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3 FoCP > Cardiovascular Week 2 > Flashcards

Cardiovascular Week 2 Flashcards

1
Q

6 cardinal symptoms for cardiovascular cases

A 
dyspnea
chest pain
syncope
palpitation
ankle swelling
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2
Q

common causes of chest pain

A 
ACS
angina
PE
pericarditis
aortic syndromes
LRTI
dyspepsia
GB/pancreatic causes
MSK/traumatic
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3
Q

what sputum does PE produce

A

pink frothy

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4
Q

questions to ask regarding SOB

A

exacerbation/relief?
when?
orthopnea?
PND?

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5
Q

palpitation details

A 
rhythm, rate
duration
precipitating factors
relieving factors
associated symptoms
pmh/dh/fmhx
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6
Q

how to grade ankle edema?

A

report how high up pitting edema goes, up to knee or thigh etc

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7
Q

risk factors for CVS diseases

A 
rheumatic fever
hypertension
diabetes
high cholesterol
thyroid disease
kidney disease
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8
Q

what phenomenon can be seen with occupations with excessive vibrations

A

raynauds phenomenons

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9
Q

what to do if apex beat cannot be felt?

A

feel more laterally or roll over to left

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10
Q

how to accentuate mitral murmur on examination?

A

roll over to left, listen at apex beat and exhale and hold

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11
Q

how to accentuate tricuspid murmurs

A

sit forward and auscultate lower left sternal edge, exhale

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12
Q

paper speed and mV calibration in ECG

A

25mm/s 10mm/mV

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13
Q

what plane view do limb leads give

A

coronal, round view

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14
Q

what plane view do chest leads give

A

transverse, horizontal plane

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15
Q

sequence to check ECG

A 
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
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16
Q

duration of tiniest square

A

0.04s

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17
Q

how many big squares for 1 min

A

300

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18
Q

how to calculate heart rate from ECG

A

look at 10s strip

OR

count big squares between R waves and divide 300 by

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19
Q

criteria for sinus rhythm

A 
regular rhythm
P waves present
P waves followed by QRS
60-100 BPM
PR interval regular and constant
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20
Q

which leads will show a left deviation?

A

I will be positive, II will be negative, also avL will be more positive

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21
Q

how to see normal axis

A

lead I and II are positive

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22
Q

what is the angle of normal axis

A

-30 to +90deg

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23
Q

indications of right deviation

A

limb lead II positive, I is negative.

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24
Q

how long should P wave be

A

less than 0.11s

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25
Q

how high should P waves be

A

<2.5mm in limb lead

<1.5mm in chest lead

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26
Q

what might cause a heightened P wave

A

enlarged atrium

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27
Q

what does a missing P wave indicate

A

loss of SA nodal firing

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28
Q

how long should PR interval be

A

between 0.12 and 0.2s

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29
Q

what does a lengthened PR interval imply

A

heart block at AV node, slowing conduction from atria to ventricles

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30
Q

how long should a QRS interval be

A

<0.12s

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31
Q

which leads usually don’t show a QRS wave

A

V1-V3

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32
Q

what does T wave represent

A

repolarisation of ventricles

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33
Q

what can be seen in hyperkalaemia

A

tall T waves

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34
Q

what does a prolonged QT segment increase the risk of

A

arrrhythmias

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35
Q

when does a systolic heart murmur happen?

A

after heart sound 1

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36
Q

why does S3 happen?

A

cos blood oscillates in ventricles due to rapid filling and frail/compliant ventricle

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37
Q

why does S4 happen?

A

when blood is forced into a stiff ventricle

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38
Q

why does a split heart sound occur

A

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

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39
Q

6 characteristics to describe murmurs

A 
timing
location
characteristics
intensity
radiation
response to respiration
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40
Q

how does a pansystolic murmur occur

A

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

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41
Q

how can an ejection murmur occur

A

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

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42
Q

how to accentuate a mitral murmur?

A

listen at mitral area and roll to the left

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43
Q

what pathology is associated with a crescendo-decrescendo murmur

A

aortic stenosis

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44
Q

what kind of a murmur can be heard over the carotids

A

aortic stenosis

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45
Q

investigations of heart conditions

A

ECG
CXR
angiogram
echograph

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46
Q

what endocrine condition can cause palpitations

A

thyroid

47
Q

how many small squares is a narrow complex tachycardia

A

2-3 small squares

48
Q

what dietary habit is a relevant question in palpitations

A

caffeine in take

49
Q

what is a quick way to assess SBP with pulses?

A

if radial pulse present, SBP at least 90

if radial absent but carotid present, then about 80

50
Q

what is the definition of PVD?

A

disorder of the circulatory system that does not involve the brain or heart

51
Q

4 types of arterial diseases

A

occlusive arterial disease
arterial ulceration
carotid disease (stenosing)
aneurysms

52
Q

2 presentations of venous insufficiency

A

varicose veins

venous ulceration

53
Q

3 factors that precipitate atherosclerosis

A

hypertension
high cholesterol
smoking

54
Q

difference between a thrombus and an embolus

A

thrombus is blood clot forming on the endothelium

embolus can be any mass in the circulation system

55
Q

3 stages of chronic arterial disease

A

intermittent claudication
critical limb ischaemia
acute limb ischaemia

56
Q

how to differentiate intermittent claudication VS critical limb ischaemia?

A

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.

57
Q

RF of PVD

A 
smoking
obesity
high cholesterol
hypertension
diabetes
age
58
Q

what 3 features are part of Leriche’s syndrome

A

claudication of thighs and buttocks
absent/decreased femoral pulse
male impotence/ED

59
Q

why do ulcers form in PVD?

A

reduced blood flow, lack of nutrients, reduced healing. leads to necrosis and inability to heal.

60
Q

difference between arterial and venous ulcers

Site
Edge
depth
Base/colour
gender
A

Arterial VS venous

pressure points VS gaiter region
regular VS jagged
punched out vs superficial
necrotic, green VS pink and yellowish
male VS female
61
Q

2 types of gangrene that can occur

A

dry and wet gangrene

62
Q

difference between dry and wet gangrene

A

infection VS no infection

63
Q

6 symptoms of acute limb ischaemia

PPPPPP

A 
pain
pallor
paraesthesia
pulseless
paralysis
perishingly cold
64
Q

what can cause acute limb ischaemia?

A

an embolus suddenly blocking off blood supply

65
Q

how long is the window the save a limb from acute limb iscahemia?

A

6 hours, before necrosis starts

66
Q

what is the presentation of an aortic abdominal aneurysm, before and after rupturing

A

palpable expansile region in the abdomen

if ruptured

  • sudden back pain
  • hypovolaemic shock
  • LoC
  • sudden death
67
Q

what can a carotid atheroma cause

A

embolus which cause TIA and stroke

68
Q

presentation of varicose veins

A

ache in leg after standing for long
night cramps
venous ulceration
superficial thrombophlebitis

69
Q

classical features of DVT

A 
calf pain
pyrexia
persistent tachycardia
swelling of leg, along the vein
pain when walking or standing
warmth over inflamed area
70
Q

key questions to ask in PVD history

A

acute/chronic
when does it come on
what makes it feel better (hanging from bed)

pmhx - RF, stroke

Dhx -

SHx - smoking, exercise tolerance, ADLs

71
Q

RF of PVD

A 
hypertension
smoking
diabetes
cholesterol
HD
previous DVT
72
Q

where to auscultate in PBD examination

A

carotids, abdomen, femoral

73
Q

what does a bat wing presentation of a CXR suggest?

A

pulmonary edema

74
Q

difference between stable angina and acute coronary syndrome

A

stable anginas are not progressive and happen on exertion.

75
Q

3 progressively worsening types of acute coronary syndrome

A

unstable angina
non ST elevation MI
ST elevation MI

76
Q

characteristics of unstable angina

A

sudden deterioration, pain coming on even at rest

no cardiac enzyme release

77
Q

characteristics of NSTEMI

A

heart attack which causes cardiac enzyme release, without ST elevation on ECG

78
Q

describe a STEMI

A

heart attack with ST elevation visible on ECG and cardiac enzyme release

79
Q

what causes an ACS

A

sudden occlusion of coronary artery by embolus/thromboembolus, rupturing of atheroma plaque

80
Q

History points in stable angina

A

site - across chest, go to arm, sometimes jaw
onset - exertion, cold, postprandial
relieve - GTN

81
Q

causes of stable angina

A

obstruction
aortic stenosis
hypertrophic cardiomyopathy

82
Q

how to investigate a stable angina?

A 
12 lead ECG
Echo
PET scan
MPS
coronary angiography

cardiac CT
angiography

83
Q

how to treat stable CHD

A 
lifestyle alterations
antiplatelet therapy, lipid management
beta blockers
ACEI
anti-anginals

PCI/CABG

84
Q

MoA of aspirin and clopidogrel

A

aspirin is COX inhibitor which prevents platelet activation

clopidogrel is an ADP receptor inhibitor, stopping platelet cross linkage

85
Q

causes of heart failure

A 
IHD
hypertension
arrhythmias
valve defects
cardiomyopathies
86
Q

Signs of acute heart failure

A 
SOB + tachypnea
tachycardia
elevated JVP
chest crepitations
abnormal ECG
87
Q

what is to be checked in a blood test of a patient with suspected heart failure, and why

A 
troponin - ?MI
FBC - anaemia?
LFT - liver congestion?
TFT - thyroid function?
glucose - diabetic status?
U+E - kidney function
88
Q

treatment of acute heart failure

A

O2 - BIPAP or ventilation
IV diuretics and nitrates
treat underlying cause

89
Q

cause of chronic heart failure

A

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

90
Q

symptoms of chronic heart failure

A 
dyspnea
orthopnea
PND
peripheral edema
wheeze
lethargy, fatigue
anorexia
91
Q

signs of CHF

A 
tachycardia
raised JVP
HS 3
displaced apex beat
crepitations
edema, ascites
cachexia
hepatomegaly
92
Q

what does a very short PR interval suggest?

A

accesory conduction path - WPW

93
Q

Old man come in with syncope ,angina and dyspnea

(Fainted in shopping mall eg.) what is the most likely cause

A

Aortic stenosis

94
Q

What pathology is a collapsing pulse associated with

A

Aortic regurgitation

95
Q

what can cause a pathological S3

A

heart failure

96
Q

during which part of the heart cycle would S3 be present in

A

diastole, during ventricular filling

97
Q

describe an aortic stenosis murmur

A

systolic murmur heard loudest over aortic site, crescendo-decrescendo murmur that radiates into the carotids

98
Q

describe a mitral regurgitation murmur

A

pansystolic murmur, heard loudest over mitral area, radiates to axilla

99
Q

associated signs of aortic stenosis

A

narrow pulse pressure
slow rising pulse
low BP
ventricle hypertrophy

100
Q

associated signs of mitral stenosis

A

malar flush, increased jvp, right ventricular heave

101
Q

common cause of mitral stenosis

A

rheumatic fever

102
Q

associated signs of aortic regurgitation

A

wide pulse pressure
collapsing pulse
displaced apex beat
volume overload

103
Q

timing of aortic regurgitation murmur

A

end diastolic

104
Q

causes of mitra regurgitation

A

infective endocarditis
connective tissue disorders
MV degeneration in old age

105
Q

causes of aortic regurgitation

A

congenital

infective endocarditis, rheumatic fever, CT disorder

106
Q

symptoms of mitral stenosis

A

dyspnea
orthopnea
PND

107
Q

what does aortic stenosis lead to?

A

angina due to relative ischaemia
left ventricular hypertrophy
left sided heart failure

108
Q

symptoms of aortic stenosis

A

exertional syncope
angina
heart failure symptoms

109
Q

signs of aortic stenosis

A

ESM
thrusting apex beat
slow rising pulse

110
Q

what is the characteristic ECG pattern of atrial flutter?

A

saw-tooth flutter of around 300 bpm in atria

111
Q

what are the 2 shockable rhythms?

A

ventricular fibrilation and pulseless ventricular tachycardia

112
Q

what are the 2 non-shockable rhythms

A

pulseless electrical activity and asystole

113
Q

what sign on examination would suggest the cause of sepsis to be infective endocarditis?

A

new murmur

114
Q

what two results can be diagnostic for infective endocarditis?

A

positive ECHO findings and 3 of 3 +ve blood cultures

3 FoCP (11 decks)

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