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Medicine > Approach To Patients With Cardiovascular Disease > Flashcards

Approach To Patients With Cardiovascular Disease Flashcards

1
Q

What are the symptoms of CVD

A

Dyspnoea
Cough with or without sputum production
Pedal swelling
Right hypochondrial pain from an enlarging liver
Abdominal distention from an enlarging liver and/or ascites
Anorexia or poor appetite
Early satiety
Palpitation (awareness of the heart beat)
Dizziness (should be distinguished from vertigo)
Syncope
Chest pain
Fatigue
Intermittent claudication

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2
Q

What are the forms of dyspnoea

A

Dyspnoea on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea

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3
Q

Functional status of patients with heart diseases

A

NYHA (New York Heart Association) classification

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4
Q

What is NYHA I

A

No dyspnoea on physical activity

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5
Q

What is NYHA II

A

Dyspnoea on extraordinary activities

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6
Q

What is NYHA III

A

Dyspnoea on ordinary activities

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7
Q

What is NYHA IV

A

Dyspnoea at rest

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8
Q

What causes cough in patients with CVD

A

Pulmonary congestion

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9
Q

Nature of cough in a CVD patient

A

Dry In early stages
Productive of frothy sputum which may be blood stained (haemoptysis) from a ruptured pulmonary vein

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10
Q

What could cause abdominal swelling in a CVD patient

A

Ascites
Hepatomegaly

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11
Q

Ascites is massive in what diseases

A

Constrictive pericarditis
Endomycardial fibrosis
When liver condition from heart failure has caused cirrhosis of the liver

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12
Q

_________ appears later than ankle swelling in heart failure

A

Ascites

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13
Q

Chest pain in CVD patients may arise from

A

Pericardium - Pericarditis
Myocardium - Myocardial ischemia or infarction
Aorta dissecting aneurysm - May resemble MI however tends to be more severe

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14
Q

What is the order of physical examination on a CVD patient

A

General examination
Examination of the pulse
Measurement of the blood pressure
JVP
Position of the apex beat
Palption of the precordium
Auscultation of the heart
Examination of the lungs and abdomen

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15
Q

What should you look for when you hold a patient’s hand in cardiovascular exam

A

Temperature (may be cold in congestive heart failure)
Sweat
State of the nails
Splinter hemorrhages
Finger clubbing
Xanthomata
Osler’s nodes
Janeway lesions
Conjunctiva of the lower eyelids (pallor)
Proptosis
Pallor and cyanosis of the tongue
Edema of the sacrum and lower extremities

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16
Q

Describe stage 1 finger clubbing

A

Increased sponginess of the nail bed

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17
Q

Describe stage 2 finger clubbing

A

Obliteration of the angle between the nail and the nail fold

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18
Q

Describe stage 3 finger clubbing

A

Increased convexity of the nail longitudinally and transversely

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19
Q

Describe stage 4 finger clubbing

A

Bulbous swelling of the distal end of the finger

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20
Q

Cardiovascular causes of finger clubbing

A

Cyanotic congenital heart disease
Infective endocarditis
Endomyocardial fibrosis
Atrial myxomas

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21
Q

What are raised yellow lesions caused by a buildup of lipids beneath the skin often seen on tendons at the wrist

A

Xanthomata

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22
Q

What is a red, tender nodules on the finger pulps or thenar eminence called

It is a rare manifestation of infective endocarditis

A

Osler’s nodes

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23
Q

What are non-tender maculopapular erythematous lesions seen on palm or finger pulps as a rare feature of bacterial endocarditis

A

Janeway lesions

24
Q

What are the various rhythms of pulses

A

Regular and irregular

25
Q

What are the subcategories under irregular heart pulse

A

Regularly irregular
Irregularly irregular - AF or multiple extrasystoles

26
Q

Examination of pulses

A

Rate
Rhythm
Volume - small, normal or large
Character- collapsing
Radio-femoral delay
Palpation of peripheral pulses

27
Q

Examples of peripheral pulses

A

Radial pulse
Brachial pulse
Carotid pulse
Femoral pulse
Popliteal pulse
Posterior tibial pulse
Dorsalis pedis pulse

28
Q

Methods of measuring BP

A

Palpation
Auscultatory - korotkoff sounds
Oscillatory - pulse wave

29
Q

How do you assess JVP

A

Measure the JVP
If the JVP is raised determine whether it is pulsatile or not
Pulsatile raised JVP - right heart failure
Non-pulsatile raised JVP - superior vena caval obstruction

30
Q

The size of the heart is assessed clinically by locating the position of the

A

Apex beat

31
Q

What is the outermost and lowermost cardiac impulse

A

Apex beat

32
Q

How do you locate the apex beat

A

The palm of the right hand is placed across the patient’s left chest so that it covers the area over the heart. The heel should rest along the sternal border while the extended fingers lying below the left nipple

The normal sized ventricle will generate an impulse that is best felt in the mid-clavicular line, roughly at the 5th intercostal space if the ventricle becomes enlarged, the apex beat is displaced laterally. In cases of significant enlargement, the AB will be located near the axilla

33
Q

What is the normal location of the apex beat in adults

A

5th left intercostal space in the mid-clavicular line

34
Q

What does a left parasternal heave represent in the palpation of the precordium

A

Right ventricular hypertrophy

35
Q

What are thrills

A

Palpable murmurs

36
Q

The diaphragm is pushed more gently and the bell with much more force during auscultation of the heart
True or false

A

False

It is the other way round

37
Q

Which part of the stethoscope is used for low-pitched sounds such as the murmur of mitral stenosis

A

The bell

38
Q

Which part of the stethoscope is used for high-pitched sounds such as the murmur of mitral regurgitation

A

The diaphragm

39
Q

Pansystolic murmur is best heard on which part of the body

A

The apex radiating to the axilla

40
Q

Rumbling mid-diastolic murmur is best heard on which part of the body

A

At the apex with patient lying on his left lateral side

41
Q

What are the normal heart sounds

A

S1 and S2

42
Q

What does S1 signify

A

Closure of the mitral and tricuspid valves

43
Q

What does S2 signify

A

Closure of the pulmonary and aortic valves

44
Q

What are the abnormal heart sounds

A

S3
S4
Murmurs

45
Q

What causes S3

A

Rapid ventricular filling in early diastole when the AV pressure is high

It is sometimes audible in individuals below the ages of 40 years, but its appearance thereafter usually means a change in ventricular compliance or stiffness as a result of a disease. Eg. LV diastolic dysfuncrion

46
Q

When does S4 occur

A

When there is a bolus of blood is delivered into the ventricle from atrial contraction

It is usually abnormal irrespective of age. It is usually associated with reduced ventricular distensibility (LV diastolic dysfunction)

47
Q

What are the two types of murmurs

A

Systolic and diastolic murmurs

48
Q

What are some things examined for in the abdomen during a CVS exam

A

Tender soft hepatomegaly
Ascites

49
Q

Orthopnoea is associated with what disease

A

Bilateral paralysis of the diaphragm

50
Q

Paroxysmal nocturnal dyspnoea is a classical symptom of what disease

A

Left heart failure

51
Q

What is the commonest cause of splinter haemorrhages

A

Trauma

52
Q

Radio-femoral delay is characteristic of what disease

A

Coarctation of the aorta

53
Q

Heart rate in which amplitude and timing are irregular is described as

A

Irregularly irregular

54
Q

What are splinter hemorrhages

A

They are small streak-like bleeding in the nail bed

55
Q

What should be the position of the patient during a cardiovascular exam

A

Position patient at 30-40 degrees and expose the precordium and the legs and start at the foot end of the patient’s bed and do a general inspection

Medicine (38 decks)

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