A

Ejection systolic murmur that radiates to the carotids and louder in expiration
Narrow pulse pressure
Plateau or anacrotic pulse or low volume pulse
S4
Aortic thrill
Signs of LVF
Pressure loaded apex beat
Reversed splitting of the second heart sound

32
Q

Signs of severity of AS

A 
Narrow pulse pressure 
LVF 
Late peaking murmur 
Plateau pulse 
Thrill 
S4
Reversed splitting of the second heart sound
33
Q

Differential diagnosis of ejection systolic murmur

A

Pulmonary stenosis - louder on inspiration over pulmonary region
HOCM - louder of left sternal edge accentuated with valsalva
Aortic sclerosis - shouldn’t radiate to carotids

34
Q

ECG of Aortic stenosis

A

LVH
Left axis deviation
COnduction abnormalities (LBBB, 1st degree HB)

35
Q

Features of tricuspid regurgitation

A

Prominent v waves
Pan-systolic murmur loudest at left sternal edge in inspiration
Pulsatile liver
Right ventricular heave

36
Q

Causes of TR

A

Functional - in pulmonary hypertension or RV failure
Congenital - Ebstein’s anomaly
IE - especially if history of IVDU
Rheumatic - rare to be the only murmur
Infarct affecting papillary muscles - rare

37
Q

What might you see on ECG for Pulmonary HT?

A

RV strain pattern - ST depression and TWI in leads anterior leads corresponding to the RV (V1- V3), right axis deviation, RBBB

38
Q

Treatment of primary pulmonary hypertension

A

Phosphodiesterase inhibitors like sildenafil

Endothelin antagonists like bosentan

39
Q

Clinical signs HOCM

A 
Ejection systolic murmur loudest over left sternal edge, louder with valsalva 
Pansystolic murmur from mitral regurg 
Double carotid arterial impulse 
JVP - prominent a wave 
Apex beat NOT displaced but pressure loaded 
Double apical impulse 
Reversed splitting second heart sound 
S4 
Look for device - ICD
40
Q

ECG changes in HOCM

A 
LV hypertrophy 
left axis deviation 
Deep Q waves 
Lateral ST segment/T wave changes 
Conduction defects
41
Q

VSD clinical signs

A

parasternal thrill
Harsh sounding pan-systolic murmur loudest over the left sternal edge
Can be associated with Downs Syndrome

42
Q

What are the complications of VSD?

A

IE
Pulmonary hypertension
Eisenmenger’s syndrome
Ventricular arrhythmias

43
Q

How do you tell the difference between a metallic aortic vs mitral prosthesis on clinical exam easily?

A

Mitral valve - hear the click with the carotid pulse

Aortic valve - hear the click just after the carotid pulse

44
Q

Which patients commonly have mixed aortic valve disease?

A

Patients with a Biscuspid aortic valve

45
Q

if you think you have mixed aortic valve pathology then what should you do?

A

Look for signs so that you can point out the predominant lesion
Predom AS - Low pulse volume, slow rising pulse, minimally displaced apex, thrill, narrow pulse pressure, low BP
Predom AR - large pulse volume, collapsing pulse, displaced apex, thrill may not be present, wide pulse pressure, high BP

46
Q

What are the clinical signs of an ASD?

A

Fixed splitting of the second heart sound
Ejection systolic murmur at the pulmonary region (from increased flow)
Pulmonary Hypertension (late)

47
Q

What is patent ductus arteriosus?

A

connection between where the pulmonary veins split and the aorta

48
Q

PDA clinical signs

A

Continuous murmur heard loudest over the left subclavicular area
Increased pulse pressure (if large)
Signs of pulmonary HT
Collapsing pulse
Displaced apex beat when severe (high volumes returning to left heart)
If Eisenmenger’s - cyanosis and clubbing of toes not fingers

49
Q

DDx of continuous murmur

A

PDA
MR and AR
VSD and AR

50
Q

What are the complications of PDA?

A

LV dysfunction
Pulmonary HT
Eisenmenger’s

51
Q

Aortic coarctation clinical signs

A 
Better developed upper body 
HT in the arms only 
Radial-femoral delay 
Midsystolic murmur over the praecordium and back 
Changes of HT in the fundi 
Features of Turner's syndrome
52
Q

Four features of tetralogy of Fallot

A

Right ventricular outflow tract obstruction (pulmonary stenosis)
Right ventricular hypertrophy
VSD
Overriding aorta

53
Q

Clinical features of tetralogy of Fallot

A 
Thoracotomy scar 
Parasternal heave 
Systolic thrill at the upper left sternal edge (RV outflow tract obstruction)
SIngle second heart sound 
Short pulmonary ejection murmur
54
Q

What is Eisenmenger’s syndrome and what are the Hallmark signs?

A

Right to left shunting through longstanding defect either ASD, VSD, PDA
Central cyanosis
Pulmonary HT
Clubbing

55
Q

What sign do you see on chest xray when there is left atrial enlargement

A

Double density sign at the right heart border on CXR

RACP short cases (8 decks)

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