Cardio OSCE Flashcards
Ddx of an irregularly irregular pulse?
- AF
- Ventricular ectopic beats
- Complete HB + variable ventricular escape
How do you differentiate between AF and VEB without using a 12 lead ecg?
Without a 12 lead ECG excercise the patient and this should abolish VEB’s but AF will remain.
Causes of central cyanosis?
1) Hypoxic lung disease
2) Right to left cardiac shunt
- cyanotic congenital heart disease
- Eisenmenger’s Syndrome
3) Methaemoglobinaemia (drug or toxin induced eg drugs like: sulfer drugs / local anaesthetics)
What are causes of peripheral cyanosis?
- Peripheral vascular disease
- Raynaud’s syndrome
- Heart failure
- Shock
- Severe central cyanosis
Important causes of AF.
- Ischaemic heart disease
- Rheumatic heart disease
- Thyrotoxicosis
- Pnemonia / PE / Alcohol
What is the most common Valvular abnormality in RA?
- Mitral stenosis
What are the causes of a non palpable apex beat?
1) Something between your fingers and the apex
- Adipose tissue
- in obese patients - Air
- in COPD and a pneumothorax - Fluid
- in pleural effusion,
- Haemothorax,
- Pericardial infusion
2) The apex is not in its normal position - Displaced (In left ventricular failure)
- Dextrocardia
Causes of heart failure
1) Pump Failure
- IHD
- Cardiomyopathy
- Constrictive Pericarditis
- Arrhythmias (e.g AF, Complete Heart Block)
- Negative inotroped and / Chronotropes
2) Excessive preload
- Regurgitant valve disease (MR/AR)
- Fluid excess (renal failure, IV fluids)
3) Excessive afterload
- AS
- Hypertension
4) Isolated RHF
- Cor pulmonale (2nd to chronic lung disease)
- pulmonary hypertension (Primary or due to MS)
5) High output cardiac failure
- Anaemia
- Pregnancy
- Metabolic (hyperthyroidism, Paget’s)
Ddx for LVH / Heaving apex.
1) Aortic stenosis
2) Hypertension
3) HOCM
4) Coarctation of the aorta
What are causes for 3rd heart sound (volume overload)?
It is normal if < 30 years old Due to volume overload which can be caused by - CCF - MI - Hypertension
- Aortic regurgitation
- Mitral regurgitation
- Constrictive percarditis
What are the causes of a 4th heart sound (pressure overload)?
- always abnormal
- CCF / MI / hypertension / Cardiomyopathy
- cannot be diagnosed in the context of AF
What are chest x-ray features of LHF?
- Alveolar oedema
- Kerley B lines
- Cardiomegaly
- Upper lobe diversion (cephasalization)
- Pleural Effusion
Causes of pericarditis?
- Viral (Coxsackie)
- Bacterial fungal infection
- immediately post MI
- Dresslers syndrome (2 - 10 weeks post MI)
- SLE / RA / scleroderma
- Uraemia
- Malignancy
Causes of an absent arteriol pulse?
- congenital usually bilateral
- Previous arterial line
- Previous cardiac catherterisation
- Atheromatous disease (usually subclavian)
- Arterial embolism (e.g. AF)
- Surgical ligation
What are the stigmata of infective endocarditis?
1) - Changing heart murmur
2) - Finger clubbing
3) - Splinter Haemorrhages
4) - Mild splenomegaly
5) - Microscopic haematuria
6) - Eponymous signs
- oslers node on finger pulps
- Janeway lesions on palms and sole
- Roth spots on the retina
