Cardio Exam Flashcards
How are heart murmurs graded
grade 1 murmur is barely audible, a grade 2 murmur is louder and a grade 3 murmur is loud but not accompanied by a thrill. A grade 4 murmur is loud and associated with a palpable thrill. A grade 5 murmur is associated with a thrill, and the murmur can be heard with the stethoscope partially off the chest.
When is dupuytrens contractures seen
Dupuytren’s contracture – thickening and contraction of the tendons in the middle of the hand, seen in patients with chronic liver disease.
Clawing of the fingers seen in ulnar nerve lesions
True or false
True
Stages of clubbing
STAGE I - STAGE II - STAGE III - STAGE IV -
increased sponginess of the nail fold.
obliteration of the angle between the nail and the nail fold.
increased convexity of the nail in both directions longitudinally and transversely.
Bulbous swelling of the distal end of the finger.
Central cyanosis is best assessed by inspecting the under surface of the tongue.
Fungiform papillae are small red flat elevations seen on the surface of the tongue especially at the tip and edges. Filiform papillae are situated in parallel rows across the tongue and they give rise to the fur
True or false
True
Palpate also for lymph node on the supra clavicular area
True or false
True
Which things are associated with coronary heart diseases and what is a major risk factor of coronary heart disease
diabetes and dyslipidaemias because of their association with coronary artery disease.
Smoking is a major risk factor for coronary artery disease. Alcohol abuse may predispose to cardiac arrhythmias and cardiomyopathy. The cardiac history should quantify both habits in terms of pack- years smoked and units of alcohol consumed.
Important causes of chest pain
cardiac ischemia, pericarditis and dissecting aneurysm. Cardiac ischemia may be related to exercise when it causes the pain called angina;
Ischemic pain is felt in the front and the centre of the chest. It is usually described as “tight”, “pressing” or “crushing”. It frequently radiates to the left arm and less frequently to the right arm
What is the functional classification of stable angina (state the grade and description, there are four grades)
1 -Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or during recreation
2 -Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or climbing stairs after meals, in cold, in wind, or when under emotional stress, or only during the few hours after awakening
3 -Marked limitation of ordinary physical activity. Walking 1–2 blocks on the level and climbing less than one flight in normal conditions
4 -Inability to carry on any physical activity without discomfort; angina may be present at rest
Pericarditis causes pain with distribution similar to ischeamia but it is often made worse by breathing and it is markedly affected by posture. It is usually worst lying flat and it is relieved by sitting up and leaning forward
True or false
True
When is a fourth heart sound heard? What is hyperlipidemia What is dyslipidaemia What is xanthelasma What is xanthoma Where do xanthomas commonly appear
In pericarditis
None, although hypertension and signs of hyperlipidaemia` (. Hyperlipidemia refers to high levels of LDL or triglycerides. Dyslipidemia can refer to levels that are either higher or lower than the normal range for those blood fats.) (xanthelasmata(Xanthelasmata is the plural of xanthelasma, also called xanthelasma palpebrarum. They are sharply demarcated yellowish collections of cholesterol below the skin, typically on the eyelids or around them.),
Xanthoma is a skin condition in which certain fats build up under the surface of the skin. Xanthomas may appear anywhere on the body. The most common places are the elbows, joints, tendons, knees, hands, feet, and buttocks. If the fatty lumps are on the eyelids, it’s called xanthelasma.
Dissection of the aorta causes severe central chest pain that is often described by the patient as “tearing”. It typically radiates through to the back. It is of sudden onset and it is frequently accompanied by dizziness or transient loss of consciousness.
True or false
True
State the difference between syncope and presyncope
Basically, presyncope (pre-sin-co-pee) is the sensation that you’re going to faint. You might feel lightheaded and weak, among other symptoms, but you don’t actually pass out. You typically feel better within a few minutes. If you do faint and regain consciousness, that’s called syncope.
Syncope means sudden loss of consciousness with a fairly quick recover
Cardiovascular causes of clubbing are?(state three)
Cardio-vascular causes of clubbing includes cyanotic congenital heart disease like Fallot’s tetralogy and transposition of the great vessels – aorta and pulmonary arteries. Other causes are infective endocarditis and mitral stenosis.
Once there is a central cyanosis one is bound to have peripheral cyanosis. But one can have peripheral cyanosis without central cyanosis
True or false
True
Difference between arterial and venous pulsations in the neck
An arterial pulsation can be felt; a venous pulsation is usually impalpable.
2. Gentle pressure just above the clavicle will obliterate a venous pulsation and the vein will fill above the point of pressure. An arterial pulsation will not be affected.
3. The pulsation in the jugular vein is best seen at the limit of venous distension, so its position in the neck will change when the patient sits up or lies down.
4. Deep inspiration reduces intra-thoracic and therefore right atrial and jugular venous pressures. The position of the venous pulsation therefore moves downwards in the neck on inspiration and upwards on expiration. The position of an arterial pulse is unaffected. However, the venous pulsations are paradoxical in pericardial effusion or constricture pericarditis.
5. There are valves between the superior vena cava, the right atrium, the inferior vena cava and the hepatic veins. Thus if pressure is applied over the liver just below the ribs, blood will be expressed from the liver and the right atrial pressure will rise with a consequent rise of the jugular venous pressure and pulsation. This is called hepato jugular reflex.
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Chapter 3 The Cardio-Vascular System
6. The pulse waveform in the carotid artery is a simple “up and down” but that of the jugular venous pulse is more complex usually seen as rapid oscillation at the top of the venous column.
carotid artery runs adjacent to the internal jugular veins.
True or false
True
the jugular venous pressure enables one to assess the pressure in the right atrium and the waveforms help you assess pressure change sin the right atrium true or false
True
Why the internal jugular venous pressure is used instead of the external one
The internal jugular vein is in direct continuity with the right atrium and hence pressure in the internal jugular veins gives a true reflection of the pressure in the right atrium.
- The external jugular vein is very tortuous in its course as it passes through the fascial planes and hence subject to kinking and giving false readings.
- There are valves in the external jugular veins which may give false readings; but there are no valves in the internal jugular veins and hence reflects the actual pressure in the right atrium.
In what condition diagnosed using JVp does this occur
prominent “v” wave which collapse due to a deep “y” descent.
Tricuspid regurgitation
In what condition diagnosed using JVp does this occur
The jugular venous pressure is more than 2-3 cm above the angle of Louis.
Heart failure
In what condition diagnosed using JVp does this occur
the atria contract independently of the ventricles so the “a” waves in the jugular venous pulse are not regularly followed by “c” or “v” waves. At times the right atrium will by change contract against a closed tricuspid valve and when this happens the whole of the right atrial volume will be expelled up the superior vena cava. This will cause a sudden and marked single pulsation in the neck which is called cannon wave.
Heart block
In which condition where the jvp is used to check for it does this occur
: High pressure in pulmonary artery causes a rise in right ventricular pressure and so a rise in right atrial pressure. The “a” wave is then prominent and can be seen as a regular “flick” in the jugular phase
Pulmonary hypertension
In which condition where the jvp is used to check for it does this occur
some chronic disease like tuberculosis or collagen diseases, the pericardium becomes thickened and stiff. On inspiration the pericardium is pulled down by the diaphragm and the heart is compressed. Instead of the usual fall in venous pressure on inspiration the jugular venous pressure rises and at the same time the reduced inflow to the heart reduces the left ventricular output and the systemic pressure falls. These abnormal responses to inspiration are called venous arterial paradox.
Constrictive pericarditis and pericardial effusion
