Cardio Station Flashcards
What are you looking out for when ‘inspecting from the end of the bed’?
GTN spray ECG Pacemaker Pillows (HF or pulmonary oedema) Catheter bags IV fluids Oxygen Cigarettes *** SOB Pallor Oedema Cyanosis Malar rash Oedema Syndromic features (Down's, Marfan's) Mitral valvotomy Thoracotomy
What would cyanosis be suggestive of? (Name 2 things)
Hypovolemia Inadequate oxygenation (right to left shifting)
What would shortness of breath be indicative of?
Cardiac problems:
Congestive heart failure
Pericarditis
Respiratory problems:
Infection (pneumonia)
Pulmonary embolism
What can malar flush be indicative of?
Mitral stenosis
SLE
What is mitral stenosis?
Narrowing of the mitral valve (LA to LV)
What is pallor indicative of?
Poor perfusion -> congestive heart failure
Anaemia -> haemorrhage, chronic disease
What would pillows, to prop up the patient during sleep, suggest?
Orthopnoea (congestive heart failure)
What are you looking for when inspecting the dorsum of the hands?
Splinter haemorrhages
Peripheral cyanosis
What would peripheral cyanosis suggest?
Heart failure
Congenital heart disease
What are splinter haemorrhages and what do they indicate?
Like blood spatters under the nails
Suggest infective endocarditis
What are you looking for when inspecting the palmar side of the hands?
Tar staining Xanthomata Osler's nodes (node); Janeway lesions (non tender on thenar and hypothenar areas) Arachnodactyly Clubbing
What is xanthomata and what does it suggest?
Yellowish cholesterol deposits under the skin, indicative of hyperlipidemia/familial hypercholestremia
Describe the characteristics, pathophysiology and pain associated with Osler’s nodes
Osler’s nodes are on the TIP of fingers and toes
Painful
Immunological infiltrates
Describe the characteristics, pathophysiology and pain associated with Janeway lesions
Janeway lesions are on the palm or sole of food
Not painful
Septic microemboli (a type of embolism with bacteria inside)
What could clubbing of the fingers be suggestive of?
Infective endocarditis
Congential cyanotic heart disease
Atrial myxoma
What is atrial myxoma?
A non-cancerous tumour in one of the atria of the heart
Turners
45 X
Cooarctation of aorta
Bicuspid instead of tricuspid valve
What else might you look for in the hands?
Tendon xanthoma
Give three signs of infective endocarditis
Clubbing
Poor dentition
Splinter haemorrhages
State another sign in the nails
Quincke’s sign (pulsation of nail bed)
aortic regurgitation
What may cause bradycardia?
Heart block
Heart rhythms
What may cause tachycardia?
Supraventricular arrhthmias
Sepsis
Phaeochromocytoma
Anxiety
State two irregular rhythms
AF -irregularly irregular
regular irregular - Heart block
State reasons for radio-radial delay
Stenosis of subclavian artery
Aortic coarctation
Brachial pulse -
Feel character - slow rising, bounding (CO2 rentention, aortic regurgitation)
Volume (thready - sepsis, hypovolemia)
Collapsing PULSE
Feel radial pulse
Feel brachial pulse
Don’t do it if they have pain in their arm
Aortic regurgitation
Difference of more than 20mmHg between two arms?
Aortic dissection
Atherosclerosis
Narrow pulse pressure (between systolic and diastolic)
Less than 25mmHg difference
Aortic stenosis, congestive heart failure
Wide pulse pressure ???????
Aorti regurg
aortic dissection
What heart conditions are associated with Marfan’s syndrome?
Aortic aneurysm mitral valve prolapse Cardial myopathy Lots of heart problems Cataracts Subluxation
Other conditions associated with heart conditions
Noonan
Edwards
What do you look for in the mouth?
Poor dentititon
High arched palate (marfan’s)
Central syanosis
What is JVP a measure of?
Indirect measure of central venous pressure because IJV connects to right atrium without a valve
How do you measure for JVP?
Between two heads of SCM
Try pressing on abdomen at liver and see if JVP comes up
Describe
Normally no pulse
VOICE
Visible
Obliterablle
Impalpable
copmles valve form
RVF
Fluid overload
What would a raised JVP be caused by?
PQRST
Pulmonary HTN, PE, pericarditis, pericardial effusion
Quantitiy of fluid (overload)
Right heart failure
Superior vena cava obstruction (e.g. due to cancer)
Tamponade (fluid in pericardium)
Chest inspection - Scars
go back to the slide
Scars:
Median sternotomy scar;
cabg
coronoary artery bipass graft
Mitral valve replacement - lateral thoracotomy
Chest inspection
Ventricular hypertrophy
Visible pulsation / heaves
Reasons for apex beat displacement
ventricular hypertrophy
tapping on apex beat?
mitral stenosis
Thrusting/heaving
mitral or aortic regurgitation
What is a heave and how do you feel for it?
Pulsation felt through chest wall
Thrills
Vibration felt due to turbulent blood flow through valves
Basically palpable murmur
Felt using fingers in valve areas
????????????
Ask pt to move to left an dlisten to axilla (radiation of mitral regurgitation
Left lateral postiion - mitral stenosis
Acronym for thinking about murmur?
SCRIPT
Site - where is it loudest? Character Radiation Intensity (grade 1 = faint, 6 = very loud with a thrill, heart without a stethoscope) Pitch Timing - systolic or diastolic
Aortic stenosis
radiates to carotides
peripheral pulses often weak and delayed
‘cresendo and descendo)
Mitral stenosis
‘loud 51 type sound)
early diastolic flap
rumbling diastolic murmur
rheumatic heart disease
complciations:
pulmonary HTN
??
Aortic regurgitation
Flowing
heard at axilla
Back
sacral oedema
?
Leg
Pitting oedema
