Cardio

Question 1

What is the pathophysiology of cyanosis?

Answer 1

• bluish discolouration due to poor circulation
• inadequate oxygenation of blood

Question 2

What diseases present with cyanosis?

Answer 2

• peripheral vasoconstriction secondary to hypovolaemia
• inadequate oxygenation due to R-to-L cardiac shunting

Question 3

What does SOB indicate?

Answer 3

• Congestive heart failure, pericarditis
• Resp: PE, pneumonia

Question 4

What does pallor indicate?

Answer 4

• pale skin
• anaemia: haemorrhage, chronic disease
• poor perfusion: congestive cardiac failure

Question 5

What does malar flush indicate?

Answer 5

• plum-red discolouration of cheeks
• mitral stenosis

Question 6

What surrounding the bed is indicative of cardiac signs?

Answer 6

• GTN spray
• multiple pillows (orthopnoea)
• oxygen delivery devices
• fluid chart

Question 7

What signs can be seen on the hands?

Answer 7

• colour: pallor or cyanosis (underlying hypoxaemia)
• tar staining: smoking is a RF
• xanthomata: cholesterol deposits on palms, tendons. associated high lipids - RF for CVD

Question 8

What is arachnodactyly and what does it indicate?

Answer 8

• long slender digits
• Marfan’s
• mitral/aortic valve prolapse
• aortic dissection

Question 9

What is clubbing?

Answer 9

• soft tissue swelling of terminal phalanx
• loss of angle between nail and nail bed
• congenital cyanotic heart disease
• infective endocarditis
• diamond window lost

Question 10

What signs of infective endocarditis are seen?

Answer 10

• splinter haemorrhages: nails
• Janeway lesions: hemorrhagic lesions on palms
• Osler’s nodes: red-purple raised lumps on fingers and toes

Question 11

What are Roth spots?

Answer 11

• a sign of infective endocarditis
• white-centred retinal haemorrhages
• seen in fundoscopy

Question 12

What should the temperature of the hands be like?

Answer 12

• healthy: symmetrically warm
• cool: poor peripheral perfusion (ACS, CCF)
• cool AND sweaty: ACS

Question 13

How do you measure capillary refill time?

Answer 13

• healthy: returns in <2s
• must assess central if >2s

Question 14

What causes bradycardia?

Answer 14

• <60bpm
• healthy athletics
• atrioventricular block
• medications
• sick sinus syndrome

Question 15

What causes tachycardia?

Answer 15

• > 100bpm
• anxiety
• supraventricular tachycardia
• hypovolaemia
• hyperthyroidism

Question 16

What causes radio-radial delay?

Answer 16

• subclavian artery stenosis
• aortic dissection
• aortic coarctation

Question 17

What is a collapsing pulse?

Answer 17

• as blood empties in diastole, feel a tapping impulse
• normal: fever, pregnancy
• aortic regurgitation, patent ductus arteriosus
• anaemia, AV fistula, thyrotoxicosis

Question 18

What are the types of brachial pulse?

Answer 18

• slow-rising: aortic stenosis
• bounding: aortic regurgitation or CO2 retention
• thready: intravascular hypovolaemia e.g. sepsis

Question 19

What does a narrow pulse pressure indicate?

Answer 19

• <25mmHg between systolic and diastolic
• aortic stenosis, congestive heart failure, cardiac tamponade

Question 20

What does wide pulse pressure indicate?

Answer 20

• > 100mHg between readings
• aortic regurgitation and aortic dissection

Question 21

What do carotid bruits sound like?

Answer 21

• low-frequency whooshing sound
• suggest carotid artery stenosis in older pts
• could also be radiating cardiac murmur

Question 22

What does the JVP look like?

Answer 22

• double pulsation
• vertical distance between sternal angle and top of pulsation point in IJV (<3cm)

Question 23

What causes a raised JVP?

Answer 23

• R sided HF (commonly caused by L sided HF)
• tricuspid regurg: IE and rheumatic HD
• constrictive pericarditis: RA/TB

Question 24

What cardiac signs can be seen in the eyes?

Answer 24

• pallor: anaemia
• corneal arcus: white/grey/blue ring in peripheral cornea in <50yos > high cholesterol
• Kayser Fleischer rings: dark rings circling iris from high copper

Question 25

What cardiac signs are seen in the mouth?

Answer 25

• central cyanosis: blue lips/tongue
• angular stomatitis: anaemia
• high arched palate: Marfan’s
• dental hygiene: RF for IE

Question 26

What signs are seen in the anterior chest?

Answer 26

• pectus excavatum: caved in
• pacts carinatum: protrusion
• visible pulsations

Question 27

What do different chest scars indicate?

Answer 27

• midline sternotomy: CABG/valve replacement
• anterolateral thoracotomy: valve replace
• infraclavicular: pacemaker
• left mid-axillary: Implantable defib

Question 28

What does displacement of the apex beat indicate?

Answer 28

• ventricular hypertrophy

Question 29

What do thrills indicate?

Answer 29

• turbulent blood flow through a valve
• palpable murmur

Question 30

How do you listen for aortic stenosis?

Answer 30

• auscultate carotids whilst patient holds breath for radiation of ejection systolic murmur

Question 31

How do you listen for aortic regurgitation?

Answer 31

• sit pt forwards
• auscultate over aortic area during expiration
• early diastolic murmur

Question 32

How do you listen for mitral regurgitation?

Answer 32

• roll patient on L side
• listen over mitral area during expiration
• pan systolic murmur
• auscultate axilla for radiation

Question 33

How do you listen for mitral stenosis?

Answer 33

• listen over mitral area using bell during expiration
• mid-diastolic murmur

Question 34

What do coarse crackles indicate?

Answer 34

• pulmonary oedema
• associated with LV failure

Question 35

What further investigations should you do?

Answer 35

• 12 lead ECG
• urine dipstick
• blood pressure
• fundoscopy
• peripheral vascular exam

Question 36

How would heart failure present?

Answer 36

• tachypnoea
• raised JVP
• bibasal fine crepitations
• peripheral oedema
• displaced apex beat
• S3