MRCP: Cardiology

Card Set Information

Author:
Mike2556
ID:
300813
Filename:
MRCP: Cardiology
Updated:
2015-04-14 18:07:23
Tags:
Cardio
Folders:

Description:
MRCP cardiology cards
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user Mike2556 on FreezingBlue Flashcards. What would you like to do?


  1. 1. What does JVP reflect?
    2. How is it observed clinically?
    • 1. Patient's right atrial pressure, hence their filling status and fluid state
    • 2. With patient at 45 degrees, internal jugular vein is found between the clavicular/sternal heads of the sternomastoid muscle, 3cm above angle of Louis in the healthy
  2. Describe the waveform of the JVP
    A: Atrial contraction increases JVP and moves SVC superiorly

    X: First gravity then ventricular contraction moves heart donwards, stretching atria and decreasing pressure

    C: Mid-x closure of tricuspid valve before ventricular systole increasing pressure

    V: At end of X, increase in pressure due to passive filling of atria against closed tricuspid

    Y: Tricuspid reopens as ventricular pressure drops, passively filling ventricle and decreasing pressure
  3. Describe the abnormal presentations of increased JVP, while describing their causes
    Normal waves: (inability of atria to clear efficiently) 1: Right or bi-heart failure 2: Fluid overload 3: Severe bradycardia

    Raising on inspiration: (Kussmaul sign - atria not able to cope with increased venous return) 1: Pericardial disease 2: Pericardial fluid/effusion/tamponade

    Raised with no wave: (Severe increase in pressure- SVC syndrome) 1: Mediastinal malignancy - head/neck/arm swelling
  4. Describe pathological A waves of JVP and explain their causes
    • Absent: (No appreciable atrial contraction) 1. AF
    • Large: (Poor emptying of right atrium/heart) 1. Tricuspid stenosis 2. RHF 3. Pulmonary hypertension
    • 'Cannon': (Complete AV dissociation allowing simultaneous contraction) 1. T3 block 2. Atrial flutter/tachycardias 3. VT 4. Ectopics
  5. Describe pathological JVP waves (not A) and explain their causes
    Steep x only: (Fast atrial emptying) 1. Tamponade

    Steep x and y: (Poor atrial stretching) 1. Constrictive pericarditis

    Giant V: (Increased passive filling) 1. Tricuspid regurgitation "c-V wave"

    Slow Y: (Poor atrial emptying) 1. Triscuspid stenosis
  6. Give 6 causes of an absent radial pulse
    • Trauma
    • Takayasu's arteritis (intimal fibrosis)
    • Aortic dissection with subclavian involvement
    • Peripheral arterial thrombo-embolism
    • Blalock-Taussig shunt (surgical management of cyanotic heart disease
    • Iatrogenic e.g. post-CVC or arterial line insert
  7. Give 3 causes of a collapsing central pulse
    • 1. Aortic regurgitation (sudden pressure drop post-ventricle contraction)
    • Any large extra-cardial shunt (fast dispensation of pressure)
    • 2. PDA
    • 3. Arteriorvenous fistula
  8. Give the single causes of Jerky, Bisferiens and Alternans pulses
    Jerky: (intermittent interruption of aortic flow) HOCM

    Bisferiens: ('double shudder' from effects of aortic stenosis and regurge simulataneously) Mixed aortic valve disease, including significant regurgitation

    Alternans: (Reduced EF increases end-diastolic volume, prompting FS mechanism to improve next beat) Moderate LVF - in severe LVF alternans lost as FS not sufficient
  9. Explain the physiology and causes of Pulsus Paradoxus
    • A drop in pulse amplitude on inspiration (systolic drops >10mmHg) from compromised venous return
    • 'Paradox' is auscultating a beat but not palpating the radial pulse

    • Pathologically increased intracardiac pressure
    • 1. Tamponade
    • 2. Ventricular compression e.g. malignancy
    • 3. Constrictive pericarditis

    4. Obstructive lung disease e.g. severe asthma, COPD, chronic sleep apnoea
  10. Where is the apical beat palpated, on what does a normal impulse rely and what might its absence indicate?
    Site: 5th intercostal space, in midclavicular line

    Physiology: Requires isovolumetric contraction of both ventricles to be correct amplitude and position

    • Causes
    • 1. Pericardial restriction e.g. effusion, constriction
      2. Emphysema
    • 3. Right pneumonectomy/dextrocardia
    • 4. Obesity
  11. Explain the causes of the following pathological apical impulses:
    Heaving (1)
    Thrusting (4)
    Tapping (1)
    Displaced and diffuse (2)
    Heaving: (Increased amplitude of LV contraction) LVH of any cause

    Thrusting: (Increased left ventricular volume causing hyperdynamic contraction) 1. Mitral regurge 2. Aortic regurge 3. PDA 4. VSD

    Tapping: (Palpable first heart sound) Mitral stenosis

    D+D: (Left ventricle impairment and dilation) 1. Dilated cardiomyopathy 2. Infarction
  12. Explain the causes of the following pathological apical impulses:

    Double impulse
    (2)
    Pericardial knock (1)
    Parasternal heave (4)
    Palpable 3rd heart sound
    Double impulse: (Deformity of ventricle shape) HOCM or ventricular aneurysm

    Pericardial knock: (Rigidity of pericardium) Constrictive pericarditis

    Parasternal heave (RVH modifying the impulse) 1. ASD 2. P-Htn 3. Cor Pulmonale 4. Pulmonary valve stenosis

    Palpable 3rd heart sound: Heart failure and severe mitral regurgitation

What would you like to do?

Home > Flashcards > Print Preview