Short Cases Q&A Flashcards
(21 cards)
Signs of Aortic Stenosis Severity
- small vol, slow rising, plateau carotid pulse
- aortic thrill
- long late peaking ESM
- S4 (reduced LV compliance)
- paradoxical splitting of S2
- presence of left ventricular failure
Signs of Aortic Regurgitation severity
- wide pulse pressure + collapsing pulse.
- long decrescendo diastolic murmur (in very severe AR + LV decompensation murmur may be soft/absent).
- S3.
- soft A2.
- Austin-Flint murmur.
- LV enlargement.
CXR features of left atrial enlargement
- straightening/convexity of left heart border
- double heart border
- splaying of carina
- posterior expansion of LA on lateral CXR
Causes of Mitral regurgitation
Secondary mitral regurgitation:
Left ventricular dilatation e.g. dilated cardiomyopathy.
Primary mitral valve disease: Chronic 1, degenerative 2. mitral valve prolapse 3. Rheumatic 4. Papillary muscle dysfunction - LV failue, ischaemia 5. Connective tissue disease - RA, ank spon 6. Congenital
Acute
- IE
- MI
- trauma
Indicators of severity of mitral regurgitation
Left ventricular dilatation. A soft S1. A split S2 (earlier A2) The presence of an S3. Complication of left ventricular failure. Small pulse volume (very severe mitral regurgitation). Early diastolic rumble pulmonary hypertension
Signs of severity of mitral stenosis
- Small pulse pressure.
- A short distance between the opening snap and S2.
- A long diastolic murmur (present as long as there is a gradient between LA & LV).
- The presence of pulmonary hypertension.
- An apical diastolic thrill.
Causes of AS
- Degenerative (calcified valve)
- Calcific bicuspid valve
- Rheumatic
Evidence of critical stenosis in echocardiogram
- valve area <0.7cm2/m2
2. valve gradient >70mmHg
Indications for surgery for AS
- symptoms (exertional angina, dyspnoea, syncope)
2. Critical obstruction & severe LVH
Causes of mitral stenosis
- rheumatic
- severe calcification
- post mitral valve repair for MR
Causes of chronic AR
Valvular 1. rheumatic 2. congenital 3. anks spon Aortic root 1. Marfan's syndrome 2. Aortitis 3. Dissecting aneurysm 4. Old age
Causes of acute AR
- Infective endocarditis
- Marfan’s syndrome
- HTN, dissecting aneurysm
Indications for surgery for AR
- Symptoms - dyspnoea on exertion
- Worsening LV function
- LV end-systolic dimension >5.5cm -> LV dilatation
Causes of tricuspid regurgitation
- Functional
- Rheumatic
- IE
- Congenital - Ebstein’’s anomaly
- RV papillary muscle infarction
- Pacemaker/defib lead
- Trauma (steering wheel injury to sternum)
Causes of anaemia in chronic liver disease
- Blood loss from portal hypertensive gastropathy
- EtOH excess causing marrow suppression
- Poor nutrition
GI causes of clubbing
- liver cirrhosis
- IBD
- coeliac disease
- GI lymphoma
Clinical manifestations of altered sex hormone metabolism in chronic liver disease
- spider naevi
- palmar erythema
- gynaecomastia
- loss of body hair
Causes of tender hepatomegaly
Recent hepatic enlargement
- infective hepatitis
- alcoholic hepatitis
- malignancy
Causes of cirrhosis
- Alcohol
- Hep B/C
3, Metabolic - NASH, haemachromatosis, a1AT deficiency - Autoimmune - AIH, PBC, PSC
- Drugs: MTX, isoniazid amiodarone, phenytoin
Signs of EtOH misuse
- tremor
- cachexia
- parotid enlargement
- Dupuytren’s contracture
- cerebellar syndrome
- peripheral neuropathy
- myopathy
Causes of decompensated cirrhosis
- Infection
- SBP
- hypoK
- GI bleeding
- Sedatives
- HCC