Cardiovascular Week 2 Flashcards
6 cardinal symptoms for cardiovascular cases
dyspnea chest pain syncope palpitation ankle swelling
common causes of chest pain
ACS angina PE pericarditis aortic syndromes LRTI dyspepsia GB/pancreatic causes MSK/traumatic
what sputum does PE produce
pink frothy
questions to ask regarding SOB
exacerbation/relief?
when?
orthopnea?
PND?
palpitation details
rhythm, rate duration precipitating factors relieving factors associated symptoms pmh/dh/fmhx
how to grade ankle edema?
report how high up pitting edema goes, up to knee or thigh etc
risk factors for CVS diseases
rheumatic fever hypertension diabetes high cholesterol thyroid disease kidney disease
what phenomenon can be seen with occupations with excessive vibrations
raynauds phenomenons
what to do if apex beat cannot be felt?
feel more laterally or roll over to left
how to accentuate mitral murmur on examination?
roll over to left, listen at apex beat and exhale and hold
how to accentuate tricuspid murmurs
sit forward and auscultate lower left sternal edge, exhale
paper speed and mV calibration in ECG
25mm/s 10mm/mV
what plane view do limb leads give
coronal, round view
what plane view do chest leads give
transverse, horizontal plane
sequence to check ECG
patient demographic technical settings rate (atrial & vent) rhythm axis (left or right or normal) P wave - PR interval QRS - narrow or broad T wave and ST segment changes QT/QTc
duration of tiniest square
0.04s
how many big squares for 1 min
300
how to calculate heart rate from ECG
look at 10s strip
OR
count big squares between R waves and divide 300 by
criteria for sinus rhythm
regular rhythm P waves present P waves followed by QRS 60-100 BPM PR interval regular and constant
which leads will show a left deviation?
I will be positive, II will be negative, also avL will be more positive
how to see normal axis
lead I and II are positive
what is the angle of normal axis
-30 to +90deg
indications of right deviation
limb lead II positive, I is negative.
how long should P wave be
less than 0.11s
how high should P waves be
<2.5mm in limb lead
<1.5mm in chest lead
what might cause a heightened P wave
enlarged atrium
what does a missing P wave indicate
loss of SA nodal firing
how long should PR interval be
between 0.12 and 0.2s
what does a lengthened PR interval imply
heart block at AV node, slowing conduction from atria to ventricles
how long should a QRS interval be
<0.12s
which leads usually don’t show a QRS wave
V1-V3
what does T wave represent
repolarisation of ventricles
what can be seen in hyperkalaemia
tall T waves
what does a prolonged QT segment increase the risk of
arrrhythmias
when does a systolic heart murmur happen?
after heart sound 1
why does S3 happen?
cos blood oscillates in ventricles due to rapid filling and frail/compliant ventricle
why does S4 happen?
when blood is forced into a stiff ventricle
why does a split heart sound occur
because during inspiration, thoracic pressure becomes more negative, causing more blood to be sucked into the pulmonary artery, delaying the closure of the pulmonary valve. hence causing a de-synch with the aortic valve
6 characteristics to describe murmurs
timing location characteristics intensity radiation response to respiration
how does a pansystolic murmur occur
can be due to mitral regurgitation, after S1, as blood is being pushed out of the ventricle, it leaks back into the atrium, causing a long murmur until S2
how can an ejection murmur occur
aortic stenosis can cause an ejection murmur during systole as blood is forced through a narrower opening of the aorta during systole. it stops before S2
how to accentuate a mitral murmur?
listen at mitral area and roll to the left
what pathology is associated with a crescendo-decrescendo murmur
aortic stenosis
what kind of a murmur can be heard over the carotids
aortic stenosis
investigations of heart conditions
ECG
CXR
angiogram
echograph
what endocrine condition can cause palpitations
thyroid
how many small squares is a narrow complex tachycardia
2-3 small squares
what dietary habit is a relevant question in palpitations
caffeine in take
what is a quick way to assess SBP with pulses?
if radial pulse present, SBP at least 90
if radial absent but carotid present, then about 80
what is the definition of PVD?
disorder of the circulatory system that does not involve the brain or heart
4 types of arterial diseases
occlusive arterial disease
arterial ulceration
carotid disease (stenosing)
aneurysms
2 presentations of venous insufficiency
varicose veins
venous ulceration
3 factors that precipitate atherosclerosis
hypertension
high cholesterol
smoking
difference between a thrombus and an embolus
thrombus is blood clot forming on the endothelium
embolus can be any mass in the circulation system
3 stages of chronic arterial disease
intermittent claudication
critical limb ischaemia
acute limb ischaemia
how to differentiate intermittent claudication VS critical limb ischaemia?
intermittent claudication presents as muscular pain on exertion which is relieved by resting
CLI is severe ischaemia that comes on with pain at night and when legs are horizontal. relieved in bed by hanging the legs off the bed at night. can present with tissue loss as ischaemia progresses.
RF of PVD
smoking obesity high cholesterol hypertension diabetes age
what 3 features are part of Leriche’s syndrome
claudication of thighs and buttocks
absent/decreased femoral pulse
male impotence/ED
why do ulcers form in PVD?
reduced blood flow, lack of nutrients, reduced healing. leads to necrosis and inability to heal.
difference between arterial and venous ulcers
Site Edge depth Base/colour gender
Arterial VS venous
pressure points VS gaiter region regular VS jagged punched out vs superficial necrotic, green VS pink and yellowish male VS female
2 types of gangrene that can occur
dry and wet gangrene
difference between dry and wet gangrene
infection VS no infection
6 symptoms of acute limb ischaemia
PPPPPP
pain pallor paraesthesia pulseless paralysis perishingly cold
what can cause acute limb ischaemia?
an embolus suddenly blocking off blood supply
how long is the window the save a limb from acute limb iscahemia?
6 hours, before necrosis starts
what is the presentation of an aortic abdominal aneurysm, before and after rupturing
palpable expansile region in the abdomen
if ruptured
- sudden back pain
- hypovolaemic shock
- LoC
- sudden death
what can a carotid atheroma cause
embolus which cause TIA and stroke
presentation of varicose veins
ache in leg after standing for long
night cramps
venous ulceration
superficial thrombophlebitis
classical features of DVT
calf pain pyrexia persistent tachycardia swelling of leg, along the vein pain when walking or standing warmth over inflamed area
key questions to ask in PVD history
acute/chronic
when does it come on
what makes it feel better (hanging from bed)
pmhx - RF, stroke
Dhx -
SHx - smoking, exercise tolerance, ADLs
RF of PVD
hypertension smoking diabetes cholesterol HD previous DVT
where to auscultate in PBD examination
carotids, abdomen, femoral
what does a bat wing presentation of a CXR suggest?
pulmonary edema
difference between stable angina and acute coronary syndrome
stable anginas are not progressive and happen on exertion.
3 progressively worsening types of acute coronary syndrome
unstable angina
non ST elevation MI
ST elevation MI
characteristics of unstable angina
sudden deterioration, pain coming on even at rest
no cardiac enzyme release
characteristics of NSTEMI
heart attack which causes cardiac enzyme release, without ST elevation on ECG
describe a STEMI
heart attack with ST elevation visible on ECG and cardiac enzyme release
what causes an ACS
sudden occlusion of coronary artery by embolus/thromboembolus, rupturing of atheroma plaque
History points in stable angina
site - across chest, go to arm, sometimes jaw
onset - exertion, cold, postprandial
relieve - GTN
causes of stable angina
obstruction
aortic stenosis
hypertrophic cardiomyopathy
how to investigate a stable angina?
12 lead ECG Echo PET scan MPS coronary angiography
cardiac CT
angiography
how to treat stable CHD
lifestyle alterations antiplatelet therapy, lipid management beta blockers ACEI anti-anginals
PCI/CABG
MoA of aspirin and clopidogrel
aspirin is COX inhibitor which prevents platelet activation
clopidogrel is an ADP receptor inhibitor, stopping platelet cross linkage
causes of heart failure
IHD hypertension arrhythmias valve defects cardiomyopathies
Signs of acute heart failure
SOB + tachypnea tachycardia elevated JVP chest crepitations abnormal ECG
what is to be checked in a blood test of a patient with suspected heart failure, and why
troponin - ?MI FBC - anaemia? LFT - liver congestion? TFT - thyroid function? glucose - diabetic status? U+E - kidney function
treatment of acute heart failure
O2 - BIPAP or ventilation
IV diuretics and nitrates
treat underlying cause
cause of chronic heart failure
damage to heart causing reduced output, activation of neurohormonal systems which cause vasoconstriction, increased heart workload, causing more damage and progressive decline in heart function
symptoms of chronic heart failure
dyspnea orthopnea PND peripheral edema wheeze lethargy, fatigue anorexia
signs of CHF
tachycardia raised JVP HS 3 displaced apex beat crepitations edema, ascites cachexia hepatomegaly
what does a very short PR interval suggest?
accesory conduction path - WPW
Old man come in with syncope ,angina and dyspnea
(Fainted in shopping mall eg.) what is the most likely cause
Aortic stenosis
What pathology is a collapsing pulse associated with
Aortic regurgitation
what can cause a pathological S3
heart failure
during which part of the heart cycle would S3 be present in
diastole, during ventricular filling
describe an aortic stenosis murmur
systolic murmur heard loudest over aortic site, crescendo-decrescendo murmur that radiates into the carotids
describe a mitral regurgitation murmur
pansystolic murmur, heard loudest over mitral area, radiates to axilla
associated signs of aortic stenosis
narrow pulse pressure
slow rising pulse
low BP
ventricle hypertrophy
associated signs of mitral stenosis
malar flush, increased jvp, right ventricular heave
common cause of mitral stenosis
rheumatic fever
associated signs of aortic regurgitation
wide pulse pressure
collapsing pulse
displaced apex beat
volume overload
timing of aortic regurgitation murmur
end diastolic
causes of mitra regurgitation
infective endocarditis
connective tissue disorders
MV degeneration in old age
causes of aortic regurgitation
congenital
infective endocarditis, rheumatic fever, CT disorder
symptoms of mitral stenosis
dyspnea
orthopnea
PND
what does aortic stenosis lead to?
angina due to relative ischaemia
left ventricular hypertrophy
left sided heart failure
symptoms of aortic stenosis
exertional syncope
angina
heart failure symptoms
signs of aortic stenosis
ESM
thrusting apex beat
slow rising pulse
what is the characteristic ECG pattern of atrial flutter?
saw-tooth flutter of around 300 bpm in atria
what are the 2 shockable rhythms?
ventricular fibrilation and pulseless ventricular tachycardia
what are the 2 non-shockable rhythms
pulseless electrical activity and asystole
what sign on examination would suggest the cause of sepsis to be infective endocarditis?
new murmur
what two results can be diagnostic for infective endocarditis?
positive ECHO findings and 3 of 3 +ve blood cultures
