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Flashcards in Pulses Deck (35):
1

Slow rising pulse
Narrow pulse pressure
Heaving apex beat
Fourth heart sound

Aortic stenosis

2

Collapsing pulse
Wide pulse pressure
"pistol shot" over femoral arteries

Aortic regurgitation

3

Radiofemoral delay in a patient with hypertension

Coarction of the aorta

4

45XO

Turner's syndrome (associated with coarctin of the aorta)

5

Puslsus paradoxicus
JVP rises on inspiration
Heart sounds muffled

Cardiac tamponade
(this is Beck's triad!!)

6

Bounding pulse in a patient who is short of breath

Acute CO2 retention

7

Pulse in severe left ventricular failure

Alterans (regular rhythm but strong beat then weak beat)

8

Slow rising pulse

Aortic stenosis

9

Narrow pulse pressure

Aortic stenosis

10

Opening snap

Mitral stenosis

11

Wide splitting of the second heart sound

Right bundle branch block

12

Mid systolic click followed by a late systolic murmur

Mitral valve prolapse

13

Ejection systolic murmur

Pulmonary stenosis

14

Low volume pulse, slow rising

Aortic stenosis

15

Forceful apex

Aortic stenosis

16

Ejection systolic murmur maximal in aortic area and radiating to carotids?

Aortic stenosis

17

Aortic stenosis on ECG?

LVH

18

If you can't give surgery for aortic stenosis (i.e. too high risk) what would you do?

Transcatheter aortic valve implantation

19

Displaced apex beat

Mitral regurgitation

20

Pansystolic murmur
-maximal at apex
-radiating to axilla

Mitral regurgitation

21

Where is mitral regurgitation murmur best heard?

Maximal at apex
Radiating to axilla

22

Drug treatment for mitral regurgitation? (DADW)

Diuretics
ACEi
Digoxin
Warfarin

23

Tapping apex

Mitral stenosis

24

Mid diastolic murmur localised to apex

Mitral stenosis

25

Malar flush
Tapping apex beat
Mid Diastolic murmur localised to apex
Later stages: Rt heart failure, cardiac cachexia

Mitral stenosis

26

Mitral stenosis on CXR?

Straight left heart border

27

Drug treatment for mitral stenosis?

DBDW
(diuretics, beta-blockers, digoxin, warfarin)

28

Causes of aortic regurgitation?

Infective endocarditis
Rheumatic heart disease
Marfan's syndrome
Acute aortic dissection

29

High volume collapsing pulse, displaced apex

Aortic regurgitation

30

When and where is aortic regurgitation murmur best heard?

Early diastolic murmur at lower left sternal edge

31

Drug treatment for aortic regurgitation?

AAD
(ACEi, ARB, diuretics)

32

Straight left heard border on CXR

Mitral stenosis

33

Harsh pan-systolic murmur, loudest at the lower left sternal edge and inaudible at the apex. The apex is not displaced. It does not intensify on inspiration

VSD

34

There is a soft late systolic murmur at the apex radiating to the axilla

Mitral valve prolapse
-there may be a mid systolic click

(mitral incompetence usually second to proplapse)

35

The pulse is regular and jerky in character. The cardiac impulse is hyperdynamic and not displaced. There is a mid-systolic murmur, with no ejection click, loudest at the left sternal edge.

This is a classical description of hypertrophic cardiomyopathy