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Talley O Connor > CVS > Flashcards

CVS Flashcards

1
Q

Cardiac pain - ddx

A

Angina (exertional)
MI (Persistent)

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2
Q

Vascular pain - ddx

A

Aortic dissection (very sudden onset with radiation to the back)
Pulmonary embolism

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3
Q

Pleuropericardial pain - ddx

A
  • Pericarditis (pain worse on lying down)
  • Pneumothorax (sharp pain with sudden onset)
  • Pneumonia/ infective pleuritic (often pleuritic, associated with fever and dyspnoea)
  • Autoimmune disease (pleuritic)
  • Mesothelioma (severe and constant)
  • Metastatic tumor (severe and constant, localized)
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4
Q

Chest wall pain (superficial) - ddx

A
  • Persistent cough
  • MSK pain
  • Intercostal myositis
  • Herpes zoster
  • Coxsackie B virus infection (pleuritic)
  • Rib fracture
  • Rib tumor
  • Tietze’s syndrome (costal cartilage tender and swollen)
  • Thoracic nerve compression or infiltration
  • Panic attack
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5
Q

Chest pain - GI causes - DDx

A
  • GORD (burning, rise towards the neck, worse on lying down)
  • Diffuse oesophageal spasm
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6
Q

Airway pain

A
  • Tracheitis (throat pain, painful breathing)
  • Inhaled foreign body (stridor)
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7
Q

Ankle oedema - ddx

A
  • venous stasis
  • CCB
  • Cardiac failure
  • Lymphoedema
  • Nephrotic syndrome
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8
Q

4 Types of syncope
DDx of syncope

A
  1. Postural syncope
  2. Micturition syncope
  3. Tussive syncope
  4. Vasovagal syncope
  • DDx: Epilepsy
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9
Q

Risk factor for valvular disease

A
  1. hx of rheumatic fever
  2. Marfans syndrome - aortic regurgitation, mitral valve prolapse, aortic dissection
  3. Down syndrome - ASD, mitral and tricuspid valve abdnormalities
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10
Q

5 signs to look for in general cardiac examination

A
  1. Breathing pattern
  2. Body habitus
  3. Cardiac cachexia (severe cardiac failure)
  4. Pallor (anemia - can worsen heart failure/ angina)
  5. Cyanosis (congenital heart disease / reduced cardiac output)
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11
Q

4 signs to look for in hand

A
  1. Peripheral cyanosis
  2. Clubbing (cyanotic congenital heart disease)
  3. Splinter haemorrhage (trauma/ infective endocarditis)
  4. Tendon xanthomata (hyperlipidemia)
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12
Q

Pulse findings - pathology?
1. Slow upstroke
2. Collapsing
3. Small volume
4. Pulsus paradoxus

A
  1. Slow upstroke - aortic stenosis
  2. Collapsing - aortic regurgitation, PDA, arteriosclerotic aorta, peripheral arteriovenous fistula
  3. Small volume - aortic stenosis, pericardial effusion
  4. Pulsus paradoxus - cardiac temponade or severe asthma
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13
Q

Significant postural BP findings

A
  • syslolic drop >= 15mmhg
  • Diastolic drop >= 10mmhg
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14
Q

What is pulsus paradoxus?

A

Drop in BP 10mmhg or more - seen in cardiac tamponade and severe asthma

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15
Q

4 signs to look for in face and mouth examination

A
  1. Xanthelasma
  2. High arched palate (marfan’s syndrome)
  3. Diseased teeth (possible source of infective endocarditis)
  4. Central cyanosis
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16
Q

JVP
1. a-wave meaning
2. v-wave meaning

A
  1. a-wave: coincides with right atrial systole
  2. v-wave: atrial filling when tricuspid valve remains closed during ventricular systole
17
Q

JVP pathologies
1. JVP >3cm - meaning?
2. Kussmaul’s sign
3. Cannon a waves
4. Large v waves
5. abdominojugular reflux test

A
  1. JVP >3cm - meaning?: right ventricular failure/ volume overload
  2. Kussmaul’s sign: elevation in JVP on breathing - constrictive pericarditis, cardiac tamponade, right ventricular infarction
  3. Cannon a waves: Complete heart block - electrical abnormalities, when right atrium contracts against a closed ventricle (both atria and ventricle contracts at the same time)
  4. Large v waves: Tricuspid regurgitation
  5. abdominojugular reflux test - positive if JVP remains >=4cm for 10s on compression of liver -> indicated right ventricular failure
18
Q

What is malignant hypertension

A

Diastolic BP > 120mmhg

19
Q

Name of the surgical scars from the following image

A

1 = pacemaker scar
2 = median sternotomy scar
3 + 4 = right and left lateral thoractomy scars
5 + 6 = surgical drain scars.

20
Q

Apex beat: causes of pathology
1. displaced apex beat
2. Dyskinetic
3. volume loaded
4. Pressure loaded

A
  1. displaced apex beat: enlarged heart, chest wall deformity, pleural or pulmonary disease
  2. Dyskinetic: Uncoordinated and large -> due to left ventricular dysfunction
  3. volume loaded: Left ventricular dilatation
  4. Pressure loaded: forceful and sustained impulse
21
Q

6 causes of systolic murmurs

A
  1. Aortic stenosis
  2. Hypertrophic cardiomyopathy
  3. Ventricular septal defect
  4. Mitral regurgitation
  5. Pulmonary stenosis
  6. Innocent murmur
22
Q

5 causes of diastolic murmur

A
  1. Aortic regurgitation
  2. S3 heart sound
  3. Mitral stenosis
  4. Pulmonary regurgitation
  5. PDA (continuous machine like murmur)
23
Q

Valvular pathology
1. Loud S1
2. Soft S1
3. Loud A2
4. Soft A2
5. Loud P2
6. S1 Split
7. Wide S2
8. Fixed split

A
  1. Loud S1: mitral stenosis
  2. Soft S1: mitral regurgitation
  3. Loud A2: Systemic hypertension
  4. Soft A2; Calcified aortic valve and reduced leaflet movement, aortic regurgitation
  5. Loud P2: pulmonary hypertension
  6. S1 Split: complete right bundle branch block
  7. Wide S2: right bundle branch block (delayed emptying) and pulmonary stenosis
  8. Fixed split: ASD
24
Q

S3 - definition, physiological and pathological
S4 - definition and pathology associated

A

S3: low-pitched, mid-diastolic sound -> galloping sound.
Physiological: pregnancy and young athletes

S4: Higher pitched late diastolic sound. happens in stiff ventricle secondary to systemic hypertension

25
Q

Valvular pathology
1. Opening snap
2. Systolic ejection click
3. Non-systolic ejection click
4. Crisp metallic sound

A
  1. Opening snap: Mitral stenosis
  2. Systolic ejection click: Aortic stenosis
  3. Non-systolic ejection click: Mitral valve prolapse
  4. Crisp metallic sound: mechanical prosthetic valve
26
Q

Systolic Murmur pathology
1. Pansystolic murmur
2. Ejection systolic
3. Late systolic

A
  1. Pansystolic murmur; Mitral & tricuspid regurgitation, ventricular septal defect
  2. Ejection systolic: Crescendo-decrescendo -> aortic/ pulmonary stenosis
  3. Late systolic: Mitral valve prolapse or papillary muscle dysfunction
27
Q

Diastolic murmurs - pathology?
1. Early diastolic murmur
2. Mid-diastolic murmur
3. Presystolic murmur

A
  1. Early diastolic murmur: aortic/pulmonary regurgitation
  2. Mid-diastolic murmur: mitral stenosis
  3. Presystolic murmur: extension of mid-diastolic murmur of mitral stenosis and are absent in patients who are in atrial fibrillation (because atrial systole is lost).
28
Q

How to compare VSD murmur from aortic stenosis?

A

The murmur of a ventricular septal defect is loudest in the right parasternal area and is not well heard at the base of the heart or at the apex. This helps distinguish it from the murmurs of aortic stenosis and mitral regurgitation, respectively.

29
Q

Grading of murmur 1-6

A

– grade 1/6: very soft and only audible in ideal listening conditions (may only be audible if told it is present)11
– grade 2/6: soft, but can be detected almost immediately by an experienced auscultator
– grade 3/6: moderate; there is no thrill
– grade 4/6: loud; thrill just palpable
– grade 5/6: very loud; thrill easily palpable
– grade 6/6: very, very loud (and very uncommon); can be heard even without placing the stethoscope on the chest.

30
Q

Possible cause in CVS examination
- Pulsatile liver
- Splenomegaly

A
  • Pulsatile liver: Tricuspid regurgitation
  • Splenomegaly: Infective endocarditis
31
Q

Leg ulcers: Differentiate between venous (5), arterial (4) and neuropathic ulcers (4)

A
32
Q

How to palpate pulses if there is pitting edema present?

A

If pitting oedema of the lower limbs makes palpation of the pedal pulses difficult, gentle pressure over the area for 10–15 seconds will temporarily displace fluid and assist.

33
Q

Venous valvular incompetence
- Cough impulse test
- Trendelenberg test

A
  • Cough impulse test: After standing the patient up, palpate just below the fossa ovalis -> Feel for an impulse (thrill). Look also for a saphena varix (dilation of the vein that produces a swelling in the fossa ovalis, which, unlike a femoral hernia, disappears when the patient lies down).
  • Trendelenberg test: After lying the patient down, elevate the (patient’s) leg to empty the veins. Then compress the upper end of the vein in the groin with your hand -> then stand the patient up; normally, if little or no filling occurs until the groin pressure is released, sapheno-femoral valve incompetence is present and the test is positive. If filling occurs before the pressure is released, incompetent veins are in the thigh or calf.

Talley O Connor (2 decks)

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