General Flashcards
What causes a fourth heart sound?
Heart failure
Myocardial infarction
Cardiomyopathy
Hypertension (pressure overload)
Due to atrial contraction in a non compliant or hypertrophied ventricle
What causes a third heart sound?
Heart failure, myocardial infarction, cardiomyopathy,hypertension (pressure overload )
PLUS
mitral and aortic regurgitation (volume overload) and constrictive pericarditis
Normal in children and young adults up to the age of 30
Due to blood rushing in during the rapid filling phase of diastole- stiff or dilated ventricle suddenly reaches its elastic limit and decelerates the incoming rush of blood
“Lub … de dub”
What are 5 signs of endocarditis?
2 in the hands - clubbing and splinters
1 in the heart- changing murmurs
2 in the abdomen- splenomegaly, microscopic haematuria— glomerulonephritis will see red cell casts
Plus a few rarities- osler, roth, janeway
Causes of splinter haemorrhages
Endocarditis
Trauma
Vasculitis- SLE
What are the four stages of clubbing.
Increased fluctuated of nail bed
Loss of angle
Increased curvature of nail
Expansion of the terminal phalanx- drum stick appearance
What are the causes of atrial fibrillation?
Ischaemic heart disease Rheumatic heart disease Mitral stenosis Thyrotoxicosis Pulmonary embolism Alcoholic heart disease Pneumonia
Why does a pulse deficit occur in atrial fibrillation sometimes?
This occurs due to the fast and irregular heart rate resulting in insufficient diastolic filling due to shorter insufficient diastolic filling time. Therefore there is insufficient blood available to produce an adequate amount of cardiac output for palpable pulse. There may be just enough filling to cause the closure of the heart valves, but not enough for cardiac output to produce a palpable pulse.
What level of INR do you aim for in a patient taking warfarin for his atrial fibrillation?
2.5 target
Target range 2-3
What level of INR would you aim for if the patient has a mechanical prosthetic valve and atrial fibrillation ?
3-4
