Cardiac

Question 1

Define afebrile, febrile, pyrexia, hyperpyrexia, hypothermia

Answer 1

• Afebrile - normal temperature (35.8-37.5)
• Febrile - pyrexia
• Pyrexia - high temperature (37.5-41)
• Hyperpyrexia - high temperature (>41)
• Hypothermia - low temperature (<35.5)

Question 2

Apical pulse rate > radial pulse rate

Answer 2

Thrust of the blood from the heart is too weak for the wave to be felt at the peripheral pulse site OR vascular disease is preventing impulses from being transmitted

Question 3

Orthostatic hypotension

Answer 3

Low blood pressure when standing up after lying or sitting down.

• > 20mmHg drop of systolic BP
• > 10mmHg drop of diastolic BP

Question 4

3 early signs of hypoxia

Answer 4

1. Tachypnoea/bradypnoea
2. Tachycardia/bradycardia
3. Confusion

Question 5

What are the lub/dub sounds of the heart?

Answer 5

Lub = mitral and tricuspid valves closing (between atria and ventricles) 
Dub = aortic and pulmonary semilunar valves closing

Question 6

Where to auscultate heart sounds?

Answer 6

1. Aortic area (base) - 2nd ICS right sternal border
2. Pulmonic area - 2nd ICS left sternal border (LSB)
3. Erb’s point - 3rd ICS LSB
4. Tricuspid area - 5th ICS at LSB
5. Mitral area (apex) - 5th ICS at MCL

Question 7

Signs of heart failure:

Answer 7

• dilated pupils
• skin pale, grey or cyanotic
• dyspnoea
• orthopnoea
• crackles/wheeze
• cough
• decreased BP
• nausea, vomiting
• ascites (fluid in peritoneal cavity)
• pitting oedema (legs)
• decreasing SaO2
• confusion
• jugular vein distension
• fatigue
• tachycardia
• decreased urine output
• weak pulse
• moist, cool skin

Question 8

Cardiac subjective assessment

Answer 8

1. Cough
2. SOB
3. Orthopnoea
4. Chest pain (sweating, nausea, palpitations)
5. Fatigue
6. Cyanosis
7. Oedema
8. Nocturia (urinate at night)

Question 9

Modifiable cardiac risk factors:

Answer 9

• Obesity
• High lipids
• Hypertension
• T2DM
• Smoking
• Sedentary lifestyle
• Diet
• Alcohol
• Stress
• Depression, social isolation

Question 10

Non-modifiable cardiac risk factors:

Answer 10

• Age
• Gender
• Ethnicity
• Family history
• Genetic inheritance
• Menopause

Question 11

Cardiac objective assessment

Answer 11

1. Inspect neck: bruising, lacerations, skin colour
2. Inspect jugular veins (distension?)
3. Palpate carotid artery
4. Inspect chest walls
5. Palpate apical pulse
6. Auscultate heart sounds
7. Inspect extremities (colour, bruising, oedema, clubbing)
8. Palpate extremities (cap refill, oedema, temp, moisture, pulses)

Question 12

Position of ECG leads:

Answer 12

• L & R wrist
• L & R inner ankle
• V1 = 4th ICS RSB
• V2 = 4th ICS LSB
• V3 = between V2 & V4
• V4 = 5th ICS at MCL
• V5 = level with V4 at left anterior axillary line (5th ICS)
• V6 = 5th ICS at left midaxillary line

Question 13

Cardiac tests:

Answer 13

• ECG
• Angiogram (view coronary arteries with dye & CXR
• Troponin (proteins released by damaged skeletal & cardiac muscle - MI gold standard)
• Creatine kinase (CK) (enzyme released by damaged muscle)
• CK-MB (more specific to cardiac cells)

Question 14

PQRST waves ECG

Answer 14

P wave = atrial depolarisation (SA node firing)
QRS complex = ventricular depolarisation (AV node firing)
T wave = ventricular repolarisation

Question 15

Causes of interference with ECG reading:

Answer 15

• Electrical beds
• Patient movement
• Irritation of myocardium can cause minor abnormalities like atrial ectopic beats
• Incorrect placing of leads

Question 16

Define: inotropic, chronotropic, dromotropic

Answer 16

Inotropic: relating to force of myocardial contraction
Chronotropic: relating to heart rate
Dromotropic: relating to rate of electrical conduction

Question 17

BLS DRSABCD

Answer 17

Dangers
Response
Send for help
Airway
Breathing (if no...)
CPR
Defibrillator

Question 18

CPR

Answer 18

30 compressions: 2 breaths

Question 19

Cardiac output formula =

Answer 19

HR x SV