Cardiovascular Flashcards
Marfans syndrome associated with?
Aortic regurgitation
Down’s syndrome associated with
Congenital heart disease
What is turners syndrome ?
Associated with
Female who is partially or totally missing an X chromosome
Coarctation of the aorta
Cardiovascular causes of clubbing
Cyanotic congenital heart disease
Subacute infective endocarditis
Causes of sprinter haemorrhages
Infective endocarditis
Profound anaemia
What are Olsers nodes
Why do you get them?
Painful lumps in fingers / Palms
Fragments of vegetation from an infected valve
Most common cause of irregularly irregular pulse
Atrial fibrillation
When do you get a collapsing pulse
Aortic regurgitation
Patent ductus arteriosus
Radial radial delay
Arterial occlusion
Atherosclerotic plaque, aneurysm
Radial femoral delay suggests ?
Coarctation of the aorta
Why check blood pressure lying and standing
Postural hypotension
Cardiac cause of jaundice
Prophetic heart valve induced haemolysis
Malar flush is?
Cause ?
Rosy cheeks with bluish tinge
Dilation of malar capillaries -
pulmonary hypertension
Low cardiac output - mitral stenosis
High arched palate seen in
Mar fans
Ways to distinguish JVP from arterial
Double impulse
Varies with position and inspiration
Cannot be palpated
Rises if pressure applied to liver
Carotid pulses Slow rising Collapsing Bisferiens (slow rising and collapsing) Small volume Pulses alternates (alternating weakens strong)
Slow rising - aortic stenosis
Collapsing - aortic regurgitation, patent ductus arteriosus
Bisferiens (slow rising and collapsing) - aortic stenosis and incompetence
Small volume - aortic stenosis, pericardial effusion
Pulses alternates (alternating weakens strong) - LV diseased
Cardiac failure -> what heard in lungs
Pan-inspiriatory crackles
Pitting oedema of sacrum occurs when
Severe right heart failure
Unilateral lower limb oedema
DVT or compression of large veins by tumour/ lymph nodes
Causes of raised JVP
HOLT Heart failure Obstruction of vena cava Lymph node enlargement - supraclavicular Thoracic pressure increase
What is cardiac tamponade ?
Becks triad?
Pericardial effusion -> slow / rapid compression of heart 3 Ds Distant heart sounds Distended jugular veins Decreased arterial pressure
Difference between valve replacement scar and cabg
Cabg always midline sternotomy
Valve may be on side
When may apex best be decimated laterally
Mitral / aortic regurgitation (volume overload)
When would you feel parasternal heaves
Rv / severe LA enlargement
Right / left sided murmurs heard loudest when ?
Right - inspiration (venous return increased)
Left - expiration
Causes of pericarditis
CARDIAC RIND Collagen vascular disease Aortic aneurysm Radiation Drugs eg. Hydralazine Infections Acute renal failure Cardiac infarction Rheumatic fever Injury Neoplasms Dressers syndrome
Radial radial delay
Aortic coarctation
Dental caries predispose to?
Infective endocarditis
Pansystolic murmur
Mitral regurgitation
Ejection systolic murmur
Aortic stenosis
Can be heard in carotids
Basic management of MI
BOOMAR bed rest Oxygen Opiate Monitor Anticoagulants Reduce clot
Causes of ST elevation
ELEVATION Electrolytes LBBB Early repolarisation Ventricular hypertrophic Aneurysm Treatment Injury Osbourne waves (hypothermia) Non-occlusive vasospasm
Causes of depressed ST
Dropping valve Enlargement of LV with strain Potassium loss Reciprocal ST Embolism in lungs Subendocardial ischemia Encephalopathy haemorrhage (cranial) Shock Toxicity (digitalis, quinidine)
Causes of T wave inversion
INVERT Ischemia Normal (young, black) Ventricular hyper trophy Ectopic foci RBBB, LBBB Treatments (digoxin)
How do you calculate ABPI
Arterial disease indicated by
Highest systolic in the ankle / highest in arms
ABPI
Haemosidderin deposition looks like?
Indicative of ?
Purplish bruise just below skin
Venous insufficiency
Malar flush indicative of
Mitral stenosis
Splinter haemorrhages
Bacterial endocarditis
2 causes of clubbing
Infective endocarditis
Cyanotic congenital heart disease
Where are janeway lesions found
Palm pulp lesions
Where are Olsers nodes found
Tender red nodules on finger pulps / thenar eminence
What is xanthomata
Raised yellow lesions often in tendons of wrist
Hyperlipidaemia
Radial radial delay suggests
Aortic coarctation
Causes of water hammer pulse
Normal - fever , pregnancy
Cardiac - AR, PDA
High output - anaemia , AV fistula, thryrotoxicosis
Narrow pulse pressure associated with
Aortic stenosis
Wide pulse pressure associated with
Aortic regurgitation
Causes of raised JVP
Fluid overload
Rv failure
Tricuspid regurgitation
Where / when do you get heaves
Left steal edge
Rv hyper trophy
What is a thrill
Palpable murmur over aortic valve and apex beat
Lateral displacement of apex beat indicates
Cardiomegaly
Lung base crackles could mean
LV failure
Sacral / pedal oedema could mean
Rv failure
Finish cv exam
Peripheral vascular examination
12 lead ECG
Dipstick urine (eg proteinuria caused by hypertension)
Capillary blood glucose
Fundoscopy ( malignant hypertension - papilloedema )
Difference in BP across arms
Aortic aneurysm
Hair loss in legs due to
PVD
Discolouration of legs due to
Eg haemosiderin Venous disease (not PVD)
Prolonged cap refil indicates
PVD
Radial femoral delay
Coarctation of aorta
Femoral Bruis indicates
Femoral / iliac stenosis
What angle of positive buergers indicates severe limb ischemia
Less than 20 degrees
What is reactive hyperaemia
When leg first goes pink and then Becomes red
Due to arteriolar dilatation to remove built up metabolic waste
Finish peripheral vascular exam
Cv exam
ABPI
Lower limb neurological examination
Usual cause of endocarditis
Strep viridans
