Cardiology Flashcards
how common is deep vein thrombosis?
25-50% of surgical patients
2/3 per 1,000
where do they occur mostly?
65% below the knees
List risk factors for the condition
age pregnancy immobility - bed bound, travelling long distances synthetic oestrogen thrombophilia surgery cancer previous DVT
signs on examination
tenderness swelling warmth of calves erythema mild fevr odema homans sign
what is homans sign?
discomfort/ increase resistance behind the knee on forced dorsiflexion of the foot
what is a test for it?
D dimer
issues with this test?
sensitive but not specific
elevated in cancer, pregnancy, , infection and post op
what are other diagnostic options?
compression US
thrombophilia test before anti-cogulation
prevention methods
avoid immobility
avoid the pil
heparin
compression stockings
a medication which can prevent it ?
what does it act in
Fondaparinux
Xa inhibitor
what are the treatment options
heparin
warfarin
inferior vena cava filters
post phlebitis changes
what can be used to assess if this is DVT or not?
wells scores
what does it compromise of?
cancer - active or palliation with 6 months
bedridden recently >3 days
major surgery within last month
calf swelling >3cm compared to other leg- measure below tibial tuberosity
collateral superficial veins
pitting odema
differentials include…
cellulitis
bakers cyst
chronic venous insufficiency
lymphedema
what is valvular disease ?
Disease or damage to any of the four heart valves that can affect blood flow through the heart- 2 main types of valve prob;
differentiating between stenosis and regurgitation
valve stenosis (doesn’t open fully in diastole- blood flow restriction) valve regurgitation (or leaky valve, doesn’t close properly in systole- blood backflow through valve)
signs
radio-radio delay - coarctation of the aorta
collapsing pulse- aortic regurgitation
slow rising- aortic stenosis
forward and tilt left- mitral murmur
lean forward, hold breath and listen in aortic area- regurgitation
mitral valve disease
mitral regurg and mitral stenosis
so this can present with :
stenosis:
rergurg:
most common reason is itral proploase, post MI damaging papillary muscle attached to chordea tenaiae
leaky valve when unable to close properly allowing blood to flow back
mid-systolic clic and pansystolic murmur
can delay when squatting down as it increases venous return and click sooner when standing due to decreased venous return
can cause LHF when hypertrophy of left ventricle
stenosis mitral
mid-diastolic urmur -increased sound when left hand side expiration using bell
rheumatic fever
pulmonary odema
narrowing from 4-6cm to 2cm of the valve therefore reduced blood flow
RHF
increased AF risk
swallowing difficulities with compression of atrium onto osephgeagus
aortic regurg and stenosis
regurg
, syncope, orthopnea, CCF
causes - anuseum, infective endocarditis, syphilis
collapsing pulse, listening whilst learning forward
carotid pulsation (quinicke sign)
displaced apex beat
diastolicmurmur increased systolic pressure and decrease diastolic pressure
stenosis sudden death syncope angina ejection systolc murmur thrill, heave, pulse radiate to carotid
