Interpreting signs

Question 0

Midline sternotomy plus murmur

Answer 0

Tissue valve

Valvotomy

Question 1

Midline sternotomy plus metallic click

Answer 1

Mechanical valve- used is AS

- last longer than bioprosthetic but need anticoagulation- young pts

Question 2

Midline sternotomy plus vein harvest scar on inner legs (saphenous vein)

Answer 2

CABG

Question 3

Midline sternotomy- Old scar, young patient

Answer 3

Repair of congenital defect

Question 4

Midline sternotomy plus signs of immunosuppression

Answer 4

Heart transplant

Question 5

Midline sternotomy plus no other findings

Answer 5

• trauma: tamponade/aortic
• inferior mammary artery CABG
• tissue valve

Question 6

Cardiac causes of clubbing

Answer 6

1. Subacute bacterial endocarditis
2. Congenital cyanotic heart disease
3. Atrial myxoma (very rare) - assoc with Carney complex/LAMES syndrome:
   Lentignes: skin pigmentation
   Atrial Myxoma
   Endocrine tumours: pituitary
   Schwanomas

Question 7

Collapsing pulse

Answer 7

Hyperdynamic circulation

1. AR
2. Thyrotoxicosis
3. Pregnancy
4. Anaemia

Question 8

Raised JVP
Left parasternal heave (LVH)
Loud P2 + pan systolic murmur of TR
Pulsatile hepatomegaly
Ascites and peripheral oedema

Answer 8

Pulmonary HTN

Question 9

Hear sound S1

Answer 9

Mitral valve closure

Question 10

Heart sound S2

Answer 10

Aortic valve closure

Question 11

Heart sound S3

Answer 11

Rapid ventricular filling of a dilated left ventricle

Question 12

Heart sound s4

Answer 12

Atrial contraction against a stiff ventricle

Question 13

Slow rising pulse

Answer 13

Aortic stenosis

Question 14

Narrow pulse pressure

Answer 14

Less than 30mmHg

Aortic stenosis

Question 15

Forceful but non displaced apex beat

Answer 15

This is due to pressure overload in aortic stenosis

Question 16

Hear sounds in aortic stenosis

Answer 16

• quiet s2
• if young, ejection click
• possible s4 (forceful atrial contraction against a stiff/hypertrophied ventricle)

Question 17

Murmur in aortic stenosis

Answer 17

Murmur: Ejection systolic
Where: Right 2nd intercostal space
Manouvre: Sitting forwards at end expiration
Radiation: carotids

Question 18

Characteristics of aortic slerosis that determines it from aortic stenosis

Answer 18

No radiation to carotids

Normal pulse character (no slow rising, no narrow pulse pressure)

Question 19

Heart murmur and findings in HOCM

Answer 19

Can sound like AS- ejection systolic murmur

Valsalva increases murmur volume.

Question 20

Causes of aortic stenosis

Answer 20

Age related senile calcification
Calcification from hyperCa2+ in renal failure
Bicuspid aortic valve
Rheumatic heart diseas.

Question 21

Signs of severe aortic stenosis

Answer 21

Quiet/absent s2
Presence of s4 (forceful atrial contraction against a hypertrophied ventricle- in an attempt to overcome stenosis)
Narrow pulse pressure.
If decompensated: LVF

Question 22

Clinical symptoms of severe aortic stenosis

Answer 22

Angina:
Syncope
Dyspnoea