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CMS OCSE > Cardio > Flashcards

Cardio Flashcards

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1
Q

What clinical signs do you look for from the end of the bed?

A
  • Cyanosis
  • Shortness of breath
  • Pallor
  • Malar flush
  • Oedema
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2
Q

What are the causes of cyanosis in a cardio context?

A
  • Poor circulation (peripheral vasoconstriction secondary to hypovolemia)
  • Inadequate oxygenation of blood which can be caused by right to left cardiac shunting
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3
Q

What is left to right cardiac shunting?

A

Abnormal communication between the right and left side of the heart allowing blood to flow directly from one circulatory system to the other. A right-to-left shunt allows deoxygenated systemic venous blood to bypass the lungs and return to the body.

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4
Q

What does shortness of breath suggest in a cardiac context?

A

Congestive heart failure or pericarditis

can also suggest pneumonia and pulmonary embolism

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5
Q

What does pallor suggest in a cardiac context?

A
  • underlying anaemia due to haemorrhage or chronic disease

- Poor perfusion which can be caused by congestive cardiac failure

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6
Q

What is congestive heart failure ?

A

-Chronic progressive condition that affects the pumping power of your heart muscle meaning muscle is pumped insufficiently

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7
Q

What does Malar flush suggest in a cardiac context?

A

mitral stenosis

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8
Q

What is the most likely reason for oedema in a cardiac context?

A

Congestive heart failure ( as the blood is unable to pump insufficiently around the body it pools in legs, ankles and feet)

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9
Q

What objects and equipment should you look for in a cardio exam?

A
  • Medical equipment such as oxygen delivery devices, ECG leads, medications (e.g. glyceryl trinitrate spray), catheters (note volume/colour of urine) and intravenous access
  • Mobility aids
  • Pillows (those with congestive heart failure suffer from orthopnoea)
  • Vital signs
  • Fluid balance
  • Prescriptions
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10
Q

What should you inspect the hands for?

A
  • Colour
  • Tar staining
  • Xanthomata
  • Spider fingers (arachnodactyly)
  • Splinter haemorrhages
  • Janeway lesions
  • Osler nodes
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11
Q

What can the colour of the hands suggest?

A
  • Pallor cans biggest poor peripheral perfusion (CHF)

- Cyanosis can indicate hypoxaemia

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12
Q

Why is it important to look for tar staining?

A

Smoking is a significant risk factor for coronary artery disease and hypertension

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13
Q

What is xanthomata?

A
  • Raised yellow cholesterol rich deposits that are palm, tendon of wrist and elbow
  • They are associated with hyperlipidaemia (typically familial). This is a big risk for CAD
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14
Q

Why is arachnodactyly significant?

A

Features or Marfan’s syndrome which is associated with mitral/aortic valve prolapse and aortic dissection

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15
Q

What is finer clubbing?

A

Uniform soft tissue swelling of the terminal phalanx of a digit - there is loss of the normal angle between the nail and the nail bed

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16
Q

What is the most likely underlying cause of finger clubbing in a cardiac context?

A
  • congenital cyanotic heart disease
  • Infective endocarditis
  • Atrial myxoma
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17
Q

What is atrial myxoma?

A

Tumour/caner of atrium

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18
Q

What should you see when you ask patient to put nails of index fingers together?

A

Schamroth’s window

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19
Q

What are can cause splinter haemorrhages?

A
  • Local trauma
  • Infective endocarditis
  • Sepsis
  • Vasculitis
  • Psoriatic nail disease
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20
Q

What are Janeway lesions?

A

Non-tender haemorrhage lesions that occur on palms and soles

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21
Q

What are Janeway lesions associated with?

A

Infective endocarditis

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22
Q

What are Osler nodes?

A

Tender, raised lumps with a pale centre that are located on fingers and toes

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23
Q

what are Osler nodes associated with?

A

Infective endocarditis

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24
Q

What could cool hands suggest when palpating for temperature?

A

Poor perfusion

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25
Q

What could sweaty/clammy hands suggest when palpating for temperature?

A

Acute coronary syndrome

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26
Q

What does a capillary refill time >2 seconds suggest?

A

Poor peripheral perfusion (hypovolamemia, congestive heart failure)

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27
Q

What do you asses when feeling radial pulse?

A

Rate and rhythm

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28
Q

what should the pulse rate be between?

A

60-100

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29
Q

What could cause bradycardia?

A

Healthy athletic individuals, supraventricular tecahycardia, hypovolaemia, hyperthyroidsim

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30
Q

What could cause tachycardia?

A

anxiety, supraventricular tachycardia, hypovolaemia, hyperthyroidism

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31
Q

What is the most common cause of irregular rhythm?

A

atrial fibirilation bit can also be caused by ectopic beats in healthy individuals and AV blocks

32
Q

What is radio-radial delay?

A

Loss of synchronicity between radial pulses on each arm

33
Q

What are the causes of radio-radial delay?

A
  • Subclavain artery stenosis
  • Aortic dissection
  • Aortic coarctation
34
Q

What is aortic coarctation?

A

Coarctation of the aorta is a narrowing, or constriction, in a portion of the aorta. The condition forces the heart to pump harder to get blood through the aorta and on to the rest of the body.

35
Q

What is a collapsing pulse?

A

A forceful pulse that rapidly increases and subsequently collapses - also known as a water hammer pulse

36
Q

what do you feel with collapsing pulse?

A

As blood empties from arm is diastole, you should feel a tapping pulse through the muscle bulk of the arm - this is caused by the sudden retraction of the column of blood within the arm during diastole

37
Q

What are the causes collapsing pulse?

A
  • Normal physiological states (fever, pregnancy)
  • Cardiac lesions (aortic regurgitation, patent ductus arteriosus)
  • High output states (anaemia, AV fistula, thyrotoxins)
38
Q

What do you assess when you palpate the brachial pulse?

A

Volume and character

39
Q

How do you palpate the brachial pulse?

A

Palpate medial to the biceps brachii tendon - deeper palpation is required compared to radial due tot the location of the brachial artery

40
Q

How do can charter of pulse be described?

A
  • Normal
  • Slow-rising
  • Bounding
  • Thready
41
Q

What is a slow rising character pulse associated with?

A

Aortic stenosis

42
Q

What is a bounding character pulse associated with?

A

Aortic regurgitation

43
Q

What is thready character pulse associated with?

A

Intravascular hypvolaemia in sepsis

44
Q

Where should you measure blood pressure?

A

in both arms and when lying and standing

45
Q

What is classed as hypertension?

A
  • greater than 140/90 mmHg if under 80 years old

- greater or equal 150/90 mmHg over 80

46
Q

What is classed as hypotension?

A

less than 90/60 mmHg

47
Q

What narrow pulse pressure?

A

less than 25mmHg difference in systolic and diastolic pulse pressure

48
Q

What is wide pulse pressure?

A

more than 100mmHg difference between systolic and diastolic blood pressure

49
Q

What can cause narrow pulse pressure?

A

Aortic stenosis, congestive heart failure and cardiac tamponade

50
Q

What can cause wide pressure pulse?

A

Aortic regurgitation and aortic dissection

51
Q

What is seen as a significant difference in blood pressure between arms?

A

20mmHg

52
Q

What does a difference in blood pressure suggest?

A

Aortic dissection

53
Q

Why is it important to auscultate the carotid artery before palpating?

A

-Auscultate to rule out the presence of a bruit which can suggest underlying carotid stenosis which could dislodging of a carotid plaque causing an ischaemic stroke

54
Q

How do you auscultate the carotid artery?

A

ask patient to take deep in and hold

55
Q

What do you assess when palpating the carotid pulse?

A

character and volume

56
Q

What does the JVP give an indirect measure of?

A

Central venous pressure

57
Q

What does a raised JVP indicate?

A

Venous hypertension

58
Q

What are the cardiac causes of raised JVP?

A
  • Right-sided heart failure (commonly caused by left sided heart failure and pulmonary hypertension can also cause right sided heart failure)
  • Tricuspid regurgitation (causes include infective endocarditis and rheumatic heart disease)
  • Constrictive pericarditis (idiopathic TB)
59
Q

What is a normal finding when exciting the hepatoajugualar reflux?

A

In healthy individuals there should be a rise that should last for no longer than 1-2 cardiac cycles and it should fall

60
Q

What is classed as a positive hepatoajugualar reflex?

A

A sustained rise that is equal or greater than 4cm

61
Q

What does a positive hepatojugular reflux suggest?

A

The right ventricle is unable to accommodate an increased venous return

62
Q

What conditions can produce a positive hepatojugular reflux?

A
  • Constrictive pericarditis
  • Right ventricular failure
  • Left ventricular failure
  • Restrictive cardiomyopathy
63
Q

what eye signs are relevant in cardio exam?

A
  • Conjunctival pallor
  • Corneal Marcus
  • Xanthelasma
  • Kayser-Fleischer rings
64
Q

What does conjunctival pallor suggest?

A

Anaemia

65
Q

What does corneal arcus suggest?

A

suggests underlying hypercholesterolaemia

66
Q

What is corneal arcus?

A

A hazy white, grey or blue opaque ring in peripheral cornea

67
Q

What is Xanthelasma suggest?

A

Hypercholesterolaemia

68
Q

What are Kayser-fleischer rings associated with?

A

Wilsons disease - this involves abnormal copper processing in the liver resulting in accumulation and deposition in various tissues including the heart where it can cause cardiomyopathy

69
Q

What are Kayser-fleischer rings?

A

Dark rings

70
Q

What are relevant clinical signs in the mouth in a cardio exam?

A
  • Central cyanosis
  • Angular stomatitis
  • High arched palate
  • Poor dental hygiene
71
Q

What is central cyanosis in the mouth associated with=?

A

hypoxameia which can be caused by a right to left cardiac shunt

72
Q

What is angular stomatitis?

A

A inflammatory condition impacting the corners of the mouth - this can be caused by iron deficiency

73
Q

What can high arched palate be a sign of?

A

Marfans syndrome - this can be associated with mitral/aortic valve prolapse and aortic dissection

74
Q

why in dental hygiene important to consider in a cardiac exam?

A

Poor dental hygiene is a risk factor for infective endocarditis

75
Q

What should you look for when inspecting the anterior chest?

A

Scars suggestive of previous thoracic surgery: see the thoracic scars section below.
Pectus excavatum: a caved-in or sunken appearance of the chest.
Pectus carinatum: protrusion of the sternum and ribs.
Visible pulsations: a forceful apex beat may be visible secondary to underlying ventricular hypertrophy.

76
Q

What are the important thoracic scars?

A

Median sternotomy scar: located in the midline of the thorax. This surgical approach is used for cardiac valve replacement and coronary artery bypass grafts (CABG).
Anterolateral thoracotomy scar: located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space. This surgical approach is used for minimally invasive cardiac valve surgery.
Infraclavicular scar: located in the infraclavicular region (on either side). This surgical approach is used for pacemaker insertion.
Left mid-axillary scar: this surgical approach is used for the insertion of a subcutaneous implantable cardioverter-defibrillator (ICD).

CMS OCSE (2 decks)

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