Cardiac Flashcards
What happens when you hear the ‘dub’ of the heart valves on S2?
The mitral and tricuspid valves open, the aortic and pulmonary valves close
Describe the normal electrical pathway for impulses through the heart
SA node - to AV node - to Bundle of His - to Left and Right Bundle branches - to Purkinje Fibres
What are the 5 main vessels that transport blood to and from the heart?
Aorta
Pulmonary artery
Pulmonary vein
Inferior vena cava
superior vena cava
Name 3 things you may consider as part of your general inspection
Pallor
Equipment
Mobility
What 7 things could cause an absent, palpable apex beat?
Obesity
Muscle
Emphysema
Left ventricular dilation
Chest Deformity
Dextocardia
Death
Why is calf palpation included within a CVS examination?
To assess for oedema or signs of a DVT
What are 3 symptoms of the hands that can be caused by endocarditis?
Splinter haemmorhage
Janeway lesions
Osler nodes
What are palpable heaves associated with?
Right ventricular hypertrophy
True or False: Is malar flush associated with mitral valve stenosis or CO2 retention?
True
What 4 things are you including when conducting a specific examination of the neck?
Position of the trachea
Nodes
Surgical Emphysema
JVP
List 3 causes of palpitations
Thickening of heart muscle
Amphetamines
Anxiety
What could cause a decreased or absent tactile fremitus?
Pleural Effusion
Pneumothorax
Name 6 causes for a raised JVP
Heart Failure
PE
Pericardial Effusion
Pericardial Constriction
Superior Vena Cava Obstruction
Pulmonary Hypertension
What is happening to the heart valves when you hear the lub on S1?
The mitral and tricuspid valves are closing
The aortic and pulmonary valves are opening
Describe the blood flow from the lungs through the CVS system and back out.
Start with the blood arriving in the left atrium.
Blood arrives in the left atrium via the pulmonary vein
Goes through the mitral valve
To the left ventricle
Through the aortic valve/aorta
Round the body/head - gases exchanged from organs and tissues
Back to the heart via the super vena cava/inferior vena cava
Into the right atrium
Through the tricuspid valve
Into the right ventricle
Through the pulmonary valve
Into the pulmonary artery to the lungs - gas exchange
What are you listening to when you listen for cardiac sounds?
Lub (S1): Aorta and Pulmonary opening
Mitral and Tricuspid closing
Dub (S2): Aorta and Pulmonary closing
Mitral and Tricuspid opening
What is the difference between regurgitation and stenosis?
Regurgitation: valve failing to close
Stenosis: valve failing to open
How does MI cardiac chest pain present?
Pain - location, quality, radiation, associations, risk factors
Chest pain: pressure, tight, heavy, often diffuse
Radiation: neck, jaw, shoulders
PMH: cardiac risk factors, possible recent episodes of chest pain
Possible FH of heart disease
Associations: palpitations, nausea, sweating, SoB
List 10 cardiac clinical signs in the hands
Clubbing: Chronic Heart Disease
Nicotine Staining: smoking = increased risk of cardiorespiratory disease
Splinter haemorrhage: endocarditis
Janeway Lesions: endocarditis
Oslar Nodes: endocarditis
Cyanosis: poor perfusion
Temperature: hot = pyrexia/infection, cold = peripherally shut down, warm = CO2 retention
Beau’s Lines: chronic disease
Xanthomata: high cholesterol
Palmer Creases: anemia
List 8 cardiac clinical signs in the face
Corneal Arcus: high cholesterol
Xanthalasma: high cholesterol
Pale conjunctiva: anaemia
Atrophic glossitis: anaemia
Angular chelitis: anaemia
Central Cyanosis: hypoxia
Pursed lips: respiratory distress
Malar Flush: mitral valve stenosis, CO2 retention
When assessing a JVP - what could you do it you weren’t sure it was a JVP?
Palpate it - JVP does not have a pulse
It connects to the right atrium without any valves
What are the 6 possible causes of a raised JVP?
Heart Failure
Pulmonary Embolism
Pulmonary Hypertension
Pericardial Effusion
Pericardial Constriction
Supervena Cava Obstruction
List 7 reasons why you may not be able to palpate the apex beat
Obesity
Muscle
Death
Emphysema
Chest Deformity
Dextrocardia
Left Ventricular dilation
What would identifying heaves tell you?
Right ventricular hypertrophy
When assessing a pulse, what 4 things are you considering?
Rate
Rhythm (regularity)
Character (bounding/thready)
Volume (strong/weak)
Name 9 things you would look for when conducting a general cardiac inspection
General Demeanour
Colour
Odour
Gait
Breathless
Posture
Carers
Agitation
Peripheral Oedema
How do you assess the JVP?
30-45 degree angle
Look at height of JVP from sternum/angle of Louis
Should be less than 4cm
What do you look for in a specific cardiac inspection?
Scars (e.g. sternotomy)
Visible implanted devices (pacemaker)
Oedema
Oxygen Therapy
Chest Drains
Arm span greater than height (Marfans)
Obvious chest deformity (scoliosis/barrel chest/pectusexcavatum)
Abnormal Pulsations
Obvious distended chest wall vessels = low central venous oxygen
Name the 8 pulses
Radial
Ulnar
Brachial
Carotid
Femoral
Popliteal
Dorsalis Pedis
Posterior Tibial
What 6 things might you assess for in the pulses?
Rate
Character
Rhythm
Radial-Radial Delay: aorta issue
Radial-Femoral Delay: aorta issue
Collapsing Pulse: aorta issue
How do you palpate the apex beat?
Left mid-clavicular line, 5th intercostal space
Where do you listen for the aortic, pulmonary, tricuspid and mitral valves?
Aortic - right sternal edge, 2nd intercostal space
Pulmonary - left sternal edge, 2nd intercostal space
Tricuspid - left sternal edge, 4-5th intercostal space
Mitral valve - left mid-clavicular, 5th intercostal space
Where might you check for radiation when listening to the heart valves?
Carotid and axilla - can help localise heart murmur
What should you do before using stethoscope?
Check turned on , check using correct side
Name 3 signs in the hands of endocarditis
Janeway Lesions
Oslar Nodes
Splinter Haemorrhage
When assessing the calves, what are you looking for?
Swelling of leg/calf
Pain - worse on standing/walking
Warmth and redness
Pitting oedema and where it extends to
May measure calves/consider WELLS
If you hear a whoosh when listening to the heart sounds - what could this mean?
A heart murmur - regurgitation or stenosis = faulty valve
Patent ductus arterioles (little ones)
What should you do if you cannot hear the apex beat?
Get the patient to sit up, turn to the right and lean forward
What should you do if you cannot hear heart sounds?
Get the patient to lean forward
Palpate the carotid or radial pulse to ignore breath sounds
Which valves are the semilunar valves?
Aortic and pulmonary
Which valves are the atrioventricular valves?
Mitral and tricuspid
