Cardiovascular Flashcards
What to look for on inspection of the hands?
General - Colour, tar staining, xanthomata, arachnodactyly, clubbing
Endocarditis - splinter haemorrhages, Janeway lesions, Osler’s nodes
Pallor/cyanosis of the hands indicates what medical condition/aetiology?
Congestive heart failure, peripheral vascular disease, Raynaud’s etc
Xanthomata indicates what?
Hyperlipidaemia
Typical locations for xanthomata?
Palms, wrist/elbow tendons
What is arachnodactyly and what does it indicate?
Fingers/toes are abnormally long + slender relative to palm of hand/arch of foot.
Indicates Marfan’s syndrome
Cardiovascular associations with Marfan’s?
Aortic/mitral prolapse + aortic dissection
Name of window seen in individual’s without clubbing?
Schamroth’s window
3 cardiovascular causes of clubbing?
Congenital cyanotic heart disease, endocarditis, atrial myxoma (rare)
What are Janeway lesions + Osler’s nodes + location + differences?
Janeway Lesions - haemorrhagic non-tender lesions on thenar/hypothenar eminences of palms/soles - septic emboli (embolic-related)
Osler’s nodes - red-purple, slightly raised, tender lumps with pale centre on fingers/toes - deposition of immune complexes (immune-related)
3 causes of radio-radial delay?
Subclavian artery stenosis (e.g. cervical rib compression)
Aortic dissection
Aortic coarctation
3 causative areas of a collapsing pulse?
Normal physiological stress states e.g. fever, pregnancy
Cardiac lesions e.g. aortic regurgitation, PDA
High output states e.g. anaemia, AV fistula, thyrotoxicosis etc
Types of pulse character + associated pathology?
Normal
Slow-rising - aortic stenosis
Bounding - aortic regurg, CO2 retention
Thready - intravascular hypovolaemia (sepsis)
Causes of narrow pulse pressure?
Aortic stenosis, congestive heart failure, cardiac tamponade
Causes of wide pulse pressure?
Aortic regurgitation, aortic dissection
Causes of raised JVP?
Venous hypertension(!)
- right-sided heart failure (due to pulmonary hypertension from COPD/ILD, or due to left-sided heart failure)
- tricuspid regurgitation (infective endocarditis, rheumatic heart disease)
- constrictive pericarditis (rheumatoid arthritis, TB)
4 conditions associated with positive hepatojugular reflex?
Constrictive pericarditis
R ventricular failure
L ventricular failure
Restrictive cardiomyopathy
4 things to look for in eyes?
Conjunctival pallor (anaemia)
Corneal arcus (hypercholesterolaemia)
Xanthelasma (hypercholesterolaemia)
Kayser-Fleischer rings (Wilson’s)
4 things to look for in mouth?
Central cyanosis (hypoxaemia e.g. L>R shunt)
High arched palate (Marfan’s)
Angular stomatitis (lots but anaemia)
Dental hygiene (poor = infective endocarditis)
4 thoracic scars to look for?
Median sternotomy
Anterolateral thoracotomy
Infraclavicular
Left mid-axillary
Locations +indication of the 4 thoracic scars?
Median sternotomy
Anterolateral thoracotomy
Infraclavicular
Left mid-axillary
Median sternotomy - midline of thorax, valve replacement or coronary artery bypass grafts
Anterolateral thoracotomy - lateral border of sternum or mid-axillary line 4th/5th intercostal space, minimally invasive valve surgery
Infraclavicular - infraclavicular region either side, pacemaker insertion
Left mid-axillary - left mix-axillary line, subcut implantable cardioverter-defibrillator (ICD)
Apex beat displacement and heaves due to what, respectively?
Apex displacement = ventricular hypertrophy
Heave = typically Right ventricular hypertrophy
4 valve locations?
Mitral - 5th ICS, midclavic
Tricuspid - 4th/5th ICS, LLSE
Pulmonary - 2nd ICS, LSE
Aortic - 2nd ICS, RSE
Aortic stenosis murmur?
Ejection systolic, may radiate to carotids
Aortic regurgitation murmur?
Early diastolic murmur, loudest pt sitting forward + breath out
Mitral regurgitation murmur?
Pansystolic murmur, loudest pt on left + breath out + diaphragm (high freq)
Mitral stenosis murmur?
Mid-diastolic murmur, loudest pt on left + breath out + bell (low freq)
Further tests and investigations to perform post-examination + why?
BP
Vascular exam (peripheral)
12-lead ECG
Urine dip
Bedside cap glucose
Fundoscopy
BP - hypo/hypertension, BP discrepancies
Vascular exam (peripheral) - peripheral vascular disease
12-lead ECG - myocardial ischaemia, arrhythmias
Urine dip - proteinuria/haematuria due to hypertension
Bedside cap glucose - underlying T1/T2DM (CVD risk factor)
Fundoscopy - malignant hypertension (papilloedema)
