Cardio Flashcards
Hand signs in cardio exam
Quinckes sign
Osler nodes
Janeway lesion
Splinter haemorrhages
Clubbing
BM marks
What looking for in eyes cardio exam
Fundoscopy for papilloedema and roth spots
Corneal arcus
Xanthelasma
Conjunctival pallor
What looking for in mouth and face
Poor dental hygiene
High arched palate
Central cyanosis
De moussets sign
Flushing for MS
What looking for in clubbing
To see if loss of schamroth window
What to look for in inspection of chest in cardiac exam
Pacemaker
Sternotomy
Thoracotomy scars in particular under armpits
In palpation of chest in cardio what need to do
Feel for apex beat and map out with fingers the location
Heaves- place palm of hand over left sternal edge- will show RVH if feel arm lifted
Thrills- place flats of fingers over each valve location with hand horizontal
Difference in loudness of systolic vs diastolic
Systolic are loud whereas diastolic soft
What does patient in AF point towards valve wise
Mitral valve pathology
Most likely causes of absent left radial pulse
AV fistula
Radial artery graft
Not dissection and coarctation
What happens to apex beat in hypertrophic vs diastolic ventricular disease
Hypertrophic- strong and heaving apex
Dilated- displaced
Midline sternotomy indications
Open valve replacements
CABG
Transplant
Corrective of congenital defects
Complications of midline sternotomy
Poor healing of scar in area
Chronic chest pain
How manage a patient with chest pain
Related to heart, lungs, GI tract, musculoskeletal or anxiety
In terms of identifying which of these is cause work through
A-E assessment, salient points within assessment
B- sats, RR, examining lungs, CXR, ABG if struggling with breathing
C- BP, HR and ECG. Listening to heart more cardiac features Bloods importantly looking for troponin, BNP, perhaps FBC, identify anaemia or inflammatory markers, cultures for sepsis
Causes of chest pain
Cardiac
- coronary problems
- valvular
- heart muscle- inflammation, infection or structural defect from cardiomyopathy
Resp
- PE, pneumonia, pneumothorax, effusion
GI
- boerhaves
- oesophagitis
- stomach pathologies
Musc
- costochondritis
- pulled muscle
- broken ribs
Mitral regurg causes
Acute- infective such as IE, RF, post MI
Congenital- marfans, ehlers danlos, mitral valve prolapse in turners
Mitral regurgitation mangement
Options vary from conservative where can follow-up patients who are asymptomatic or those who are not candidates for surgery
Medical treatment of heart failure or atrial fibrillation. For heart failure acei and beta blockers. for atrial fibrillation long term warfarin or rate control
Consider surgery in patients who are candidates and symptomatic, reduced LVEF (60%), pulmonary HTN, atrial fibrillation, end systolic diameter of left atrium
Complications of valve replacements
Short term associated with procedure
- infection
- bleeding
- anaesthetic side effects
- DVT
- stroke
- arrythmias
If had mitral valve replacement what will hear
S1 will be replaced with click
If had aortic valve replacement what will hear
S2 will be replaced with click
When do aortic valve replacement for aortic stenosis
Symptomatic and aortic gradient over 40mm of mercury, reduced LVEF under 60%, aortic valve area under 1cm
Asymptomatic and BNP raised to 2x limit, valve area under 0.6cm, LVEF under 55%
Causes of aortic stenosis
Congenital- williams syndrome, bicuspid valve
Acquired- calcification worsened by CKD, DM and high lipids, endocarditis and RF, sclerosis
Valve operations done for aortic stenosis
Open heart surgery with mechanical valves
Transcatheter aortic valve implant with bioprosthetic valves
Valve balloon valvulotomy in palliative patients
Management of aortic stenosis
Conservative with regular follow up in asymptomatic patients with normal function and echo parameters. Symptomatic and unfit for surgery
Medical heart failure
Surgery if candidate and
Symptomatic and aortic gradient over 40mm of mercury, reduced LVEF under 60%, aortic valve area under 1cm
Asymptomatic and BNP raised to 2x limit, valve area under 0.6cm, LVEF under 55%
Complications of mechanical heart valves
Haemolytic anaemia
Thrombous requiring warfarin with INR target 3.5 which higher than AF
Endocarditis
Atrial fibrillation management
Initially depends on stability- HF, shock, collapse then cardiovert
Rhythm or rate control. Rhythm if
- under 48 hours
- causing HF
- identifiable cause
CHADVASC and ORBIT
Options for rhythm control
DC cardioversion
Flecainide
Amiodarone
Rate control AF options
Beta blockers
CCB like verapamil
Digoxin
ICD indications
Previous VT/VF
Long QT
HOCM/arrythmogenic right ventricular cardiomyopathy
Pacemaker indications
Symptomatic bradycardia
T2 mobitz or complete HB
Severe HF
Sick sinus
Ablation at AVN
What are types of pacemaker
Single chamber in either RA or RV
Dual in both
Triple therapy
Scar for pacemaker
Sub-clavicular scar
Types of mechanical valve
Starr edwards
Tilting disc
St jude
If had previous valve repalcement what do for next investigations
Review notes and imaging
ECG
