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Clinical Examinations > Cardiovascular System 2 > Flashcards

Cardiovascular System 2 Flashcards

1
Q

What questions should be asked when a patient presents with palpitations?

A
  1. how often?
  2. how long does it last?
  3. what are the precipitating/relieving factors?
  4. is it regular or irregular? (ask patient to tap it out)
  5. are there any associated cardiovascular symptoms?
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2
Q

What associated cardiovascular symptoms may be present in a patient with palpitations?

A
  1. sweating
  2. shortness of breath
  3. chest pain
  4. syncope/pre-syncope
  5. oedema
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3
Q

What is meant by syncope?

A

temporary loss of consciousness related to insufficient blood flow to the brain

it often occurs due to hypotension meaning that not enough blood is pumped to the brain

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4
Q

What are typical causative factors for palpitations that the patient should be asked about?

A
  1. caffeine and alcohol intake
  2. smoking habits
  3. use of illicit substances
  4. history of anxiety and panic attacks
  5. regular medication
  6. family history of cardiac disease
  7. is the palpitation triggered by exercise?
  8. pregnancy
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5
Q

What are the 5 categories of causes of palpitations?

A
  1. cardiac arrhythmias
  2. structural heart disease
  3. psychiatric
  4. systemic conditions
  5. drugs
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6
Q

What conditions may cause cardiac arrhythmias, leading to palpitations?

A
  1. ectopics
  2. atrial fibrillation
  3. atrial flutter
  4. heart-block
  5. Wolff-Parkinson-White syndrome
  6. supraventricular tachycardia
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7
Q

What types of structural heart disease can cause palpitations?

A
  1. congenital heart diseases
  2. cardiomyopathy
  3. mitral valve prolapse
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8
Q

What psychiatric conditions may cause palpitations?

A
  1. anxiety
  2. panic attacks
  3. depression
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9
Q

What types of drugs may cause palpitations?

A
  1. alcohol
  2. caffeine
  3. nicotine
  4. cocaine
  5. vasodilators
  6. beta blocker withdrawal
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10
Q

What types of systemic conditions may cause palpitations?

A
  1. anaemia
  2. pregnancy
  3. hypovolaemia
  4. hyperthyroidism
  5. phaeochromocytoma
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11
Q

What is phaeochromocytoma?

A

a rare tumour of the adrenal glands that releases adrenaline and noradrenaline

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12
Q

complete the table for expected findings in atrial fibrillation

A

if oedema is present in AF, this is a more worrying sign

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13
Q

complete the table for the expected findings in anxiety

A
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14
Q

complete the table for expected findings in hyperthyroidism

A
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15
Q

What are the 4 locations in which the stethoscope is placed during a cardiovascular examination?

A

aortic valve:

2nd - 3rd right interspace

pulmonary valve:

2nd - 3rd left interspace

mitral valve:

apex - 5th intercostal space

tricuspid valve:

left sternal border

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16
Q

What 5 factors should be listened to when investigating a cardiac murmur?

A
  1. timing (is it systolic or diastolic)
  2. site heard the loudest
  3. radiation of murmur
  4. volume of murmur
  5. associated features
17
Q

Going through timing, site, radiation, volume and associated features, what would be expected in aortic stenosis?

A

timing with carotid pulse:

  • systole
  • ejection systolic

site:

  • aortic valve
  • patient is reclined at 45 degrees

radiation:

  • to carotids

volume:

  • loud with diaphragm of stethoscope

associated features:

  • slow rising pulse
  • heaving apex
18
Q

In terms of timing, site, radiation, volume and associated features, what would be expected in mitral regurgitation?

A

timing with carotid pulse:

  • systole - pan-systolic

site:

  • mitral valve
  • patient is reclined at 45 degrees

radiation:

  • to axilla

volume:

  • loud with diaphragm of stethoscope

associated features:

  • thrusting apex
19
Q

In terms of timing, site, radiation, volume and associated features, what would be expected in mitral stenosis?

A

timing with carotid pulse:

  • diastolic - mid-diastole

site:

  • mitral valve
  • patient is lying in left lateral position

no radiation

volume:

  • soft rumbling sound heard with bell of stethoscope

associated features:

  • malar flush
  • tapping apex
20
Q

In terms of timing, site, radiation, volume and associated features, what would be expected in aortic regurgitation?

A

timing with carotid pulse:

  • diastole - early diastolic

site:

  • tricuspid valve
  • patient is sat forward in held expiration

no radiation

volume:

  • soft blowing sound heard with bell of stethoscope

associated features:

  • collapsing pulse
  • thrusting apex
21
Q

What is meant by aortic stenosis?

A

a narrowing of the aortic valve opening

this restricts blood flow from the left ventricle to the aorta

22
Q

What is mitral regurgitation?

A

leakage of blood backward through the mitral valve each time the left ventricle contracts

this allows blood to flow in 2 directions during contraction

23
Q

What is mitral stenosis?

A

narrowing of the mitral valve that blocks blood flow from the left atrium to the left ventricle

24
Q

What is aortic regurgitation?

A

the diastolic flow of blood from the aorta into the left ventricle

25
Q

What is malar flush and why does it occur?

A

plum-red discolouration of the high cheeks

classically associated with mitral stenosis due to the resulting CO2 retention and its vasodilatory effects

26
Q

What simple investigations should be carried out in a patient with cardiac murmurs?

A
  1. blood tests - U&Es, FBC and thyroid function test (TFT)
  2. urine hCG for pregnancy
  3. ECG
27
Q

What further/outpatient tests should be carried out on someone with cardiac murmurs?

A
  1. ambulatory monitoring with a 24 or 72 hour tape and reveal device
  2. echocardiogram
  3. stress testing
28
Q

What is shown in this ECG?

A

the hump rather than straight line on the QRS complex is the delta wave

this is present in Wolff-Parkinson-White syndrome

29
Q

What causes WPW syndrome?

What are typical symptoms?

A

it is congenital and caused by abnormal conductive cardiac tissue between the atria and ventricles - accessory pathway

some patients are asymptomatic but some have palpitations, dizziness, syncope, chest pain and sweating

30
Q

What age group are usually affected by WPW syndrome?

A

it is normally diagnosed at 20-40 years of age as this is when symptoms start to occur

31
Q
A

Clinical Examinations (12 decks)

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