Cardio Station Flashcards by Thivyaa Gangatharan

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

How well did you know this?

Not at all

Perfectly

What would cyanosis be suggestive of? (Name 2 things)

Hypovolemia
Inadequate oxygenation (right to left shifting)

How well did you know this?

Not at all

Perfectly

What would shortness of breath be indicative of?

Cardiac problems:
Congestive heart failure
Pericarditis

Respiratory problems:
Infection (pneumonia)
Pulmonary embolism

How well did you know this?

Not at all

Perfectly

What can malar flush be indicative of?

Mitral stenosis

SLE

How well did you know this?

Not at all

Perfectly

What is mitral stenosis?

Narrowing of the mitral valve (LA to LV)

How well did you know this?

Not at all

Perfectly

What is pallor indicative of?

Poor perfusion -> congestive heart failure

Anaemia -> haemorrhage, chronic disease

How well did you know this?

Not at all

Perfectly

What would pillows, to prop up the patient during sleep, suggest?

Orthopnoea (congestive heart failure)

How well did you know this?

Not at all

Perfectly

What are you looking for when inspecting the dorsum of the hands?

Splinter haemorrhages

Peripheral cyanosis

How well did you know this?

Not at all

Perfectly

What would peripheral cyanosis suggest?

Heart failure

Congenital heart disease

How well did you know this?

Not at all

Perfectly

What are splinter haemorrhages and what do they indicate?

Like blood spatters under the nails

Suggest infective endocarditis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is xanthomata and what does it suggest?

Yellowish cholesterol deposits under the skin, indicative of hyperlipidemia/familial hypercholestremia

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

What could clubbing of the fingers be suggestive of?

Infective endocarditis
Congential cyanotic heart disease
Atrial myxoma

How well did you know this?

Not at all

Perfectly

What is atrial myxoma?

A non-cancerous tumour in one of the atria of the heart

How well did you know this?

Not at all

Perfectly

Turners

45 X
Cooarctation of aorta
Bicuspid instead of tricuspid valve

How well did you know this?

Not at all

Perfectly

What else might you look for in the hands?

Tendon xanthoma

How well did you know this?

Not at all

Perfectly

Give three signs of infective endocarditis

Clubbing
Poor dentition
Splinter haemorrhages

How well did you know this?

Not at all

Perfectly

State another sign in the nails

Quincke’s sign (pulsation of nail bed)

aortic regurgitation

How well did you know this?

Not at all

Perfectly

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