Cardio Flashcards
1
Q
What is the pathophysiology of cyanosis?
A
- bluish discolouration due to poor circulation
- inadequate oxygenation of blood
2
Q
What diseases present with cyanosis?
A
- peripheral vasoconstriction secondary to hypovolaemia
- inadequate oxygenation due to R-to-L cardiac shunting
3
Q
What does SOB indicate?
A
- Congestive heart failure, pericarditis
- Resp: PE, pneumonia
4
Q
What does pallor indicate?
A
- pale skin
- anaemia: haemorrhage, chronic disease
- poor perfusion: congestive cardiac failure
5
Q
What does malar flush indicate?
A
- plum-red discolouration of cheeks
- mitral stenosis
6
Q
What surrounding the bed is indicative of cardiac signs?
A
- GTN spray
- multiple pillows (orthopnoea)
- oxygen delivery devices
- fluid chart
7
Q
What signs can be seen on the hands?
A
- colour: pallor or cyanosis (underlying hypoxaemia)
- tar staining: smoking is a RF
- xanthomata: cholesterol deposits on palms, tendons. associated high lipids - RF for CVD
8
Q
What is arachnodactyly and what does it indicate?
A
- long slender digits
- Marfan’s
- mitral/aortic valve prolapse
- aortic dissection
9
Q
What is clubbing?
A
- soft tissue swelling of terminal phalanx
- loss of angle between nail and nail bed
- congenital cyanotic heart disease
- infective endocarditis
- diamond window lost
10
Q
What signs of infective endocarditis are seen?
A
- splinter haemorrhages: nails
- Janeway lesions: hemorrhagic lesions on palms
- Osler’s nodes: red-purple raised lumps on fingers and toes
11
Q
What are Roth spots?
A
- a sign of infective endocarditis
- white-centred retinal haemorrhages
- seen in fundoscopy
12
Q
What should the temperature of the hands be like?
A
- healthy: symmetrically warm
- cool: poor peripheral perfusion (ACS, CCF)
- cool AND sweaty: ACS
13
Q
How do you measure capillary refill time?
A
- healthy: returns in <2s
- must assess central if >2s
14
Q
What causes bradycardia?
A
- <60bpm
- healthy athletics
- atrioventricular block
- medications
- sick sinus syndrome
15
Q
What causes tachycardia?
A
- > 100bpm
- anxiety
- supraventricular tachycardia
- hypovolaemia
- hyperthyroidism
16
Q
What causes radio-radial delay?
A
- subclavian artery stenosis
- aortic dissection
- aortic coarctation
17
Q
What is a collapsing pulse?
A
- as blood empties in diastole, feel a tapping impulse
- normal: fever, pregnancy
- aortic regurgitation, patent ductus arteriosus
- anaemia, AV fistula, thyrotoxicosis
18
Q
What are the types of brachial pulse?
A
- slow-rising: aortic stenosis
- bounding: aortic regurgitation or CO2 retention
- thready: intravascular hypovolaemia e.g. sepsis
19
Q
What does a narrow pulse pressure indicate?
A
- <25mmHg between systolic and diastolic
- aortic stenosis, congestive heart failure, cardiac tamponade
20
Q
What does wide pulse pressure indicate?
A
- > 100mHg between readings
- aortic regurgitation and aortic dissection
21
Q
What do carotid bruits sound like?
A
- low-frequency whooshing sound
- suggest carotid artery stenosis in older pts
- could also be radiating cardiac murmur
22
Q
What does the JVP look like?
A
- double pulsation
- vertical distance between sternal angle and top of pulsation point in IJV (<3cm)
23
Q
What causes a raised JVP?
A
- R sided HF (commonly caused by L sided HF)
- tricuspid regurg: IE and rheumatic HD
- constrictive pericarditis: RA/TB
24
Q
What cardiac signs can be seen in the eyes?
A
- 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
25
What cardiac signs are seen in the mouth?
- central cyanosis: blue lips/tongue
- angular stomatitis: anaemia
- high arched palate: Marfan's
- dental hygiene: RF for IE
26
What signs are seen in the anterior chest?
- pectus excavatum: caved in
- pacts carinatum: protrusion
- visible pulsations
27
What do different chest scars indicate?
- midline sternotomy: CABG/valve replacement
- anterolateral thoracotomy: valve replace
- infraclavicular: pacemaker
- left mid-axillary: Implantable defib
28
What does displacement of the apex beat indicate?
- ventricular hypertrophy
29
What do thrills indicate?
- turbulent blood flow through a valve
- palpable murmur
30
How do you listen for aortic stenosis?
- auscultate carotids whilst patient holds breath for radiation of ejection systolic murmur
31
How do you listen for aortic regurgitation?
- sit pt forwards
- auscultate over aortic area during expiration
- early diastolic murmur
32
How do you listen for mitral regurgitation?
- roll patient on L side
- listen over mitral area during expiration
- pan systolic murmur
- auscultate axilla for radiation
33
How do you listen for mitral stenosis?
- listen over mitral area using bell during expiration
- mid-diastolic murmur
34
What do coarse crackles indicate?
- pulmonary oedema
- associated with LV failure
35
What further investigations should you do?
- 12 lead ECG
- urine dipstick
- blood pressure
- fundoscopy
- peripheral vascular exam
36
How would heart failure present?
- tachypnoea
- raised JVP
- bibasal fine crepitations
- peripheral oedema
- displaced apex beat
- S3
