Cardiology Flashcards
what questions should be asked in a cardiovascular history?
presenting complaint chest pain; site, severity, character, duration, radiation, periodicity, frequency, episodic duration, precipitating/relieving factors, associated symptoms dyspnoea orthopnoea paroxysmal nocturnal dyspnoea ankle swelling palpitations syncope claudication PMHx: diabetes, HTN, MI, stroke, angina DHx FHX; IHD, diabetes, hyperlipidaemia, stroke, HTN SHx systematic questioning summary
what are the causes of dyspnoea?
anxiety obesity anaemia heart failure pulmonary disease pleural effusions
what are the causes of exertional dyspnoea?
cardiac failure
chronic pulmonary disease
poor physical condition
what are the causes of paroxysmal nocturnal dyspnoea?
congestive cardiac failure
asthma
what questions should be asked about palpitations?
fast regular irregular skipped beats how long they lasted for associated symptoms; dyspnoea, chest pain, syncope
describe the general inspection in the cardiovascular examination
cyanosis; peripheral vasoconstriction secondary to hypovolaemia, right-to-left cardiac shunting
dyspnoea; congestive heart failure, pericarditis, pneumonia, PE
pallor; haemorrhage, congestive heart failure
malar flush; mitral stenosis
oedema; congestive heart failure
medical equipment
mobility aids
pillows
vital signs
fluid balance
prescriptions
describe the inspection of the hands in the cardiovascular examination
pallor; poor peripheral perfusion, congestive heart failure
tar staining
xanthomata; hyperlipidaemia
arachnodactyly; Marfan’s syndrome
finger clubbing; congenital cyanotic heart disease, infective endocarditis, atrial myxoma
temperature
cool; poor peripheral perfusion, CCF, acute coronary syndrome
sweaty/clammy; acute coronary syndrome
CRT; increased in hypovolaemia, CCF
what signs in the hands are associated with endocarditis?
splinter haemorrhages
janeway lesions
osler’s nodes
what is examined after hands in a cardiovascular examination?
radial pulse collapsing pulse brachial pulse blood pressure carotid pulse; palpation and auscultation JVP; hepatojugular reflex
what are the causes of radio-radial delay?
subclavian artery stenosis; compression by cervical rib
aortic dissection
aortic coarctation
what are the causes of carotid bruits?
underlying carotid stenosis
radiating cardiac murmur; aortic stenosis
what are the causes of a raised JVP?
venous hypertension
right-sided heart failure
tricuspid regurgitation
constrictive pericarditis
what conditions are associated with a positive hepatojugular reflex?
right ventricle is unable to accommodate an increased venous return constrictive pericarditis right ventricular failure left ventricular failure restrictive cardiomyopathy
describe the inspection of the face in the cardiovascular examination
eyes; conjunctival pallor, corneal arches, xanthelasma, Kayser-fleischer rings
mouth; central cyanosis, angular stomatitis, high arched palate, dental hygiene
what are the causes of bradycardia?
healthy athletic individuals
atrioventricular block
sick sinus syndrome
medications
what are the causes of tachycardia?
anxiety
supra ventricular tachycardia
hypovolaemia
hyperthyroidism
what are the causes of a collapsing pulse?
fever pregnancy aortic regurgitation patient ductus arteriosus anaemia arteriovenous fistula thyrotoxicosis
describe the inspection of the chest in the cardiovascular examination
scars; previous thoracic surgery
Pectus excavatum
Pectus carinatum
visible pulsations; ventricular hypertrophy
describe the palpation of the chest in the cardiovascular exam
apex beat
heaves; parasternal heaves (RVH)
thrills
name the steps of the entire cardiovascular exam
introduction general inspections hands pulses blood pressure JVP face inspection of the chest palpation of the chest auscultation of the chest thank patient
describe the auscultation of the chest in the cardiovascular exam
hold carotid pulse
diaphragm; mitral, tricuspid, pulmonary, aortic
bell; mitral, tricuspid
special manoeuvre; roll onto left lateral position, palpate the apex beat, listen with the bell for mitral stenosis and axilla (mitral incontinence)
learn forward, inhale, exhale, hold breath; aortic and tricuspid (aortic incompetence)
carotids; aortic stenosis, bruits
describe the process of taking an ECG
introduction; explanation chest electrode placement limb electrode placement ask the patient to stay still check the electrodes are placed correctly press button to record ECG once recorded, switch off the machine remove the leads thank the patient label the ECG with the patient's details; name, DOB, H&C, indication for ECG
describe the placement of the ECG chest leads
V1; 4th intercostal space right sternal edge
V2; 4th intercostal space left sternal edge
V3; between V2 and V4
V4; 5th intercostal space mid-clavicular line
V5; left anterior axillary line at the same level as V4
V6; left mid-axillary line at the same level as V4 and V5
describe the placement of the ECG limb leads
red; ulnar styloid process of RA
yellow; ulnar styloid process of LA
green; medial/lateral malleolus of LL
blue; medial/lateral malleolus of RL
describe the process of interpreting an ECG
confirm details heart rate heart rhythm cardiac axis P waves PR interval QRS complex ST segment T waves U waves document interpretation
what questions should be asked in the presenting compliant of a haematology history?
fatigue weakness palpitations swollen ankles postural dizziness bleeding bruising fever night sweats weight loss jaundice lymph node enlargement lumps bone pain tingling and loss of sensation skin rash
what questions should be asked in the past medical history and family history of a haematology history?
pregnancy menstrual history frequency infection diarrhoea tarry stools blood in stools recent trauma with bleeding radiotherapy previous cancers GIT surgery transplants bleeding disorders previous transfusions rheumatoid arthritis
what drugs are important to ask about in the social history of a haematology history?
NSAIDs anticoagulants thrombolytics steroids vitamin supplements allergies
name the steps of a haematology exam
inspection; general hands arms axilla face neck chest abdomen legs
describe the general inspection in a haematology exam
race; thalassaemia, sickle cell anaemia gender pale; anaemia jaundice; haemolytic anaemia cyanosis; haemoglobinopathy, polycythaemia bruising; clot disorder scratch marks; lymphoid cancer plethoric red face; polycythaemia wasted/cachexic; cancer
describe the inspection of the hands in a haematology exam
nicotine staining koilonychia; iron deficiency pale nails; anaemia clubbing; cancer vasculitis of the nail bed; bacteraemia palmar creases; anaemia joints gouty topi; secondary to myeloproliferative disease hot hands; febrile pulse; shock, peripheral B12 neuropathy
describe the inspection of the arms and axilla in a haematology exam
blood pressure
scratch marks
palpable purpura; vasculitis, septicaemia
enlarged nodes; central, lateral, pectoral, intraclavicular, subscapular
describe the inspection of the face in a haematology exam
eyes; jaundice, conjunctiva pallor, haemorrhage, injected sclera
mouth; hypertrophied gums, bleeding, scurvey
tongue; glossitis, ulcerated, tonsillar/adenoid enlargement
describe the examination of the neck and chest in a haematology exam
auscultation; carotid bruit
inspect nodes; submental, submandibular, preauricular postauricular, occipital, jugular chain, post triangle, supraclavicular, paratracheal
bone pain; knock on ribs
feel for apex beat
describe the examination of the abdomen in a haematology exam
lie patient down abdominal breathing; anaemia dyspnoea palpate liver and spleen with respiration scars pulsatile stretch marks ascites black umbilicus portal hypertension; caput medusae inguinal nodes
describe the inspection of the legs in a haematology exam
ulcers bruising ecchymosis petechiae peripheral stocking neuropathy; B12 deficit popliteal nodes swollen leg; uni/bilateral purpura varicosity toe clubbing nail changes; similar to fingers?
what aspects are assessed in examining the arterial pulses?
rate rhythm character; collapsing pulse volume symmetry vessel wall character presence of bruits
examine on both sides
which arterial pulses are examined?
radial
brachial; medial to the medial head of biceps
carotid; medial border of sternocleidomastoid muscle and lateral to thyroid cartilage, should not examine both at the same time
femoral; inferior to mid inguinal point
popliteal; deep in the popliteal fossa
posterior tibial; against the tarsal bones
dorsalis pedis; usually 1cm behind the medial malleolus
what are the causes of a raised JVP?
right sided heart failure
fluid overload
tricuspid regurgitation
massive PE
how do you examine JVP?
semi-supine position
rest their head against a pillow
neck flexed slightly and looking to the left
inspect between the heads of the sternocleidomastoid muscle just above the clavicle
hepatojugular reflex; press on the RUQ
should return to normal after a few seconds
if it remains at the new high level; right sided heart failure
