Cardiovascular Flashcards
What angle for the bed and what exposure?
45 degrees and exposed from the waist up. Also exposure of lower legs for CABG harvest, peripheral oedema and peripheral vascular disease signs. Ask the patient if they are in any pain
What signs are you looking for on general inspection?
- Cyanosis due to poor circ (peripheral vasoconstriction 2nd to hypovolaemia) or inadequate oxygenation (right to left cardiac shunting)
- SOB (Cardio = congestive heart failure) (resp = pneumonia, PE)
- Pallor from anaemia (haemorrhage, chronic) or poor perfusion (congestive cardiac failure)
- Malar flush (mitral stenosis)
- Oedema = pedal or ascites. Congestive heart failure main cause for cardio
What objects and equipment should you look for?
Medical = ECG, GTN spray, catheters Mobility = zimmer frame Pillows = (congestive heart failure = orthopnoea) Vital signs and Fluid balance Prescriptions
What do you inspect for on the hands?
- Pallor for PPP (CHF) and cyanosis (hypoxaemia)
- Tar staining (coronary artery disease and hypertension)
- Xanothomata (coronary artery disease 2nd to hypercholesteraemia)
- Arachnodactyly (Marfans therefore mitral/aortic valve prolapse and aortic dissection)
- Finger clubbing
- Endocarditic features
What are the cardio causes of finger clubbing?
Congenital cyanotic heart disease, infective endocarditis and atrial myxoma
Infective endocarditis signs?
Janeway lesions, splinter haemorrhages, Oslers nodes, clubbing
What do you palpate for in the hands?
- Temperature (Cool = PPP = CHF or ACS)
Cool + clammy = ACS - Cap refill time (>2 seconds = CHF)
What do you assess for in radial HR?
Rate and rhythm.
Common causes of bradycardia?
Healthy athletes, atrioventricular block, medications
Common causes of tachycardia?
Anxiety, supraventricular tachycardia, hypovolaemia and hyperthyroidism
Causes of irregular rhythm?
Atrial fibrillation
What are the causes of radio-radio delay?
- Subclavian artery stenosis (compression by cervical rib)
- Aortic dissection
- Aortic coarction
How to assess collapsing pulse?
Ask patient if any pain in the right shoulder. Palpate radial pulse with right hand and brachial pulse with left hand. Raise arm above their head briskly. Should feel tapping impulse through muscle bulk of the arm due to the sudden retraction of blood during diastole
Causes of collapsing ulse?
Normal = fever, pregnancy
Cardiac lesions = aortic regurgiation, patent ductus arteriosus
high output states = anaemia, arteriovenous fistula and thryotoxicosis
What are you looking for in brachial pulse?
Pulse volume and character
What are the types of pulse character?
Normal, slow rising (aortic stenosis), bounding (aortic regurgitation), thready (intravascular hypovolaemia in sepsis)
What are the types of BP abnormalities?
- Hypertension + hypotension
- Narrow pulse pressure (<25mmHg. CHG, aortic stenosis, cardiac tamponade)
- Wide pulse pressure (>100mmHg. aortic regurgiation and aortic dissection)
Difference between arms = >20mmHg . may be aortic dissection
What are we auscultating/palpating for on carotid pulse?
Bruit (indicates aortic stenosis. if present, palpation could dislodge carotid plaque = ischaemic stroke)
Assess the character and volume
What are the causes of raised JVP?
Venous hypertension from 1) right sided heart failure (2nd to left or pulmonary hypertension (from COPD)). 2) Tricuspid regurgitation (infective endocarditis/rheumatic heart disease) 3) constrictive pericarditis (idiopathic/rheumatoid arthritis/TB)
What conditions are associated with positive hepatojugular reflex?
constrictive pericarditis
Right and left ventricular failre
Restrictive cardiomyopathy
What are you looking for in the eyes?
- Conjunctival Pallor (anaemia)
- Corneal Arcus
- Xanthelasma
Kayser-Fleischer Rings (Wilsons therefore copper deposition = cardiomyopathy)
What are you looking for in the mouth?
Central cyanosis - (hypoxaemia from righ to left cardiac shunt)
Angular Stomatitis - anaemia
High arched palate - Marfans (aortic/mitral valve prolapse and aortic dissection)
Dental Hygiene - Infective endocarditis
What chest features are we inspecting for?
Scars, pectus excavatum and cariatum. Visible pulsations from ventricular hypertrophy
What scars and why?
Median Sternotomy = Cardiac valve replacement and CABG
Anterolateral thoracotomy = (Between lateral sternum border + MAL in 4th/5th ICS) for minimally invasive valve replacement surgery
Infraclavicular = pacemake insertion
Left Mid-axillary scar = Subcut implantable cardioverter-defibrillator
