Comprehensive: Cardio

Diastolic or Systolic: Mitral regurgitation

Systolic

Diastolic or Systolic: Tricuspid regurgitation

Systolic

Diastolic or Systolic: Aortic stenosis

Systolic

Diastolic or Systolic: Pulmonic stenosis

Systolic

Diastolic or Systolic: Mitral stenosis

Diastolic

Diastolic or Systolic: Tricuspid stenosis

Diastolic

Diastolic or Systolic: Aortic regurgitation

Diastolic

Diastolic or Systolic: Pulmonic regurgitation

Diastolic

Continuous musical hum of grade 1-2 intensity

Venous hum

Where is a venous hum loudest?

Right infraclavicular area

What resolves a venous hum?

Turning the child's neck, placing the child supine, compressing the jugular

What accentuates a venous hum?

Diastole and inspiration

Harsh, diamond-shaped, crescendo-decrescendo systolic ejection murmur heard at the RUSB radiating to the neck (carotid)

Aortic stenosis

What are the 3 symptoms associated with AS?

Exertional dyspnea, angina, syncope

What test is used to diagnose an AS murmur?

TEE

What 2 other physical exam findings are associated with AS?

- Paradoxical split S2
- Pulsus parvus et tardus

High pitched decrescendo diastolic murmur heard best along LLSB (valve) or RLSB (aortic root)

Aortic regurgitation

What murmur may result in a Austin Flint murmur?

Aortic regurgitation

What accentuates an aortic regurgitation murmur?

Sitting up and leaning forward

What 2 abnormal pulses are associated with aortic regurgitation?

Pulsus alternans & Bisferens pulse

Wide pulse pressure presentation with forceful arterial pulse upswing with rapid falloff

Water-Hammer pulse

Unusually large carotid pulsation

Corrigan's pulse

Pulsatile blanching and reddening of fingernails upon light pressure

Quincke's sign

Pulsatile bobbing of the uvula

Muller's sign

To & fro murmur over femoral artery heard best with mild pressure applied to the artery

Duroziez's sign

What is the most important testing used to diagnose aortic regurgitation?

TTE

What is the medical treatment for aortic regurgitation?

Reduce afterload- CCBs (nifedipine), ACEI, ARBs, hydralazine

What is the most common cause of mitral stenosis?

Rheumatic fever

What symptoms are associated with mitral stenosis?

Palpitations, HF, dyspnea (PHD), A fib, Ortner's syndrome

Palpitations, Heart failure, Dyspnea (PHD)- what murmur?

Mitral stenosis

What murmur may be associated with Ortner's syndrome?

Mitral stenosis

Hoarseness due to recurrent laryngeal nerve compression

Ortner's syndrome

Opening snap, low-pitched diastolic rumble, Loud (crisp) S1, Increased P2

Mitral stenosis

Where is mitral stenosis best heard?

Apex in the left lateral decubitus position

Mitral stenosis may present for the first time in __________

Pregnancy

What is the treatment for mitral stenosis?

Percutaneous balloon valvuloplasty

Holosystolic murmur, high-pitched and loud heart at the apex radiating to the left axilla

Mitral regurgitation

What is the most common cause of mitral regurgitation?

Mitral valve prolapse

What symptoms are associated with mitral regurgitation?

Dyspnea, fatigue, PND, orthopnea

What is the best testing for diagnosis of mitral regurgitation?

TEE & color Doppler echo

What can be seen on an EKG of a person with mitral regurgitation?

LVH and LAE

What is the treatment for chronic mitral regurgitation?

Percutaneous MV repair with catheter based clip

What is the most common patient demo for mitral valve prolapse?

Slender, tall females

"Barlow's syndrome"

Mitral valve prolapse

"Click murmur syndrome"

Mitral valve prolapse

What symptoms are rare with mitral valve prolapse?

Edema and HF

Mid systolic click, followed by a late systolic murmur best heard at the apex

Mitral valve prolapse

What is the effect of Valsalva on mitral valve prolapse?

More holosystolic, louder, earlier click

What is the effect of squatting on mitral valve prolapse?

Shorter, delayed click

What is the best testing for diagnosis of mitral valve prolapse?

TEE

Is endocarditis prophylaxis recommended for patients with mitral valve prolapse?

No

What is the symptomatic treatment (palpitations) for mitral valve prolapse?

Beta blockers

Systolic crescendo-descrescendo ejection murmur in the left upper sternal border that increases with inspiration and radiates diffusely

Pulmonic stenosis

What symptoms associated with pulmonic stenosis may develop?

RVH, JVD, RV ischemia

When is pulmonic stenosis usually detected?

Childhood- congenital

What is the most common cause of primary pulmonic regurgitation?

Congenital abnormality

What are causes of secondary pulmonic regurgitation?

Pulmonary HTN, Dilated cardiomyopathy

Crescendo-decrescendo early diastolic murmur heard at the LUSB

Pulmonic regurgitation

What condition is associated with a Graham Steell murmur?

Pulmonic regurgitation

High-pitched early diastolic descrescendo murmur heard over the LUSB, a result of high-velocity regurgitant flow across an incompetent pulmonic valve

Graham Steell murmur

What symptoms may be associated with pulmonary regurgitation?

RHF symptoms

When tricuspid regurgitation is due to rheumatic heart disease, it generally occurs in combination with __________

Tricuspid stenosis

What is the most common congenital form of tricuspid regurgitation?

Ebstein anomaly

Injection of foreign agents into venous system (IVDA) hits the ________ valve FIRST

Tricuspid

High pitch blowing pansystolic murmur at the 4th ICS LSB

Tricuspid regurgitation

What symptoms are associated with tricuspid regurgitation?

Symptoms of RHF

Patient with a hx of IVDA presents with Osler nodes, Janeway lesions, and Roth spots. What condition are you thinking & what is the associated murmur?

Bacterial endocarditis, Tricuspid regurgitation

Filling volume of the ventricle at the end of diastole

Preload

What are the 4 determinants of preload?

Total blood volume returning, distribution of blood volume, atrial contraction, compliance

Amount of resistance against which the ventricle pumps

Afterload

What are the 2 determinants of afterload?

Aortic pressure and volume of ventricle cavity/thickness of ventricular wall

Most venous blood returns via the _____

Coronary sinus

What are the 3 factors that determine stroke volume?

Preload, Afterload, Contractility

What is used to measure preload?

LV EDV

What is a normal ejection fraction?

55-70%

What does Frank-Starling's Law state?

The greater the EDV, the greater the SV

Language of hands used to describe chest pain

Levine sign

Abnormally uncomfortable awareness of breathing

Dyspnea

Dyspnea upon assuming the supine position

Orthopnea

Dyspnea upon assuming the lateral decubitus position

Trepopnea

Dyspnea upon assuming the upright position

Platypnea

What NYHA Classification:

Patients with no limitation of activities; they suffer no symptoms from ordinary activities

Class I

What NYHA Classification:

Patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion

Class II

What NYHA Classification:

Patients with marked limitation of activity; they are comfortable only at rest

Class III

What NYHA Classification:

Patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest

Class IV

The obliteration of the window that appears when placing the fingertips together

Schamroth's sign

A positive Schamroth's sign is indicative of _______

Clubbing

Xanthelasma palpebrarum and Xanthoma are signs of ________

Familial dyslipidemia

What JVP wave is due to atrial contraction?

A wave

What JVP wave is due to bulging of tricuspid valve with ventricular systole?

C wave

What JVP wave is due to atrial relaxation?

X wave

What JVP wave is due to ventricular filling?

V wave

What JVP wave is due to tricuspid valve opening & atrial emptying?

Y wave

A giant A wave might be indicative of ______

Tricuspid/Pulmonary stenosis or RV HF

A cannon A wave might be indicative of ______

Complete heart block, junctional rhythm, or V tach

A giant V wave might be indicative of ______

Tricuspid regurgitation

A prominent X and Y descent might be indicative of ______

Constrictive pericarditis, RV HF

What is a normal JVP?

3-4 cm above the sternal angle

What is a normal pulse pressure in healthy patients?

40 mmHg

What is a normal mean arterial pressure in healthy patients?

60-100 mmHg