Lateral thoracotomy scar in cvs station
BT Shunt
Mvr
Mitral valvotomy
Coartation repost
BT Shunt in fallots
Lateral thoracotomy scar
Absent radial pulse and scar
Clubbing and cyanosis
Systolic murmur
Midline sternotomy scar + lateral thoracotomy scar
Coartation repair
Tof repair
Vsd repair
Metallic mvr with previous valvoplasty
Aortic stenosis
Slow rising pulse
Undisplaced heaving apex beat
ESM at aortic radiating to carotid
Midline sternotomy scar
Valve replacement scar
Cabg
Corrective surgery in congenital heart
Heart transplant
Thymectomy
Rule of 5P in valve replacement
Peripheral sign of infective endocarditis
Pulmonary hypertension
Pulmonary congestion
Pitting oedema
Peripheral sign of anticoagulant
Aortic regurgitation
Collapsing pulse
Corrigan sign at neck
Displaced thrusting apex beat
EDM at LLSE
Mitral stenosis
Malar flush
Atrial fibrillation
Undisplaced tapping apex beat
Loud S1
MDM at mitral region
Mitral regurgitation
Atrial fibrillation
Apex beat displaced, thrusting
Soft S1
Psm at mitral radiating to axillary
Vsd
Parasternal thrill at apex
Psm at LLSE, harsh, may radiate to the RLSE
No change in inspiration
Triscupid regurgitation
Giant c - v wave
Parasternal heave
Psm at LLSE, soft, louder on inspiration
Murmur special maneuvers
RILE
Right sided murmur increase with inspiration
- triscupid regurgitation
Left sided murmur increase with expiration
- aortic stenosis
- aortic regurgitation
- mitral stenosis
- mitral regurgitation
Prothesis valve not functioning
Presence of diastolic murmur
Decrease intensity/ absence of closing click
Signs of heart failure
Recurrence of symptoms (sob, palpitations, syncope)
Causes of failure of prosthetic valve
Infective endocarditis
Valvular dehiscence
Valvular leakage
Indication of aortic valve replacement
Aortic stenosis
Symptomatic as (mean gradient >50mmhg)
Assymptomatic -
- moderate/ severe As undergoing other cabg/ aortic surgery
- means transvulvular more than 40mmg hg
- ef less than 50%
- valve area less than 0.6cm
- vt/ abnormal bp response during exercise
Aortic regurgitation
- Lvef less than 50%
- dilated lv > 50mm
- enlarged aortic root > 50mm.
- IE
- severe acute IE
Aortic stenosis vs aortic sclerosis
No severity sign
ESM which localised to aortic arch with normal s2 in elderly
Echo criteria for severe AS
Aortic valve area <1cm
Jet velocity > 4m/s
Mean transvulvular pressure > 40mmhg
Features of severe AS
Slow rising pulse
Narrow pulse pressure
Reverse split S2
Soft S2
Loud P2
Sign of heart failure
S3
Complications of AS
Cardiac arythmmias
Pulmonary hypertension
Left ventricular failure
Heart block
Infective endocarditis
Hemolytic anemia
Complication of murmur - PACE
Pul htn : palpable 2nd heart sound, parasternal heave
Atrial fibrillation
CCF: raised Jvp, bibasal crepitation, pedal edema
Endocarditis : Osler node, Janeway lesion, splinter hemorrhage
Echo for severe AR
Regurgitation fraction >50%, volume >60ml/beat
Central jet width >65%
Echo severe MS
Valve area<1cm
Severe left atrial enlargement
Elevated pul artery systolic pressure
Collapsing pulse
Aortic regurgitation
PDA
Triad of TOF
VSD
Right ventricular outflow tract obstruction
Right ventricular hypertrophy
Overriding aorta
