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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
how high should P waves be
<2.5mm in limb lead | <1.5mm in chest lead
26
what might cause a heightened P wave
enlarged atrium
27
what does a missing P wave indicate
loss of SA nodal firing
28
how long should PR interval be
between 0.12 and 0.2s
29
what does a lengthened PR interval imply
heart block at AV node, slowing conduction from atria to ventricles
30
how long should a QRS interval be
<0.12s
31
which leads usually don't show a QRS wave
V1-V3
32
what does T wave represent
repolarisation of ventricles
33
what can be seen in hyperkalaemia
tall T waves
34
what does a prolonged QT segment increase the risk of
arrrhythmias
35
when does a systolic heart murmur happen?
after heart sound 1
36
why does S3 happen?
cos blood oscillates in ventricles due to rapid filling and frail/compliant ventricle
37
why does S4 happen?
when blood is forced into a stiff ventricle
38
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
39
6 characteristics to describe murmurs
``` timing location characteristics intensity radiation response to respiration ```
40
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
41
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
42
how to accentuate a mitral murmur?
listen at mitral area and roll to the left
43
what pathology is associated with a crescendo-decrescendo murmur
aortic stenosis
44
what kind of a murmur can be heard over the carotids
aortic stenosis
45
investigations of heart conditions
ECG CXR angiogram echograph
46
what endocrine condition can cause palpitations
thyroid
47
how many small squares is a narrow complex tachycardia
2-3 small squares
48
what dietary habit is a relevant question in palpitations
caffeine in take
49
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
50
what is the definition of PVD?
disorder of the circulatory system that does not involve the brain or heart
51
4 types of arterial diseases
occlusive arterial disease arterial ulceration carotid disease (stenosing) aneurysms
52
2 presentations of venous insufficiency
varicose veins | venous ulceration
53
3 factors that precipitate atherosclerosis
hypertension high cholesterol smoking
54
difference between a thrombus and an embolus
thrombus is blood clot forming on the endothelium | embolus can be any mass in the circulation system
55
3 stages of chronic arterial disease
intermittent claudication critical limb ischaemia acute limb ischaemia
56
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.
57
RF of PVD
``` smoking obesity high cholesterol hypertension diabetes age ```
58
what 3 features are part of Leriche's syndrome
claudication of thighs and buttocks absent/decreased femoral pulse male impotence/ED
59
why do ulcers form in PVD?
reduced blood flow, lack of nutrients, reduced healing. leads to necrosis and inability to heal.
60
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 ```
61
2 types of gangrene that can occur
dry and wet gangrene
62
difference between dry and wet gangrene
infection VS no infection
63
6 symptoms of acute limb ischaemia PPPPPP
``` pain pallor paraesthesia pulseless paralysis perishingly cold ```
64
what can cause acute limb ischaemia?
an embolus suddenly blocking off blood supply
65
how long is the window the save a limb from acute limb iscahemia?
6 hours, before necrosis starts
66
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
67
what can a carotid atheroma cause
embolus which cause TIA and stroke
68
presentation of varicose veins
ache in leg after standing for long night cramps venous ulceration superficial thrombophlebitis
69
classical features of DVT
``` calf pain pyrexia persistent tachycardia swelling of leg, along the vein pain when walking or standing warmth over inflamed area ```
70
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
71
RF of PVD
``` hypertension smoking diabetes cholesterol HD previous DVT ```
72
where to auscultate in PBD examination
carotids, abdomen, femoral
73
what does a bat wing presentation of a CXR suggest?
pulmonary edema
74
difference between stable angina and acute coronary syndrome
stable anginas are not progressive and happen on exertion.
75
3 progressively worsening types of acute coronary syndrome
unstable angina non ST elevation MI ST elevation MI
76
characteristics of unstable angina
sudden deterioration, pain coming on even at rest | no cardiac enzyme release
77
characteristics of NSTEMI
heart attack which causes cardiac enzyme release, without ST elevation on ECG
78
describe a STEMI
heart attack with ST elevation visible on ECG and cardiac enzyme release
79
what causes an ACS
sudden occlusion of coronary artery by embolus/thromboembolus, rupturing of atheroma plaque
80
History points in stable angina
site - across chest, go to arm, sometimes jaw onset - exertion, cold, postprandial relieve - GTN
81
causes of stable angina
obstruction aortic stenosis hypertrophic cardiomyopathy
82
how to investigate a stable angina?
``` 12 lead ECG Echo PET scan MPS coronary angiography ``` cardiac CT angiography
83
how to treat stable CHD
``` lifestyle alterations antiplatelet therapy, lipid management beta blockers ACEI anti-anginals ``` PCI/CABG
84
MoA of aspirin and clopidogrel
aspirin is COX inhibitor which prevents platelet activation clopidogrel is an ADP receptor inhibitor, stopping platelet cross linkage
85
causes of heart failure
``` IHD hypertension arrhythmias valve defects cardiomyopathies ```
86
Signs of acute heart failure
``` SOB + tachypnea tachycardia elevated JVP chest crepitations abnormal ECG ```
87
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 ```
88
treatment of acute heart failure
O2 - BIPAP or ventilation IV diuretics and nitrates treat underlying cause
89
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
90
symptoms of chronic heart failure
``` dyspnea orthopnea PND peripheral edema wheeze lethargy, fatigue anorexia ```
91
signs of CHF
``` tachycardia raised JVP HS 3 displaced apex beat crepitations edema, ascites cachexia hepatomegaly ```
92
what does a very short PR interval suggest?
accesory conduction path - WPW
93
Old man come in with syncope ,angina and dyspnea (Fainted in shopping mall eg.) what is the most likely cause
Aortic stenosis
94
What pathology is a collapsing pulse associated with
Aortic regurgitation
95
what can cause a pathological S3
heart failure
96
during which part of the heart cycle would S3 be present in
diastole, during ventricular filling
97
describe an aortic stenosis murmur
systolic murmur heard loudest over aortic site, crescendo-decrescendo murmur that radiates into the carotids
98
describe a mitral regurgitation murmur
pansystolic murmur, heard loudest over mitral area, radiates to axilla
99
associated signs of aortic stenosis
narrow pulse pressure slow rising pulse low BP ventricle hypertrophy
100
associated signs of mitral stenosis
malar flush, increased jvp, right ventricular heave
101
common cause of mitral stenosis
rheumatic fever
102
associated signs of aortic regurgitation
wide pulse pressure collapsing pulse displaced apex beat volume overload
103
timing of aortic regurgitation murmur
end diastolic
104
causes of mitra regurgitation
infective endocarditis connective tissue disorders MV degeneration in old age
105
causes of aortic regurgitation
congenital | infective endocarditis, rheumatic fever, CT disorder
106
symptoms of mitral stenosis
dyspnea orthopnea PND
107
what does aortic stenosis lead to?
angina due to relative ischaemia left ventricular hypertrophy left sided heart failure
108
symptoms of aortic stenosis
exertional syncope angina heart failure symptoms
109
signs of aortic stenosis
ESM thrusting apex beat slow rising pulse
110
what is the characteristic ECG pattern of atrial flutter?
saw-tooth flutter of around 300 bpm in atria
111
what are the 2 shockable rhythms?
ventricular fibrilation and pulseless ventricular tachycardia
112
what are the 2 non-shockable rhythms
pulseless electrical activity and asystole
113
what sign on examination would suggest the cause of sepsis to be infective endocarditis?
new murmur
114
what two results can be diagnostic for infective endocarditis?
positive ECHO findings and 3 of 3 +ve blood cultures

3 FoCP (11 decks)

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