- *Causes of elevated JVP
- lungs
- heart
- PE
- constrictive pericarditis, RHF
- Volume overload
Central vs peripheral cyanosis causes
Central
- hypoxic lung disease
- R-L shunt (CHD)
Peripheral
- Ryanards
- PVD
- Heart failure
- Shock
**6 Causes of AF
- Ischemic heart disease
- Rhematic heart disease
- Thryotoxicosis
- Pneumonia
- PE
- Alcohol
- Heart failure
- cardiomyopathy
Features of JVP vs carotid pulse
- double pulsation
- non-palbale
- obliteraiton when pressure applied at base of neck
- Height changes with resp
- height changes w angle of patient
- rises w hepatojugular reflux
Causes of pulsus paradoxus
think of things that cause restrict the heart pumping
- When get decrease of more than 10mmHg on inspiration between systolic BP
- tamponade, constrictive pericarditis, restrictive cardiomyopathy, severe asthma, COPD.
What causes a non-palpable apex beat
Displaced
- Cardiomyopathy
- Heart failure - LHF
To thick
-adipose tissue
-air - pnenumothroax
Fluid - pleural or pericardial effusion
3rd and 4th heart sounds
-both in diastole
3rd -Volume overload - CCF, MR, AR, MI
-heard mid diastole and is caused by rapid ventricular filling
-can be normal in <30 year olds
(turbulent blood filling the ventricles)
4th - (sound when atria contracts) Poorly compliant ventricle
-Pressure overload - AS, HTN, HOCM
Heave - left ventricular hypertrophy causes
-AS, HTN, HOCM, coarctation of aorta
same things as 4th heart sounds - pressure overload
CXR features of Left sided heart failure
- Alveolar oedema
- kurly B lines
- Cardiomyopathy
- upper lobe venous diversion
- Pleural Effusion
Causes of pericarditis
Infection - viral, bacterial, fungal
Malignancy
Causes of cardiac failure
- Pump failure (IHD, cardiomyopathy, constrictive pericarditis, arrythmia, drugs)
- Excessive preload (valvular disease MR, AR), fluid overload, ventricular spetal defect
- Excessive afterload - AS, HTN
- High output failure (anaemia, pregnancy, hyperthrydoism)
- Isolated RHF - cor pulmonale, primary pulmonary HTN
Aortic Stenosis
-causes, presentation, signs (LVH)
Causes
-Bicuspid valve, calcified valve, rheumatic heart disease
Presentation - SOB, syncope/presyncope , angina
Signs
- 4th heart sound
- heaving apex
- slow rising pulse
- narrow pulse pressure
- ejection click
- quiet 2nd heart sound
ECG - LVH, LV strain pattern
treat - HTN, valve replacement
Mitral Regurgitation
Cause - Rheumatic heart disease, IE, mitral valve prolapse, marfans, SLE
-secondary - LV dilation
Presentation - SOB, fatigue, other LVF - ortopnoea, paroxymal nocturnal dyspnoea
Signs
- 3rd heart sound
- displaced apex
- quiet first heart sound
- AF
- click in valve prolapse
ECG - AF, ventricular ectopic beats
Mitral stenosis
-think logically - pushes pressure back to lungs
-middiastolic murmur
- Rheumatic fever
- SOB, fatigue, pulmonary oedema, RHF
ECG-AF common , p mitrale
treatment - AF + anticoagulation
- diretics
- baloon vavuloplasty
Aortic regurg
- early diastolic murmur
- Rhematic heart disease, IE, HTN, aortic dissection,
SOB, fatigue, palpitations
Cardiomegaly, cardiac failure
Stigmata of infective endocarditis
- splint haemorrhages
- oslers and janeway lesions
- changing heart murmurs
-finger clubbing, mild splenomegaly, microscopic haematuria
Complications of prosthetic valve
- valve failure
- valve leak
- thrombosis and obstruction
- infective endocarditis
Aortic sclerosis
- is like a aortic stenosis but is asymptomatic
- normal pulse pressure, no slow rising pulse
Indications for a bio-prosthetic valve?
- Elderly (wear out in 10-15 years)
- Contraindication to warfarin
- patient choice
Chest pain differentials
MI / angina Pericarditis Pleurisy Aortic dissection Musculoskeletal pain oesophageal reflux Pulmonary embolism Pneumonia
Differentials of dyspnoea
Heart - acute pulmonary oedema, pulmonary embolism, MI, arrhythmia
Resp - PE, pneumothorax, severe asthma, severe COPD, severe pneumonia
Other - sepsis, anaemia, toxins, anxiety
Ankle oedema differentials
- Heart failure
- Chronic liver disease
- Nephrotic syndrome
- Drugs
- lymphedema
- Venous disease of legs
Palpitations differentials
- ectopic beats
- AF, A flut
- SVT
- VT
Right vs left ventricular failure
Right - 3rd heart sound, JVP, tricuspid regurg, peripheral oedeam, ascities
Left - 3rd heart sound, apex beat displaced, bilateral basal inspiratory crackles, dyspnoea, orthopnoea, pleural effusion
