Samir Rafla-Questions and Answers asked in the Exam of the Medical Rounds Manifestations of R.

heart failure Congested neck veins Enlarged tender liver Lower limb edema R. ventricular gallop Manifestations of L. heart failure Basal crepitations L. ventricular gallop Orthopnea Paroxysmal nocturnal dyspnea Neck Veins: Systolic pulsations in tricuspid incompetence and atrial fibrillation. Giant pr ominent a wave in tricuspid stenosis and RV hypertrophy as in pulmonary stenosis and ulmonary hypertension. Canon a wave in complete heart block. Clubbing causes Cardiac causes Cyanotic heart diseases Infective endocarditis Respiratory Supportive lung disease (bronchiectasis, lung abscess) Bronchogenic carcinoma BUT (bronchial asthma, TB) never cause clubbing Blue clubbing: congenital heart disease Pale clubbing: Infective endocarditis Myocardial infarction Chest pain compressing Severe radiation to the arm and back Syncope, sweating Auscultation S4 or nothing Congested non pulsating neck veins: SVC obstruction Causes : wide fixed splitting of S2: ASD Signs of DVT: 1- one calf larger than the other 2- tender calf muscles 3- Homans sign: pain in dorsiflexion of ankle Kussmaul sign in 1- constrictive pericarditis 2- restrictive cardiomyopathy 3- severe Rt. side heart failure 4- pericardial effusion with tamponade Causes of atrial fibrillation Mitral valve disease coronary heart disease Hypertension hyperthyroidism Constrictive pericarditis ASD Complications of atrial fibrillation Thromboembolic (embolus) Decreased cardiac performance Diagnosis of Infective endocarditis Blood culture vegetations by ECHO Aortic dissection Severe lancinating chest pain Unequal blood pressure in both arms (due to closure of LT subclavian artery) - Valvular heart disease - Mitral stenosis: Signs: Snappy S1, mid diastolic rumbling murmur, diastolic thrill, O.S. Aortic regurgitation

Soft blowing early diastolic murmur propagated to the apex Aortic stenosis Harsh ejection systolic murmur Systolic thrill Absent A2 Sustained apex Plateau pulse Tricuspid regurgitation Pansystolic murmur increases in inspiration Systolic pulse in the liver Systolic neck veins Rheumatic fever John s criteria major and minor A-Major criteria - Myocarditis (L. heart failure- gallop- arrhythmia) - Endocarditis (mitral regurgitation aortic regurgitation) - Pericarditis. (How to diagnose pericarditis by ECHO: by presence of pericardia l effusion) B-Minor criteria - Clinical (fever, arthralgia, history of previous tonsillitis 1-3 wks, presence of Rh. valve lesion) - Lab. (Increased CRP, ESR, prolonged PR) 60 year male patient with hypertension presented with BP 200/100 mmHg, s evere chest pain, unequal pulse: Most probable diagnosis is dissecting aortic aneurysm - Pulsus alternans occurs in heart failure. - Paradoxical pulse occurs in pericardial tamponade, constrictive pericarditis. MCQs abcdabcdacdAccentuated first heart sound in all except: Short P-R interval Increase cardiac output Mitral stenosis Myocarditis Eisenmenger syndrome occurs in all except: Large VSD Large ASD PDA Fallot`s tetralogy Epigastric pulsations in all except: portal hypertension b- aortic aneurysm congestive heart failure Rt ventricular enlargement

- In AF all is present except: a. absent a wave b. S4 c. S1 of variable intensity d. Systolic neck venous pulsation e. Irregular irregularity in the pulse - In pulmonary hypertension all is present except: a. systolic thrill on the pulmonary area

b. c. d. a. b. c. d. abcd-

S2 close (narrow) splitting Diastolic shock Ejection systolic murmur AF is caused by all except: Ischemic heart disease Thyrotoxicosis Mitral valve disease Cor pulmonale Edema in congestive heart failure occur in all except: Peri-orbital Ankle Sacrum External Genitalia