First Aid: Cardio II

  1. Signs of mitral stenosis
    • Exertional dyspnea
    • Cough
    • Systemic embolism, due to enlarged LA
    • Accentuated RV precordial thrust
    • Hoarse voice (if enlarged LA compresses recurrent laryngeal)
  2. Murmur of mitral stenosis
    Mid-diastolic, low pitched rumble with opening snap
  3. When should a patient with valvular disease be given prophylaxis for endocarditis?
    • Before dental procedures
    • Before GI procedures
    • Before urologic procedures
  4. Murmur of mitral regurg
    • Loud, holosystolic
    • Radiates to the axilla
    • Wide splitting of S2 on inspiration
    • Rapid filling of LV with blood regurgitated during systole may cause an S3
  5. Causes of S2 splitting
    • Splitting on inspiration--mitral regurg
    • Fixed splitting--ASD
  6. A young woman presents with atypical chest pain and a mid-systolic click
    Mitral prolapse
  7. Murmur of mitral prolapse
    • Mid-systolic click, followed by late systolic murmur
    • S3 may be present
    • Wide splitting of S2
  8. Symptoms of late stage aortic stenosis
    Angina and syncope, particularly during exercise, when peripheral resistance falls and LV pressure stays the same, due to the stenotic valve
  9. Signs of LV strain on ECG
    ST depression and T wave inversion in I, aVL, and the left precordial leads
  10. Narrow pulse pressure is characteristic of...
    Aortic stenosis
  11. Indications for aortic valve replacement
    • Persistent symptoms
    • Valve area < 0.5 cm
  12. Conditions associated with proximal aortic root dissection
    • Cystic medial necrosis
    • Marfan's
    • Syphilis
    • HTN
    • Ehlers-Danlos
    • Turner's
    • 3rd trimester of pregnancy
  13. Conditions associated with wide pulse pressure
    • Hyperthyroidism
    • Anemia
    • Wet beriberi
    • Hypertrophic subaortic stenosis
    • Hypertension
  14. Corrigan's pulse
    Bounding pulses, seen in aortic regurg
  15. Pulsus bisferiens
    Dicrotic pulse with two palpable waves in systole, seen in aortic regurg
  16. Duroziez sign
    • Presence of a diastolic femoral bruit when the femorals are compressed enough to hear a systolic bruit.
    • Seen in aortic regurg
  17. Hill's sign
    • Systolic pressure in legs > 20 mmHg higher than in arms
    • Seen in aortic regurg
  18. Quincke's sign
    • Alternate flushing and blanching of the fingernails in response to light pressure
    • Seen in aortic regurg
  19. De Musset's sign
    Head bobs with heartbeat, seen in aortic regurg
  20. Murmur of aortic regurg
    • High pitched, blowing, decrescendo diastolic murmur
    • Accentuated by leaning forward
  21. Austin Flint murmur
    • Low pitched diastolic rumble, seen in severe aortic regurg
    • Caused by regurgitated blood striking the anterior mitral leaflet
  22. Signs of tricuspid stenosis
    • Peripheral edema
    • JVD
    • Hepatosplenomegaly, ascites, jaundice
    • Diastolic murmur that increases with inspiration (unlike the diastolic murmur of mitral stenosis
  23. Murmur of tricuspid regurg
    Blowing holosystolic murmur
  24. Infectious causes of dilated cardiomyopathy
    Viral myocarditis--irreversible
  25. Toxic causes of dilated cardiomyopathy
    • Alcohol abuse--reversible
    • Doxorubicin
    • Cocaine
    • Heavy metals (Pb, Hg)
  26. Endocrine causes of dilated cardiomyopathy
    • Thyroid disease (hypo or hyper, reversible)
    • Acromegaly
    • Pheochromocytoma
  27. Metabolic causes of dilated cardiomyopathy
    • Thiamine deficiency (wet beriberi, reversible)
    • Pregnancy (reversible)
    • Neuromuscular disease
    • Idiopathic
  28. Indications of dilated cardiomyopathy on ECG
    • RBBB (R, S, R' in V1 and V2)
    • Ventricular hypertrophy
    • Arrhythmias (usually a fib)
  29. Causes of restrictive cardiomyopathy
    • Endomyocardial fibroelastosis
    • Hypereosinophilic syndrome
    • Primary amyloidosis
    • Hemochromatosis
    • Sarcoidosis
    • Carcinoid syndrome
  30. Signs of restrictive cardiomyopathy
    • Right heart failure
    • Exercise intolerance
  31. Hypertrophic cardiomyopathy
    • Hypertrophy of the LV septum narrows the LV outflow tract.
    • Increased LV outflow tract velocity draws the anterior mitral leaflet forward, causing outflow tract obstruction
  32. Causes of paradoxical splitting of S2
    • HCM
    • Aortic stenosis
    • LBBB
    • (when the LV contracts against an obstructed outflow tract, which delays closure of the aortic valve--split decreases on inspiration, because delayed closure of pulmonic valve on inspiration brings pulmonic closure closer to aortic closure)
  33. Factors that increase and decrease the systolic ejection murmur of HCM
    • Decrease--increased venous return (e.g. squatting, fluids)
    • Increase--decreased venous return (e.g. exercise, valsalva)
  34. Most common cause of viral myocarditis
    Coxsackie B
  35. Most common cause of acute bacterial endocarditis
    Staph aureus
  36. Most common cause of subacute bacterial endocarditis
    Strep viridans (infects previously damaged valves)
  37. Bacteria associated with bacterial endocarditis and colonic neoplasms
    Strep bovis
  38. Symptoms of acute bacterial endocarditis
    • Acute onset of fever, chills, and weight loss (in the DD for FUO)
    • New murmur
    • Metastatic infections (pneumonia, meningitis)
  39. Symptoms of subacute bacterial endocarditis
    • Gradual onset of fever, sweats, weakness, arthralgia, anorexia, weight loss, and cutaneous lesions
    • New murmur
    • Splenomegaly
  40. Signs of endocarditis
    • Petechiae on upper chest and mucus membranes
    • Osler's noes--tender, violet nodules on fingers and toes
    • Janeway lesions--hemorrhagic, non-tender nodules on palms and soles
    • Splinter hemorrhages
    • Roth spots on fundoscopy
    • Conjunctival hemorrhage
  41. Diagnosis of bacterial endocarditis
    • Two positive blood cultures, 12 hours apart, or 3 positive cultures, 1 hour apart
    • Vegetations on echo (specific, but nonsensitive)
    • Hematuria, elevated ESR/CRP, leukocytosis
  42. Causes of pericarditis
    • Infection
    • Mets (usually from breast or lung tumors)
    • Acute MI
    • Uremia (chronic renal failure with mental status chnages)
    • Hx of radiation
    • Drug reaction (procainamide, INH, hydralazine)
    • SLE, scleroderma
    • Myxedema
  43. Signs of pericarditis on ECG
    Diffuse ST elevation with PR depression
  44. Tx for pericarditis
    • NSAIDs
    • Steroids, in severe cases (e.g. Dressler's, post-MI)
  45. Pericardial tamponade
    • Accumulation of fluid in the pericardial sac
    • Impairs cardiac filling and reduces CO
  46. Beck's triad (indicates cardiac tamponade)
    • Hypotension
    • Muffled heart sounds
    • JVD
  47. Kussmaul's sign
    • Failure of jugular venous pressure to fall during inspiration
    • May indicate constrictive pericarditis, restrictive cardiomyopathy, or cardiac tamponade
    • (sign of limited RV filling)
Card Set
First Aid: Cardio II
internal medicine rotation