Cardiovascular Flashcards
Three things about general appearance?
Unwell? Breathless/cyanosed? Distressed?
SUMMARISE what you are looking for in the hands?
Tobacco staining, peripheral cyanosis, feel temperature, clubbing, splinter haemorrhages, Janeway lesions, Osler’s nodes, xanthomata, petechiae.
Cardiovascular causes of clubbing?
CEAAI = cyanotic congenital heart, endocarditis, atrial myoxma, aneurysms, infected grafts.
Causes of splinter haemorrhages
Infective endocarditis or some vasculitic disorders
Where are Janeway lesions?
Palms
What are Janeway lesions?
Painless red spots which blanch on pressure - primarily on thenar/hypothenar eminences.
Causes of Janeway lesions?
Infective endocarditis
What are Osler’s nodes?
Painful raised erthymatous lesions
Causes of Osler’s nodes?
Infective endocarditis
Causes of xanthomata?
Lipid deposition
Nice phrase to use in OSCE R.E. hands??
There was no peripheral stigmata of infective endocarditis.
SUMMARISE What are you looking for in face and eyes?
Central cyanosis, angular stomatitis, xanthelasmata, corneal arcus, petechial haemorrhage, fundoscopy.
Where would you look for central cyanosis?
Mouth
Causes of central cyanosis?
Heart failure, congenital heart disease
Cause of angular stomatits?
Anaemia
Where is xanthelasmata? What is the cause?
Eyelids - hyperlipidaemia (soft yellowish plaques)
Where is corneal arcus? What is the cause?
The iris - Hyperlipidaemia
Where would you look for petechial haemorrhage?
Conjunctivae
What are you looking for in the pulse?
Rate, rhythm, volume and character
How would you record individual pulses?
Normal, reduced, absent or aneurysmal
Which pulses would you primarily take in a CV exam?
Radial and carotid
How do you detect collapsing pulse?
Check patient has no shoulder pain, feel pulse with base of fingers, raise patient’s arm vertically about head
What is a collapsing pulse a sign of?
Aortic incompetence
What else would you do with a radial pulse?
Check for radial-radial delay, or any other discrepancy between the two
Where is the carotid pulse?
Between the larynx and the anterior border of sternocleidomastoid
What else would you do with a carotid pulse?
Listen for bruits over both carotid arteries - use diaphragm during held inspiration.
What would you do before you take BP?
Palpate the systolic BP first
What would a difference in BP in each arm >10mmHg suggest?
Aortic or subclavian artery disease
Where is the JVP visible?
Between the sternal and clavicular heads of sternocleidomastoid
What does JVP reflect?
Right atrial pressure, so it is a sign of right ventricular function
When would JVP be elevated?
In states of fluid overload - i.e. heart failure and conditions with right heart dilatation (PE, COPD)
Where is the sternal angle in relation to the right atrium? What does this mean for JVP?
5cm above - JVP in health should be <4cm above this angle when the patient lies at 45 degrees.
If RA pressure is low/high, how would the patient have to lie?
Low - lie flat
High - sit upright
Where would you see the JVP pulsation?
Suprasternal notch or behind sternocleidomastoid
Which test would you use to confirm JVP?
Abdomino-jugular test or occlusion (press firmly in right upper quadrant)
How is JVP measured?
In cm between upper limit of venous pulsation and sternal angle
Explain waveform of JVP?
Double waveform - ‘a’ wave corresponds to atrial contraction, occurs just before first heart sounds (absent in AF). ‘v’ wave caused by atrial filling during ventricular systole when tricuspid valve closed.
What is pectus excavatum?
Funnel chest - posterior displacement of lower sternum
Pectus carinatum?
Pigeon chest - may displace heart and affect palpation and asculatation.
What would a midline sternotomy scar indicate?
Previous coronary artery bypass surgery or aortic valve replacement
What would a left submammary scar indicate?
A mitral valvotomy
What would infraclavicular scars indicate?
Pacemaker or defibrilator implantation.
Where is the apex beat?
Fifth left intercostal space, midclavicular line
What is a thrill?
A palpable murmur
What is a heave?
A palpable impulse that noticably lifts the hand. Ask patient to hold breath in expiration.
4 areas for ascultation?
Apex, lower left sternal border, upper right and left sternal borders (DIAPHRAGM)
Where would you listen with the bell?
Apex and lower left sternal border
What are you listening for in the carotid arteries?
Ejection systolic murmur of aortic stenosis
What are you listening for in the axilla?
Pansystolic murmur of mitral regurgitation
What should you identify at each ascultation site?
S1 and S2 heart sounds - assess character and intensity. Added sounds and murmurs.
How would you listen for mitral stenosis?
Roll patient onto left side -listen at apex using light pressure with bell (mid-diastolic and presystolic murmur of mitral stenosis).
How would you listen for aortic regurgitation?
Ask patient to sit up and lean forwards, then breathe out fully and hold breath. Listen over right 2nd intercostal space and over left sternal edge with diaphragm.
End pieces?
Check for ankle and sacral oedema, check peripheral pulses.
