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Cardiovascular exam Flashcards

(53 cards)

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1
Q

Causes of dominant a wave

A

Tricuspid stenosis
Pulmonary stenosis
Pulmonary HTN

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2
Q

Causes of dominant v wave

A

Tricuspid regurgitation

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3
Q

Causes of cannon a waves

A

Complete heart block
VT
Paroxysmal nodal tachycardia with retrograde atrial conduction

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4
Q

Causes of elevated central venous pressure

A

RV failure
Tricuspid stenosis or regurgitation
Pericardial effusion, constrictive pericarditis
SVC obstruction
Fluid overload
Hyperdynamic circulation- fever, anaemia, pregnancy, hypoxia

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5
Q

Collapsing pulse

A 
Aortic regurgitation
Arteriosclerotic aorta
Hyperdynamic circulation
Patent ductus arteriosus
Peripheral AV aneurysm
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6
Q

Small volume pulse

A

Aortic stenosis, pericardial effusion

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7
Q

Severe mitral stenosis

A

Small pulse pressure
Early opening snap
Diastolic thrill at apex
Presence of pulmonary HTN- prominent a wave, RV impulse, loud P2, pulmonary regurgitation, TR

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8
Q

Severe MR

A

Enlarged LV
Pulmonary HTN
Third heart sound
Early diastolic rumble
Soft S1
A2 heart earlier
Small volume pulse
LV failure

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9
Q

Loud P2

A

Pulmonary HTN

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10
Q

Loud A2

A

Congenital aortic stenosis, systemic HTN

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11
Q

Fixed splitting

A

ASD

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12
Q

Causes of 3rd heart sound

A 
Physiologic
LV failure 
AR
MR
VSD
PDA
RV failure 
Constrictive pericarditis
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13
Q

Causes of 4th heart sound

A 
Aortic stenosis
Acute MR
IHD
HOCM
Pulmonary HTN
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14
Q

Severe AR

A

Collapsing pulse
Wide pulse pressure
Length of decrescendo diastolic murmur
S3
Soft A2
Austin Flint murmur
LV failure
LVH

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15
Q

Severe AS clinical signs

A

Narrow pulse pressure
Plateau pulse
Aortic thrill
Length, lateness of peak, and harshness of murmur
S4
Paradoxical splitting of S2
LV failure
LVH

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16
Q

Causes of SVC obstruction

A 
Lung carcinoma
Retrosternal tumours
Retrosternal goitre
Massive mediastinal lymphadenopathy
Aortic aneurysm
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17
Q

HOCM

A

Sharp rising jerky pulse
JVP- prominent a wave
Apex beat- double/triple impulse
ESM at left sternal edge- louder with Valsalva or standing, softer with handgrip or squatting

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18
Q

Tricuspid regurgitation

A

Large v waves
RV heave
Pansystolic murmur at left sternal edge, louder on inspiration
Pulsatile liver

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19
Q

Pulmonary stenosis

A 
Peripheral cyanosis
Giant a waves 
RV heave
Ejection systolic murmur
Presence of S4 
Signs of RV failure
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20
Q

Grades of murmurs

A 
1- very soft
2- soft
3- moderate but no thrill
4- loud, thrill just palpable 
5- very loud, thrill easily palpable
6- audible without stethoscope
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21
Q

Valsalva manoeuvre

A

Decreases preload

Increases MVP and HOCM

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22
Q

Handgrip manoeuvre

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A

Increased after load
Decreases MVP, AS and HOCM
Increases MR, AR, VSD

23
Q

Murmurs loudest with expiration

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A

Left-sided (aortic, mitral)

24
Q

Murmurs loudest with inspiration

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A

R-sided murmurs (pulmonary, triscuspid)

25
Loud S1
Mitral/tricuspid stenosis
26
Soft S1
Mitral regurgitation
27
Severe AS classification
Mean transvalvular pressure gradient ≥40mmHg AVA <0.8cm Aortic velocity ≥4m/s LVH
28
Causes of pansystolic murmur
MR TR VSD ASD
29
Causes of ejection systolic murmur
Aortic stenosis/sclerosis HOCM Pulmonary stenosis ASD
30
Pressure loaded apex beat
Hyperdynamic, systolic-overloaded Forceful with sustained impulse Seen in AS, HTN
31
Volume-loaded apex beat
Hyperkinetic, diastolic-overloaded Forceful but unsustained impulse Seen in AR or MR
32
Causes of MR
Degenerative disease Mitral valve prolapse Rheumatic heart disease Papillary muscle dysfunction- LV failure, ischaemia CT disease- RA, ank spond Congenital IE Trauma Functiona- LV dilatation (DCM, HCM)
33
Causes of AR
Rheumatic Congenital- bicuspid CT disorders/inflammatory- seronegative spondyloarthropathies, RA, SLE Degenerative Collagen disorders- Marfan's syndrome, Ehlers-Danlos, PCKD Aortitis- tertiary syphillis, vasculitis Dissecting aneurysm Old age IE
34
Causes of TR
Functional- RV failure, pulmonary HTN Degenerative Rheumatic IE CT disease Congenital- Ebstein's anomaly Tricuspid valve prolapse RV papillary muscle infarction Pacemaker/defib lead Trauma
35
Pulmonary stenosis signs
``` Peripheral cyanosis Giant a waves in JVP (due to RA hypertrophy) RV heave Pulmonary thrill Harsh ESM in pulmonary region- increases with inspiration Pulsatile liver S4 Signs of RV failure ```
36
VSD signs
``` Harsh pansystolic murmur in LSE Thrill LV hypertrophy on CXR/ECG Enlarged RV Associated with Down syndrome ```
37
Eisenmenger's syndrome
Peripheral and central cyanosis Clubbing Polycythaemia Dominant a wave in JVP Pulmonary HTN- RV heave, palpable P2 RV failure Dysmorphic features- Down's Systolic murmur
38
LVH criteria on ECG
S wave depth in V1 + R wave height in V5-6 >35mm
39
CHADSVASC score
``` CHF HTN Age >75 (2) Diabetes Stroke Hx Vascular- MI, peripheral artery disease Gender ```
40
HASBLED score
``` HTN Altered LFTs/renal function Stroke Hx Bleeding Hx Labile INR Elderly >65 Drugs/EtOH ```
41
Investigations in AS
ECG- LVH, LV strain CXR- LVH, pulmonary oedema, calcified aortic annulus Echocardiogram- severity (valve area <1cm2, mean gradient >40mmHg, peak velocity >4m/s
42
Causes of AS
Calcified- elderly patients Congenital valvulopathy- bicuspid valve Rheumatic heart disease SLE Fabry's disease
43
Management of AS
Medical therapy- HF treatment Balloon aortic valvuloplasty Valve replacement- TAVI or SAVR
44
Investigations in AR
ECG- LVH, LA enlargement, LV strain CXR- LV dilatation, aortic root dilation Echo- confirm Dx, concomitant stenosis
45
Mitral valve prolapse
Most common heart lesion Mid-systolic click and late systolic murmur Longer with Valsalva
46
Ix in MR
ECG- AF, LA enlargement, LVH, LV strain CXR- cardiomegaly, LA enlargement Echo- prolapsing/thickened leaflets, cardiomyopathy, decrease in LVEF (late)
47
Causes of mitral stenosis
Rheumatic heart disease Degenerative- annular calcification Iatrogenic- following MR repair Congenital
48
Investigations in mitral stenosis
ECG- AF, LA enlargement, RAD, RVH CXR- LA enlargement Echo- valve area <1cm
49
Investigations in TR
ECG- RAD, RA enlargement, RVH CXR- cardiomegaly, RV enlargement
50
Causes of pulmonary stenosis
Iatrogenic- post repair for PR Congenital Carcinoid syndrome
51
Investigations in HOCM
ECG- LVH + strain, deep Q-waves CXR- LV enlargement Echo- asymmetric septal hypertrophy, prominent diastolic dysfunction Exercise stress testing- inducible LV outflow tract obstruction
52
Causes of pulmonary HTN
I- idiopathic, CT diseases, congenital, drugs II- left heart failure III- chronic hypoxic pulmonary disease (COPD, IPF) IV- chronic thromboembolic pHTN V- misc (sarcoidosis, glycogen storage disorders)
53
Investigations in pulmonary HTN
ECG- RVH, RV strain, RAE CXR- R) sided cardiomegaly Echo- RA dilation, TR/PR, elevated RV and PA pressures RHC

Clinical exam things (7 decks)

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