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Flashcards in Cardiovascular system Deck (27)
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1
Q

What cardiac signs and potential findings are there in the hands?

A

Temperature and capillary refill time - warm and well perfused or peripherally shut down (CRT >2)

Peripheral cyanosis - PVD, Raynaud’s, CCF or with central cyanosis

Tendon xanthomata - hypercholesterolaemia

Oslers nodes and Janeway lesions - IE

2
Q

What do you examine the nails for?

A

Finger clubbing
Koilonychia
Splinter haemorrhages
Nailfold infarcts

3
Q

Give the cardiovascular conditions associated with clubbing?

A

IE, cyanotic CHD, atrial myxoma

4
Q

What condition is koilonychia associated with?

A

Iron deficiency anaemia

5
Q

Splinter haemorrhages are associated with what?

A

IE, trauma (e.g. gardening, joinery)

6
Q

What might nailfold infarcts indicate?

A

Vasculitis, systemic lupus erythematosus

7
Q

List what you’re looking for in the radial pulse and potential findings

A

Rate (time over 15 seconds) - tachycardia/ bradycardia
Rhythm - regular/ irregular/ irregularly irregular
Volume - normal/ thread/ bounding
Character - Bisferiens pulse (mixed AR/AS), slow rising pulse (AS)

8
Q

In what condition could you find a collapsing pulse?

A

Aortic regurgitation

9
Q

Differential diagnosis for radio-radial (or femoral) delay?

A

Aortic dissection / coarctation, embolism

10
Q

List the signs and potential findings in the face

A

Malar flush - Mitral stenosis

Corneal arcus & xanthalasma - hypercholesterolaemia

Conjunctival pallor - anaemia

Central cyanosis - lung disease, cardiac shunt, abnormal Hb

Poor dentition - risk factor for IE

11
Q

Signs and indications in the neck

A

Carotid pulse (useful for assessing character): Corrigans sign (exaggerated pulsation - AR

JVP (normally

12
Q

Potential findings from inspecting the chest

A

Scars-
Pacemaker/ ICD - under either clavicle
Midline sternotomy - CABG, valve replacement
Left submammary - mitral valvotomy, pericardial windor
Legs - vein harvesting

Visible heave - Apical (LVH) or parasternal (RVH)

13
Q

Potential findings from palpating the chest

A

Apex beat - Tapping (MS), heaving (LVH), thrusting (MR/AR, LVF)

Left parasternal heave - right ventricular hypertrophy

Thrills - palpable murmur

14
Q

Concluding remarks for CVS examination

A

Review obs chard (BP, temp, SaO2)

Abdominal exam and peripheral pulses –> hepatomegaly & ascites (RHF), spenomegaly (IE), AAA

Investigations: ECG, CXR, echocardiogram
urinalysis –> Microscoptic haematuria (IE)

15
Q

Ddx Central cyanosis

A
  • Hypoxic lung disease
  • Right to left cardiac shunt (cyanotic congenital heart disease or Eisenmenger’s syndrome)
  • Methasemoglobinaemia (drugs or toxins)
16
Q

Ddx peripheral cyanosis

A
Peripheral vascular disease
Raynaud's syndrome
Heart failure
Shock
(Central cyanosis when severe)
17
Q

Ddx Irregularly irregular pulse

A

AF
Ventricular ectopic beats (VEBs)
Complete HB + variable ventricular escape

18
Q

Causes of absent radial pulse

A
Congenital (usually bilateral)
Arterial embolism (e.g. due to AF)
Atheroma (usually subclavian)
Previous arterial line
Previous coronary angiography
Cervical rib
Coarctation of the aorta
19
Q

Six causes of AF

A
Ischaemic heart disease
Rheumatic heart disease
Thyrotoxicosis
Pneumonia
PE
Alcohol
20
Q

Kussmaul’s sign

A

Rise in JVP on inspiration (due to impaired RV filling)

Caused by tamponade, constrictive pericarditis, restrictive cardiomyopathy

21
Q

Causes of a non-palpable beat

A
  1. Something between your fingers and apex
    • Adipose (obese pt)
    • Air (pneumothorax or emphysema)
    • Fluid (pleural or pericardial effusion)
  2. Apex is not in its normal position
    • Displaced (usually laterally in LHF)
    • Dextrocardia
22
Q

Ddx heaving apex (LVH)

A

Aortic stenosis
Hypertension
Hypertrophic obstructive cardiomyopathy
Coarctation of the aorta

23
Q

CXR features of LHF

A

ABCDE

Alveolar oedema
kerley B lines
Cardiomegaly
upper lobe venous Diversion
pleural Effusion
24
Q

Causes of pericarditis

A
Viral (Coxsackie)
Bacterial / fungal
Immediately post -MI
Dressler's syndrome (2-10 weeks post MI)
SLE / RA/ scleroderma
Uraemia
Malignancy
25
Q

Heart sounds

A

S1 - Isovolumetric contraction - Closure of mitral and tricuspid valves

S2 - Isovolumetric relaxation - Closure of aortic and pulmonic valves

S3 - Early ventricular filling - Normal in children; in adults, associated with ventricular dilation (e.g. ventricular systolic failure)

S4 - Atrial contraction - Associated with stiff, low compliant ventricle (e.g., ventricular hypertrophy; ischemic ventricle)

26
Q

Causes of cardiac failure

A
  1. Pump failure
    - IHD
    - Cardiomyopathy
    - Constrictive pericarditis
    - Arrhythmia
    - Iatrogenic (negative inotropes)
  2. Excessive preload
    - Regurgitant valvular disease (MR / AR)
    - Fluid overload (renal failure, IV fluids)
  3. Excessive afterload
    - AS
    - HTN
  4. Isolated RHF
    - Cor pulmonary HTN
  5. High-output failure (rare)
    - Anaemia
    - Pregnancy
    - Metabolic (hyperthyroidism, Pagets)
27
Q

Common presenting symptoms of heart disease

A
Chest pain
Dyspnoea
Palpitations
Syncope
Other - tiredness, lethargy, oedema,