Cardio MedEd Part 2 Flashcards
What scars do you look for on the inspection of the chest?
- Implantable electronic device
- Minimally invasive surgery
- Median sternotomy
- Left thoractomy
- Chest drain scars
- Right thoractomy
What are examples of implantable electronic devices?
- Pacemaker
- Defibrillator
- Resynchronisation device
What are examples of minimally invasive surgeries?
- Repair of septal defects
- Tricuspid valve surgery
- Aortic valve surgery
- Mitral valve surgery
What surgeries may cause of a median sternotomy scar?
- Mitral valve surgery
- Repair of the transposition of the great arteries
- Fontan circulation with fenestration
- Repair of tetralogy of Fallot
- Central shunt
- Pulmonary artery banding
- CABG
What may give a left thoracotomy scar?
- Repair of coarcation of the aorta
- Ligation of patent ductus arteriosus
- Pulmonary artery banding
- Balock-Taussing shunt
- Mitral valve surgery
What would cause a right thoracotomy scar
- pulmonary artery banding
2. Balock-Taussing shunt
When would you look in legs for scars?
If midline sternotomy scar (vein harvesting for CABG)
What may cause a left submammary scar?
- mitral valvotomy
2. pericardial window
Where is the apex beat usually found?
5th intercostal space in midclavicular line
When might the apex beat be displaced?
ventricular hypertrophy
What is a parasternal heave?
precordial (chest) impulse that can be palpated
How do you feel parasternal heave?
- heel of your handparallel to theleft sternal edge(fingers vertical)
- you should feel the heel of your hand beingliftedwith each systole
When are parasternal heaves present?
right ventricular hypertrophy
What is a thrill?
apalpable vibrationcaused byturbulent blood flowthrough a heart valve (a thrill is a palpable murmur)
How do you palpate for thrills?
- each of the heart valvesin turn
- place your handhorizontallyacross the chest wall, with theflats of your fingersandpalm over thevalveto be assessed
Where is the mitral valve?
5th intercostal space in mid clavicular line
Where is the tricuspid valve?
4th or 5th intercostal space at the lower left sternal edge
Where is pulmonary valve?
2nd intercostal space at the left sternal edge
Where is aortic valve?
2nd intercostal space at the right sternal edge.
What are the normal heart sounds?
LUB DUB
What is the s1 sound?
lub
What is the s2 sound?
dub
What is a sound between s1 and s2 classified as?
systolic
What is a sound after s2 classified as?
diastolic
What is the sound of an ejection systolic murmur?
whoosh dub
Where would you here an ejection systolic murmur?
- Aortic valve + radiation to the carotids
2. Patient to hold breath as you listen over the carotids
What pathology causes an ejection systolic murmur?
aortic stenosis
What does an early diastolic murmur sound like?
lub whoosh
Where would you hear an early diastolic murmur?
listen over aortic valve, then get patient to sit forward to extenuate
What is the pathology of an early diastolic murmur?
aortic regurgitation
What does a pansystolic murmur sound like?
whooosh
Where can you hear a pansystolic murmur?
- mitral valve + radiation to the axilla
- roll patient onto their left and listen during expiration
- then move stethoscope up to axilla
What is the pathology of a pansystolic murmur?
motral regurgitation
What does a mid-diastolic murmur sound like?
Lub whoosh
Where do you hear a mid diastolic murmur?
listen over mitral area with the bell during expiration
What is the pathology of a mid-diastolic murmur?
mitral stenosis
How do you systematically listen to hear sounds?
- Listen to mitral with diphragm + move to axilla
- Listen to mitral with bell turn to left deep breath in and out and hold + move to axilla
- Tricuspid with D
- Pulmonary with D
- Aortic with D
- Carotid D (hold breath)
- Bell sit up and forward, breath in and out and hold
- Then listen to lung bases and palpate for sacral oedema
Why do you auscultate lung bases?
pulmonary oedema (bi-basal crackles)
What else do you palpate for?
sacral oedema and ankle oedema
What would sacral oedema and ankle oedema suggest?
heart failure
How do you close the exam?
- Thank patient
- Offer to help cover up
- Wash hands
- Summarise findings
What other investigations would you want to do?
- Check for peripheral stigmata of cardiovascular disease
- Check fundi
- Abdominal examination check for AAA
- Urine dip
- BP
- ECG
