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CPA Surface Markings + Qs > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Heart valves names and surface markings

A

Aortic - right sternal border at 2nd ICS
Pulmonary - left sternal border at 2nd ICS
Tricuspid - left sternal border 4th ICS
Mitral - left MCL 5th ICS - APEX BEAT

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2
Q

Inspection

A

Scars, redness, bruising, swellings, chest wall deformities, SOB, cyanosis

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3
Q

What are the heart sounds and what do they signify?

A

S1 “lub” - AV valves closing
S2 “dub” - aortic + pulmonary valves closing

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4
Q

Causes of abnormal apex beat

A

Dextrocardia
Obesity
Pericardial effusion/TPT –> mediastinal shift
Emphysema (COPD)
Student incompetence/skeletal (pectus excavatum)

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5
Q

Causes of non-palpable apex beat

A

COPD (emphysema)
Obesity
Pericardial effusion
Dextrocardia
Shock

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6
Q

What type of murmur occurs in aortic stenosis? How is it accentuated?

A

ejection systolic
auscultate carotids

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7
Q

What type of murmur occurs in aortic regurgitation? How is it accentuated?

A

early diastolic
ask to lean forward

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8
Q

What type of murmur occurs in mitral stenosis? How is it accentuated?

A

mid-diastolic
left lateral decubitus

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9
Q

What type of murmur occurs in mitral regurgitation? How is it accentuated?

A

pansystolic
left lateral decubitus then move round to axilla

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10
Q

Lead placement in 12 lead ECG

A

Limb leads - R, Y, G, B

Chest leads
V1 - 4th ICS RSB
V2 - 4th ICS LSB
V3 - between V2 and V4
V4 - 5th ICS MCL
V5 - 5th ICS AAL
V6 - 5th ICS MAL

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11
Q

View and blood supply of lead I, aVL, V5, V6

A

lateral and left circumflex artery

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12
Q

View and blood supply of lead II, lead III, aVF

A

Inferior and right coronary artery

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13
Q

View and blood supply of V1, V2, V3, V4

A

V1/V2 - septal
V3/V4 - anterior

left anterior descending artery

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14
Q

Where can a central line be put?

A

IJV - between two SCM heads
Subclavian vein
Common femoral vein

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15
Q

Which arteries would you palpate to measure rate, rhythm, character and volume?

A

Pulse rate - right radial pulse (in bpm)
Rhythm - right radial pulse (reg/irreg)
Character and volume - RCC pulse

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16
Q

What is the apex beat and where is it palpated?

A

The most lateral and inferior point where a beat can be felt with each systole

5th ICS OR in children 5th rib
Always at MCL

17
Q

What is a heave? Where can it be palpated?

A

LV hypertrophy can produce a forceful beat

Palpated by placing hand vertically parasternally

18
Q

What is a thrill? Where can it be palpated?

A

Palpable heart murmurs due to volume overload in mitral/aortic regurgitation
–> hyperkinetic and sustained

Can be palpated at valve locations

19
Q

Where does the common carotid artery divide?

A

The upper border of the thyroid cartilage into internal and external arteries

20
Q

Common site used for phlebotomy?

A

Antebrachial (median cubital) vein in cubital fossa

21
Q

Common site used for phlebotomy?

A

Antebrachial (median cubital) vein in cubital fossa

22
Q

What is pericardiocentesis? When is it done? What are two locations?

A

Drainage of fluid from pericardium

In cardiac tamponade

Two points of needle entry:
- left 5th ICS near sternal border (needle perpendicular to chest wall)

  • left sub-xiphesternal (needle facing leftf shoulder and going in posteriorly and superiorly)
23
Q

Outline the symptoms of acute coronary syndrome (aka unstable angina MI)

A

Sudden onset chest pain
Central crushing chest pain
Radiate to arms or neck
Previous Hx of angina, MI

CV risk factors- diabetes, smoking, FH, anaemia, arrhythmias, hyperlipidaemia, obesity

24
Q

Outline the symptoms of aortic dissection

A

Tearing pain

Radiates to back between scapulae

25
Q

Outline the symptoms/signs of pneumothorax

A

Low O2 sats

Hyper inflated chest wall

Absent breath sounds

Tracheal deviation

Hyper resonant percussion

Shortness of breath

26
Q

Outline the symptoms of a pulmonary embolism

A

Diagnosis of exclusion

Deep vein thrombosis (recent travel, pregnancy)

Shortness of breath

Hemoptysis

27
Q

Outline the symptoms of Boerhaave’s perforation

A

Pain after vomiting

CXR- thin line around mediastinum- air

28
Q

What are the symptoms of aortic stenosis?

A

Ejection systolic murmur (radiates to carotids)

Exertional shortness of breath

Dizziness (syncope)

Tight chest and wheeze

Triad: CHEST PAIN; SOB; DIZZINESS/PRESYNCOPE/SYNCOPE

29
Q

What are the symptoms of atrial fibrillation?

A

Associated with aortic stenosis

Irregularly irregular pulse

30
Q

What are the symptoms of decompensated heart failure?

A

Struggling to breathe

Cardiomegaly

Displaced apex beat with LVH

Pitting oedema

EXERTIONAL ANGINA; SOB (BIBASAL CREPITATIONS) ; PITTING OEDEMA

31
Q

What are the main symptoms of congestive HF?

A

Chest pain
Breathlessness

32
Q

What does an echocardiogram show in aortic stenosis?

A

Immobile aortic valve leaflets

Reduced opening of the valve resulting in increased pressure and turbulent flow

Resulting in ejection systolic murmur radiating to carotids

Associated with slow rising pulse and narrow pulse pressure (low SBP)

33
Q

How does aortic stenosis lead to chest pain?

A

LV has to work harder to eject sufficient blood

LVH so LV has increase oxygen demand

In AS, coronary artery disease is a common comorbidity, occluded coronary arteries

Temporary ischaemia of the cardiac muscle of LV

During diastole, aortic valve closes, coronary arteries perfused but in AS, valve compromised so blood can go back to LV instead of coronary arteries—→ ischaemia of myocardium

Reduced coronary artery perfusion due to faulty aortic valve

34
Q

What is the gold standard imaging to test for suspected valve disease?

A

Echocardiogram
–> allows evaluation of flow and pressure across the valve and assessment of overall cardiac function

  • Other useful - CXR, ECG
35
Q

What is transcatheter aortic valve implantation (TAVI)?

A

Replacement of diseased aortic valve

Catheter inserted into femoral or subclavian artery

New valve sits on top of diseased valve

CT scan for pre-TAVI work up

36
Q

What is the parameter for cardiomegaly in CXR?

A

Transverse diameter of heart should not exceed 50% of that of thorax

CPA Surface Markings + Qs (7 decks)

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