Cardio MedEd Flashcards
How do you explain the cardio exam to a patient?
- Which would involve me having a look and feel of your hands, arms, face and neck
- Then have a look, listen and feel of your chest
- Would that be ok?
How do you explain exposure to patient?
For this examination you would have to be exposed from the waist up so I can get a clear view of your chest (can keep on your bra), would that be ok? Do you need any help removing your shirt?
What must you not forget to ask?
- Any pain
2. Chaperone
What should you check in patients general state?
- Sweaty
- SOB
- Anxiety
- Malar flush
- Pallor
- Cyanosis
- Nutritional status
What syndromes can you identify on inspection?
- Marfan’s
- Downs
- Turner’s
What are the cardio impacts in Marfan’s?
- Valve disease
- Aortic aneurysm
- Dissection
What are the cardio impacts in Down’s?
septal defects
What are the cardio impacts in Turner’s?
aortic coarctation
What are the syndromic features of Marfan’s?
- High arched palate
2. Arachnodactyly (‘spider fingers’):fingers and toes are abnormally long and slender
What are the syndromic features of Down’s?
- low muscle tone
- small stature
- an upward slant to the eyes
- single deep crease across the center of the palm
What are the syndromic features in Turner’s?
- short neck with a webbed appearance
- low hairline at the back of the neck
- low-set ears
- hands and feet that are swollen or puffy at birth
- soft nails that turn upward
What scars do you look for?
- Midline sternotomy scar (CABG + vein graft in leg)
- Thoracotomy scar
- Pacemaker
- Femoral-popliteal bypass
What other signs do you look for on the chest?
- Listen for click of prosthetic valve
- Visible pulsations on chest
- Amputations
- Ulceration
- Ascites
- De Mussets sign
What medical parapehrnalia can you look around for?
- Cannula, drip, IV fluids
- IV antibiotics
- Diuretics
- GTN spray
- Monitors / telemetry
- Cigarettes
- Other meds
- Temp chart
- ECG
What could IV antibiotics suggest?
infective endocarditis
What could diuretics suggest?
- Heart failure
2. Pedal oedema
What could GTN spray suggest?
angina
What could monitors/telemetry suggest?
- recent chest pain
- arrythmias
What are you looking for on inspection of the hands?
- Tar staining
- Clubbing
- Spliter haemorrhages
- Osler nodes
- Janeway lesions
- Tendon Xanthoma
- Peripheral cyanosis
What are you doing on palpitation of the hands?
- Temperature
- Cap refill
- CO2 retention flap
- Radial pulse: collapsing, bounding, radial-radial delay, radial-femoral delay)
- Resp Rate
- Blood pressure
What would tar staining suggest?
smoking
What are the cardiac causes of clubbing?
- Infective endocarditis
- Cyanotic congenital heart disease
- Atrial myxoma
What do osler nodes / janeway lesions suggest?
infective endocarditis
What do splinter haemorrhages suggest?
infective endocarditis
What does xanothoma suggest?
- hyperlipidaemia (typically familial hypercholesterolaemia)
- important risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension)
What does poor pallor suggest?
poor peripheral perfusion (e.g. congestive heart failure, hypovoleamia)
What could cyanosis indicate?
underlying hypoxaemia
What could a bounding pulse be due to?
- aortic regurgitation
- CO2 retention
What are causes of radio-radial delay?
- subclavian artery stenosis (e.g. compression by a cervical rib)
- aortic dissection
- aortic coarctation
What are causes of a radio-femoral delay?
aortic coarctation distal to the left subclavian artery
What are causes of CO2 retention flap?
- COPD
2. Type 2 resp failure
What do you look for in the face?
- Malar fllush
- Xanthelasma
- Corneal arcus
- Conjunctival pallor
What are the causes of malar flush?
mitral stenosis
What are the causes of xanthelasma?
hypercholesterolaemia
When is corneal arcus not benign?
under 50 suggest hypercholesterolaemia
What does conjuctival pallor suggest?
anaemia
What do you look for on the mouth?
- Central cyanosis
- Hydration
- High arched palate
What could central cyanosis suggest?
hypoxaemia (e.g. a right to left cardiac shunt)
What would a high arched palate suggest?
feature of Marfan syndrome
What is Marfan’s syndrome associated with?
- mitral/aortic valve prolapse
- aortic dissection
What do you look for in the neck?
- JVP
- carotid bruits
What is the reason for a raised JVP?
fluid overload / venous hypertension
What are the cardiac causes of a raised JVP?
- right sided heart failure
- tricuspid regurgitation
- constrictive pericarditis
What can cause right sided heart failure?
- left sided heart failure
2. pulmonary hypertension (due to COPD or ILD)
What can cause tricuspid regurgitation?
- infective endocarditis
2. rheumatic heart disease
What can cause constrictive pericarditis?
- idiopathic
- TB
- RA
What does a positive hepatojugular reflux suggest?
- right ventricle is unable to accommodate an increased venous return
- not diagnosticof any specific condition
What conditions usually cause a positive hepatojugular reflex?
- Constrictive pericarditis
- Right ventricular failure
- Left ventricular failure
- Restrictive cardiomyopathy
How do you palpate the carotid?
listen for bruits first because bruits indicate an underlying carotid stenosis
How do you auscultate for carotid bruits?
- diaphragm of the stethoscope 2. place between larynx and the anterior border of the SCM)
- ask the patient to take a deep breath in and hold it
- listen when they are holding their breath
What is a carotid bruit?
a vascular sound usually heard with a stethoscope over the carotid arterybecause of turbulent, non-laminar blood flow through a stenotic area
When do you palpate the carotid?
if no bruit heard: asses character and volume of pulse
What must you avoid with palpating the carotids?
NOT at same time
What could cause a collapsing pulse?
- normal physiological states (e.g. fever, pregnancy)
- Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)
- High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)
What are different types of pulse character?
- Normal
- Slow-rising
- Bounding
- Thready
What is a slow rising pulse associated with?
aortic stenosis
What is a thready pulse associated with?
intravascular hypovolaemia in conditions such as sepsis
