Cardiovascular Assessment Flashcards
External Signs of Cardiovascular Distress
- Cyanosed
- Sweating
- Holding their chest
- Sitting upright with legs dependant
- Appearing ill or time critical
- Obvious distress
- Obvious dyspnoea
- Pale/clammy
ECG Red Flags
- Abnormal T wave inversion
- Ventricular arrythmias
- Sustained atrial fibrillation
- Brugada Syndrome
- Conduction problems eg RBBB, LBBB or degree blocks
- Long/short QT interval, ST or T abnormalities
- Inappropriate persistent bradycardia
- Left/Right ventricular hypertrophy
- Paced rhythm
- Pathological Q waves
- Ventricular pre-excitation
Typically Presenting Cardiac Conditions
- Angina pectoris
- AF
- Congenital heart disease
- Heart attack - MI
- Heart failure - RVF/LVF/CCF (congestive cardiac failure)
- Ischaemic heart disease
- Valvular heart disease
Most Common Cardiac Symptoms
- Chest pain
- Dyspnoea
- Dizziness and syncope
- Nausea
- Oedema
- Palpitations
- Transient LOC
Cardiac Conditions; Un/Stable/Crescendo Angina, Pericardial Pain
Stable Angina - chest tightness/heaviness associated with exercise
Unstable Angina - pain upon rest (ECG can show ST depression, flattened/inversion of T wave)
Crescendo Angina - More frq episodes of chest pain, may progress to an MI
Pericardial Pain - Pericardium being inflamed causing sharp pain either retrosternal or epigastric. Exacerbated by movement/inspiration but relieved by sitting forward (ECG may show saddle shaped ST elevation)
Cardiac Conditons;
-Aortic pain (Type of pain, how can affect BP)
-Orthopnoea (What is it?)
-PND (What is it, what causes it?)
Aortic Pain - sudden severe tearing retrosternal pain which radiates to the back. If branch arteries are affected, can cause unequal BP in arms.
Orthopnoea - breathlessness when lying flat
Paroxysmal Nocturnal Dyspnoea (PND) - waking up breathless during the night, caused by pulmonary oedema accumulating fluid in the lungs
Co-morbidities that Increase Cardiac Risk
- Diabetes
- Hypertension
- Dyslipidaemia
- Chronic kidney disease
- Influenza
- Rheumatoid Arthritis
- Serious MH problems
- Periodontitis
Common Cardiac Operations (6)
- Coronary artery bypass grafting (CABG)
- Heart transplant
- Pacemaker or implantable cardioverter defibrillator (ICD)
- Percutaneous coronary intervention (stent)
- Percutaneous transluminal; coronary angioplasty (PTCA) (balloon dilation)
- Valve replacement
Cardiac Medications (9)
- ACE inhibitors
- Angiotensin II receptor antagonists
- Anti-coagulants
- Beta blockers
- Ca channel blockers
- Cardiac glycosides
- K channel blockers
- Statins
- GTN spray
Appearance
of Unwell pt with Cardiovasuclar problem
- Looking ill
- Pale, clammy, cold (signs of cardiovascular compromise)
- Check patients colour (cyanosed/flushed)
- Oedema
Hands; 5 things looking for
- Are they well perfused? (cold, clammy, cyanosed)
- Splinter haemorrhage under pt’s nail beds
- Finger clubbing? (associated w/ endocarditis atrial myxoma, cyanotic, congenital heart disease)
- Any Janeway lesions? (red macules)
- Do they have Osler’s nodes (tender lumps in the pulp of the finger tips)
Pulses (Types of irregular pulse and what causes them) (4)
- Small volume pulse? (shock, aortic stenosis, pericardia effusion)
- Jerky pulse (hypertrophic obstructive cardiomyopathy, HOCM)
- Pulses paradoxus - when the pt inspires (systolic falls <10mmHg) may be due to pericardial constriction or cardiac tamponade
- Collapsing pulse (pulse w/ forcible impulse but immediate collapse) characteristic of aortic regurgitation, can be felt radially
Blood Pressure Abnormalities Examples (4)
- BP may be raised or lowered depending on cardiac issues
- A narrow pulse pressure (aortic stenosis)
- Wide pulse pressure (aortic regurgitation)
- Fall in systolic pressure <10mmHg on inspiration indicates pulses paradoxus and may be due to pericardial constriction or cardiac tamponade
- Postural hypotension eg drop of 10+ systolic drop to 90mmHg diastolic
Precordium Inspection (What are you looking for?)
- ICD or pacemaker
- Deformity
- Pulsations
- Scars
In JVP, What does;
- Decrease mean?
- Increase mean?
- Inspiratory filling of neck vains
- Decrease in JVP pressure can mean hypovolaemia from GI bleeding or dehydration
- Inspiratory filling of neck veins. (Kussmauls signs) can mean constrictive pericarditis
- Raised JVP indicates RHF obstructive shock eg tension pneumothorax
