Cardiovascular System 2 Flashcards
What questions should be asked when a patient presents with palpitations?
- how often?
- how long does it last?
- what are the precipitating/relieving factors?
- is it regular or irregular? (ask patient to tap it out)
- are there any associated cardiovascular symptoms?
What associated cardiovascular symptoms may be present in a patient with palpitations?
- sweating
- shortness of breath
- chest pain
- syncope/pre-syncope
- oedema
What is meant by syncope?
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
What are typical causative factors for palpitations that the patient should be asked about?
- caffeine and alcohol intake
- smoking habits
- use of illicit substances
- history of anxiety and panic attacks
- regular medication
- family history of cardiac disease
- is the palpitation triggered by exercise?
- pregnancy
What are the 5 categories of causes of palpitations?
- cardiac arrhythmias
- structural heart disease
- psychiatric
- systemic conditions
- drugs
What conditions may cause cardiac arrhythmias, leading to palpitations?
- ectopics
- atrial fibrillation
- atrial flutter
- heart-block
- Wolff-Parkinson-White syndrome
- supraventricular tachycardia
What types of structural heart disease can cause palpitations?
- congenital heart diseases
- cardiomyopathy
- mitral valve prolapse
What psychiatric conditions may cause palpitations?
- anxiety
- panic attacks
- depression
What types of drugs may cause palpitations?
- alcohol
- caffeine
- nicotine
- cocaine
- vasodilators
- beta blocker withdrawal
What types of systemic conditions may cause palpitations?
- anaemia
- pregnancy
- hypovolaemia
- hyperthyroidism
- phaeochromocytoma
What is phaeochromocytoma?
a rare tumour of the adrenal glands that releases adrenaline and noradrenaline
complete the table for expected findings in atrial fibrillation
if oedema is present in AF, this is a more worrying sign
complete the table for the expected findings in anxiety
complete the table for expected findings in hyperthyroidism
What are the 4 locations in which the stethoscope is placed during a cardiovascular examination?
aortic valve:
2nd - 3rd right interspace
pulmonary valve:
2nd - 3rd left interspace
mitral valve:
apex - 5th intercostal space
tricuspid valve:
left sternal border
What 5 factors should be listened to when investigating a cardiac murmur?
- timing (is it systolic or diastolic)
- site heard the loudest
- radiation of murmur
- volume of murmur
- associated features
Going through timing, site, radiation, volume and associated features, what would be expected in aortic stenosis?
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
In terms of timing, site, radiation, volume and associated features, what would be expected in mitral regurgitation?
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
In terms of timing, site, radiation, volume and associated features, what would be expected in mitral stenosis?
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
In terms of timing, site, radiation, volume and associated features, what would be expected in aortic regurgitation?
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
What is meant by aortic stenosis?
a narrowing of the aortic valve opening
this restricts blood flow from the left ventricle to the aorta
What is mitral regurgitation?
leakage of blood backward through the mitral valve each time the left ventricle contracts
this allows blood to flow in 2 directions during contraction
What is mitral stenosis?
narrowing of the mitral valve that blocks blood flow from the left atrium to the left ventricle
What is aortic regurgitation?
the diastolic flow of blood from the aorta into the left ventricle
What is malar flush and why does it occur?
plum-red discolouration of the high cheeks
classically associated with mitral stenosis due to the resulting CO2 retention and its vasodilatory effects
What simple investigations should be carried out in a patient with cardiac murmurs?
- blood tests - U&Es, FBC and thyroid function test (TFT)
- urine hCG for pregnancy
- ECG
What further/outpatient tests should be carried out on someone with cardiac murmurs?
- ambulatory monitoring with a 24 or 72 hour tape and reveal device
- echocardiogram
- stress testing
What is shown in this ECG?
the hump rather than straight line on the QRS complex is the delta wave
this is present in Wolff-Parkinson-White syndrome
What causes WPW syndrome?
What are typical symptoms?
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
What age group are usually affected by WPW syndrome?
it is normally diagnosed at 20-40 years of age as this is when symptoms start to occur
