1. Consultant Cardiologist
Final Year Revision
December 2016
Dr Cara Hendry
Consultant Cardiologist

2. How you feel about finals

4. 5-10% patients >65yo
Lone AF
Anaemia
Drugs/Alcohol

5. Treating AF
Start with ABCDE Aim for restoration of SR (flecainide / amiodarone / electrical cardioversion) Or rate control via AV node blocking drugs (beta blockers / digoxin) Anticoagulation

7. JVP Versus Arterial Pulsation
1. More easily seen than felt “JVP is Impalpable”
2. JVP fills from above
3. Hepato - jugular reflux
4. Double wave form MAY be visible
5. JVP varies with position
6. JVP varies with respiration
7. Timing against carotid (“a’ wave out of sync)
8. Valsalva manoevre
9. JVP fills much more slowly

9. Approach for murmurs

10. Systolic Murmurs: Commonest Causes
Aortic Stenosis
Mitral Regurgitation
Pulmonary Stenosis
Tricuspid Regurgitation
Venticular Septal Defect (VSD)
(Innocent/Benign Systolic Murmur!)

11. Systolic Murmurs: Aortic Stenosis Ejection Type
Mitral Regurgitation Pan systolic
Pulmonary Stenosis Ejection Type
Tricuspid Regurgitation Pan systolic
Venticular Septal Defect (VSD) Pan systolic
(Innocent/Benign Systolic Murmur)

12. The Murmur of Aortic Stenosis
Aortic stenosis causes an “ejection type” systolic murmur usually best heard at the 2nd right intercostal space classically radiating into the carotids.
“USUALLY best heard at the 2nd right intercostal
Space, but commonly WELL HEARD at the apex.

13. Auscultation Tips for Finals
Listen at the 2nd right interspace first
If you hear a systolic murmur the patient probably has aortic stenosis.
If you hear a systolic murmur at the 2nd right interspace and also at the apex – the patient probably has aortic stenosis.
If you can only hear a systolic murmur at the apex – the patient probably has mitral regurgitation.

14. Causes of Aortic Stenosis
1. Congenital (Usually Bicuspid Valve)
2. Rheumatic Heart Disease
3. Degenerative (most common nowadays)

15. Severe Aortic Stenosis : Prognosis

16. Aortic Regurgitation

17. Aortic Regurgitation Features
Large volume pulse
Collapsing
Corrigan’s Sign in neck
EDM at Left sternal edge
“Breathe in, breathe out, stop breathing”
Best heard leaning forward
Wide pulse pressure
RILE- Right murmurs best heard on Inspiration, Left on Expiration

18. Management

19. Mitral Regurgitation