Cardiac history and examination Flashcards
Name 10 symptoms of cardiovascular disease
Chest pain Dyspnoea Orthopnoea Paroxysmal nocturnal dysponea Ankle oedema Cough, sputum, haemoptysis Dizziness Lightheadedness Presyncope and syncope Palpitations Nausea Sweating Claudication Systemic symptoms - fatigue, weight loss, anorexia, fever
What are the risk factors for ischaemic heart disease?
Male Age Smoking Hypertension DM FHx of IHD Hypercholesterolaemia Sedentary lifestyle Obesity
What factors lead to you thinking that IHD is NOT the cause of chest pain?
Character - knife-like, sharp, stabbing, pleuritic (aggravated by respiration)
Location - L submammary area, L hemithorax
Exacerbating factors - pain after completion of exercise, specific body motion
What should you ask about in a SOB history specific to cardiac?
Timing - on exertion, at rest, constant, at night
Exacerbating factors - position (no. of pillows)
How debilitating?
Exercise tolerance
What questions are important to ask about palpitations?
Does anything seem to provoke them?
Does it start suddenly or build up gradually?
Any other symptoms?
Can you tap the rhythm?
What conditions are important to ask about in the past medical history?
Similar episodes Previous diagnoses, treatments and responses Previous cardiac surgery Hypertension Hypercholesterolaemia Anaemia Diabetes Angina MI Cerebrovascular accident/TIA PVD Cardiac failure Rheumatic fever
What drugs are important to ask about in the history?
Anti-hypertensives
All cardiac drugs
Other drugs with cardiac side effects
OTC eg NSAIDs
What drugs can have a cardiac side effect?
Corticosteroids - hypertension and fluid retention
Salbutamol, theophyilline, nifedipine, thyroxine - causes sinus tachycardia
What should you ask about in a social history?
Occupation Smoking Alcohol Diet Stress
Why is alcohol important to ask about?
It can cause
- AF
- Cardiomyopathy
- Hypertension
- Tachycardia
What is important to clarify in FHx?
At what age IHD or cerebrovascular accident occurred
ie before 65
What are the main steps in a cardiac examination?
Inspection
Palpation
Auscultation
Special tests
What should you inspect?
Around the bed space General appearance of patient Hands Eyes Face Mouth/lips JVP Chest
What should you look for in the general appearance of the patient?
Body habitus Colour Breathing Comfort Position Build
What cardiac signs should you look for in the hands?
Tar staining Vasodilatation/constriction Temperature Sweating Pallor of palmar creases (anaemia) Peripheral cyanosis (low cardiac output) Clubbing (low blood O2) Splinter haemorrhages Osler's nodes and Janeway lesions (infective endocarditis) Tendon xanthomas (hypercholesterolaemia)
What should you look for in the eyes?
Subconjunctival pallor
Corneal arcus
Xanthelasmata
What should you look for in the face?
Malar flush
What should you look for in the mouth/lips?
Central cyanosis
High arched palate
Dental caries
What should you look for in the chest?
Sternotomy scar
Severe pectus excavatum
Severe kyphoscoliosis
Visible cardiac pulsation
What should you palpate?
Radial pulse Radial-radial delay? Brachial pulse Collapsing pulse Carotid pulse Apex beat Parasternal heaves Thrills
What are you feeling for when palpating the pulses?
Rate
Rhythm
Character
Volume
What is a collapsing pulse a sign of?
Aortic regurgitation
What should you auscultate?
Aortic, pulmonary, tricuspid and mitral valve areas
Lung bases
What special manoeuvres can you do to identify where the extra sound is coming from and what are they showing?
Left axilla - mitral regurgitation
Using bell - apex with patient rolled to 45 degrees to L - mitral stenosis
Sit patient forwards in 4th/5th intercostal spaces on held expiration - aortic regurgitation
Carotids - aortic stenosis
What is the murmur from mitral regurgitation?
Pansystolic murmur
What is the murmur from mitral stenosis?
Diastolic murmur
What is the murmur from aortic regurgitation?
Early diastolic decrescendo murmur
What is the murmur from aortic stenosis?
Ejection-systolic murmur
What special tests should you do?
Palpate for hepatomegaly Shifting dullness if suspect ascites Femoral pulses - radio-femoral delay? Pitting oedema BP in both arms Lying and standing BP Ophthalmoscopy 12-lead ECG
