Examination - Cardiovascular Flashcards
(36 cards)
What are the potential reasons someone might be in warfarin?
AF
Metallic valve replacement
Which pathology causes a slow rising pulse and a narrow pulse pressure and why?
Aortic stenosis because it is an outflow obstruction of the stroke volume meaning it takes longer for the pulse to rise and there is a smaller gap between the systolic and diastolic blood pressures.
What sort of murmur is heard in aortic stenosis?
Ejection systolic murmur in the aortic region.
How can you differentiate between aortic stenosis and aortic sclerosis?
Sclerosis:
- Ejection systolic murmur in aortic region
- Everything else normal
Stenosis:
- Ejection systolic murmur in aortic region
- Murmur radiates to carotids
- Slow rising pulse
- Narrow pulse pressure
- Heaving apex beat
What are the causes of aortic stenosis?
Calcification degeneraion
Bicuspid vale
What are the symptoms of aortic stenosis?
- syncope
- angina (because coronary arteries are not filling sufficiently
- LV heart failure
- sudden death
What are the signs of severe aortic stenosis?
- heaving apex beat
- palpable thrill
- narrow pulse pressure/slow rising pulse
- CCF features
- Symptomatic
‘ASH’ - decreasing prognosis:
- angina
- syncope
- heart failure
What are the indications for surgery of aortic stenosis?
- symptomatic
- CCF signs
- mean transvalvular pressure gradient >40mmHg, valve area <1cm2 or jet velocity >4m/s
- concomitant CABG
How do you grade heart murmurs?
- Just audible to expert
- Just audible to non-expert
- Clearly audible
- Clearly audible with palpable thrill
- Audible with stethoscope pressed lightly
- Audible without stethoscope on chest
What are the two differentials for a sternotomy scar and how do you differentiate them?
Valve replacement - Heart sounds
CABG - saphenous harvest, signs of RF e.g. tar staining, xanthelasma
What is the main differential if someone has a sternotomy scar and warfarin?
Metallic valve replacement
What does a metallic click on the first heart sound indicate?
Metal mitral valve replacement
What are the differential diagnoses for a patient with a sternotomy scar, no saphenous scar and no metallic heart sounds?
Tissue valve replacement
CABG
Congenital heart disease repair
What type of valve replacements are there?
Metallic or tissue
Do metallic or tissue valves have a higher chance of blood clots?
Metallic
What does a metallic click on the second heart sound indicate?
Metal aortic valve replacement
What vessels can be used in CABG and what are their longevities?
Great saphenous vein - poor longevity as it becomes atherosclerosed quickly as it is a vein
Internal thoracic (mammary) artery - greater longevity
What are the indications for CABG?
Left main-stem disease
2 or more vessel disease
Failure of medical management
Concomitant (aortiC) valvular replacement
What medications would you give post-CABG?
- Dual antiplatelet therapy [aspirin + clopidogrel] for 12 months then aspirin along for life
- Cardio-selective beta blocker e.g. bisprolol
- ACE-inhibitor or ARB
What is the main differential for someone with no sternotomy scar, normal pulse and a pansystolic murmur?
Mitral valve regurgitation
What sort of murmur would you expect to hear in mitral valve regurgitation?
Pansystolic murmur heard only at mitral region
What are the differentials for a systolic murmur heard loudest in the upper chest?
Aortic stenosis
Aortic sclerosis
What is the differential for a systolic murmur heard loudest at the apex?
Mitral regurgitation
What is the manouvre to hear the murmur in aortic stenosis?
Auscultates carotids whilst patient hears breath
