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Systems Review > CVS > Flashcards

CVS Flashcards

1
Q

Where is pain felt in aortic dissection?

A

tearing pain felt interscapular but may be retrosternal

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2
Q

relieving factor for pericarditic pain?

A

leaning forward

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3
Q

symptoms of MI?

A

central crushing chest pain, radiation to 1 or both arms, neck, jaw, shoulders
nausea
vomiting
sweating

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4
Q

signs of cardiac tamponade?

A

shock (cardiogenic) with raised JVP

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5
Q

cardinal symptoms for CVS system?

A 
chest pain
dyspnoea
palpitations
oedema
claudication
syncope
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6
Q

in what conditions may you decide to use a beta blocker?

A

hypertension
heart failure
hyperthyroidism- assoc. tachycardia
MOA: binds to beta 1 adrenoceptors of heart, -ve inotrope and chronotrope? some can also bind B2 adrenoceptors in kidneys to inhibit renin release in control of hypertension. so in hypetension, act at heart, peripheries and kidneys.

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7
Q

what does a collapsing pulse indicate?

A

aortic regurgitation- would be heard as an early diastolic or mid diastolic murmur.
AV malformation
patent DA

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8
Q

what does radio-femoral delay indicate?

A

coarctation of aorta- narrowing of aorta in region of ligamentum arteriosum, just distal to origin of L subclavian artery.

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9
Q

what might radio-radial delay indicate?

A

aortic dissection- tear in wall of aorta.

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10
Q

1st line drugs for HF?

A

ACE-Is

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11
Q

what other exam.s or investigations would you like to carry out following a CVS examination?

A

full peripheral vascular exam.- radial and brachial, carotids, abdominal aorta, popliteal and foot
abdominal exam for ascites and hepatosplenomegaly- signs of RHF
fundoscopy- in cases of diabetes, hypertension and endocarditis
bedside investigations- temp and urine dipstick, BP if not already done

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12
Q

CVS causes of chest pain?

A 
angina- stable or unstable
MI
percarditis
aortic dissection- but pain often felt interscapular
aortic aneurysm
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13
Q

Non-CVS causes of chest pain?

A

GORD, indigestion
asthma- chest tightness
pneumonia, PE, rib fracture
anxiety

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14
Q

All causes of palpitations?

A 
AF
supraventricular tachycardia
anxiety
thyrotoxicosis
pheochromocytoma
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15
Q

what is carotid artery dissection and why might it be responsible for Horner’s syndrome?

A

tear in a layer of the wall of carotid artery, blood leaks through this tear and spreads between the layers of the wall. As the blood collects in the area of the dissection, it forms a clot that limits blood flow through the artery.
Sympathetic fibres from superior cervical ganglion hitch hike onto the carotid artery to supply the superior tarsal muscle responsible for elevation of the upper eyelid, the dilator pupillae muscle responsible for dilating the pupil and vasomotor fibres responsible for swearing.
3 key features: partial ptosis, usually unilateral
miosis
hemifacial anhydrosis

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16
Q

causes of atrial fibrillation?

A 
hypertension
heart valve defects
complication of ischaemic heart disease
obesity
hyperthyroidism
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17
Q

what murmur is heard with aortic stenosis, where is it heard loudest and where does it radiate to?

A

ejection systolic
aortic valve- right 2nd IC space
radiates up into neck, can listen over right carotid

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18
Q

what murmur is heard with mitral regurgitation, where is it heard loudest and where does it radiate to?

A

pansystolic
apex=mitral valve- left 5th IC space, MCL
may radiate into L axilla

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19
Q

what murmur is heard with mitral stenosis, where is it heard loudest and where does it radiate to?

A

mid-diastolic

apex=mitral valve

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20
Q

what murmur is heard with aortic regurgitation, where is it heard loudest and where does it radiate to?

A

early diastolic

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21
Q

why is patient asked to breath out when listening for aortic regurge?

A

expiration increases blood flow to L side of the heart so accentuates L sided murmurs

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22
Q

how can the JVP be helped to be seen in a patient?

A

press on liver: will increase pressure in veins in liver, which are connected to internal jugular vein in the neck, so may now be able to see pulsation.

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23
Q

causes of raised JVP?

A

right sided heart failure

cardiac tamponade

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24
Q

management of AF

A

pharm.= control rate of heart= beta blocker e.g. bisoprolol, or Ca2+ channel blocker e.g. diltiazem, will slow HR down, heart can then work more efficiently again and pulse should no longer feel fast. These affect heart electrical impulses telling the muscle to contract, reducing the number of times the heart is beating by stopping that muscle contraction will reduce the HR.
drug to control heart rhythm- set a normal regular rate of the heart beating rather than beating irregularly, can use K+ blocker e.g. amiodarone, or flecainide if no known IHD.
thromboprophylaxis e.g. warfarin to reduce risk of stroke- medication to stop your blood from sticking together and so stop clots forming. This will mean regular blood tests are required (INR) to check how long it takes for the blood to clot, as want to make sure we don’t increase your risk of bleeding too much, but don’t want blood to clot too easily, so aiming to achieve a good balance.

treat any underlying cause e.g. hyperthyroidism- carbimazole?,
nonpharm.= can avoid precipitating factor e.g. alcohol, lifestyle changes to treat assoc conditions e.g. heart failure*

25
Q

explain AF to a patient

A

Normally, the squeezing of each chamber is in response to a control centre in the heart, which sends out electrical signals to tell the heart to contract. This signal is sent to the heart muscle to contract, squeezing the chambers to allow blood to move. Normally, the 2 top chambers of the heart- atria, contract at the same time to move blood into the lower chambers= ventricles. The ventricles then contract at the same time, and blood is moved from the right ventricle to the lungs, and from the left out to the rest of the body. Blood from the lungs enters the left atrium, to then be moved into the left ventricle and out to the rest of the body as it has been given oxygen in the lungs
In AF, the control centre doesn’t work as well, so the electrical signals it sends out to tell your heart to move blood out to the rest of your body aren’t effective so instead, various other signals are created within the heart so it thinks it is being told to contract lots, so you may feel your heart beating faster than normal, but it can’t contract fully because it is being told to contract so often, so there isn’t enough force to move out as much blood from the heart as you normally would, so blood is left behind in the chambers.

26
Q

differential diagnoses of AF

A

Atrial flutter.
Atrial extrasystoles.
Supraventricular tachyarrhythmias.
Atrioventricular nodal re-entrant tachycardia.
Wolff-Parkinson-White syndrome= a congenital abnormality which can result in supraventricular tachycardia (SVT) that uses an atrioventricular (AV) accessory tract
Ventricular tachycardia

27
Q

clinical presentation of AF

A

breathlessness
dizziness, and can be loss of consciousness
palpitations
chest pain
Breathlessness, dizziness and chest pain may happen as a heart that is beating faster doesn’t have time to carry out its job fully. Small amounts of blood moved more quickly out of the heart are not as useful to the body as larger amounts pumped at a slower, normal rate. A reduced output of blood from the heart can lead to blood pooling in the veins of the lungs, which can lead to these symptoms. Not enough O2 to areas that need it?
Palpitations as heart is beating in a fast and irregular way

3 main features:
Your heart rate is usually (but not always) a lot faster than normal.
Your heartbeat is irregular - that is, an abnormal heart rhythm (an arrhythmia).
The force of each heartbeat can vary in intensity.

28
Q

AF ECG, and other investigations?

A

ultrasound scan of the heart (echocardiogram)= can look for structural indications of heart failure, and blood tests e.g. look for thyroid hormone levels.
These tests look for an underlying cause of AF, such as a heart problem or an overactive thyroid gland.
renal function e.g. creatinine and urea, eGFR and electrolytes- abnormal K+ levels may precipitate arrhythmias
LFTs and clotting screen before warfarin

29
Q

explain IHD to a patient

A

1

30
Q

explain heart failure to a patient

A

1

31
Q

heart failure management

A

pharmacological e.g. ACEIs/AngII receptor antagonists, beta blockers and aldosterone antagonists e.g. spironolactone. ACEIs= open up vessels that blood is being moved out of heart into, reducing pressure in the arteries and hence pressure heart has to work against to move blood out, also reduce fluid in body to reduce how hard has to work as less force of blood coming into heart. loop diuretic can reduce swelling around ankles and improve breathless if fluid has collected in the lungs, as makes you pee more of it out when blood is being filtered by the kidneys, like a sieve.
non-pharmacological e.g. diet- control BP to reduce how hard heart has to work If you are overweight, try to lose weight to reduce the extra burden on your heart. Do not have too much salt in your diet, as salt can cause water retention. For example, do not add salt to your food at the table and avoid cooking with it.
Do not smoke. The chemicals in tobacco cause blood vessels to narrow, which can make heart failure worse. Smoking can also make IHD worse.
Exercise. For most people with heart failure, regular exercise is advised. The fitter the heart, the better it will pump. Muscle-loves exercise!The level of exercise to aim for will vary from person to person. Can go for a daily walk if not use to much exercise.
Immunisation. You should have an annual influenza jab and be immunised against the pneumococcal bacterium.
Weigh yourself each morning if you have moderate-to-severe heart failure. If you retain fluid rapidly, your weight goes up rapidly too. So, if your weight goes up by more than 2 kg (about 4 lb) over 1-3 days, then you should contact a doctor. You may need an increase in your medication.
Alcohol. You should not exceed the recommended amount of alcohol, as more than the recommended upper limits can be harmful.

32
Q

explain what BP is to a patient and why it is important to control it?

A

the pressure of blood within the vessels in your body taking blood to all of the different areas which need it to function normally (vessels= arteries.) It’s measured in millimetres of mercury (mm Hg). Your blood pressure is recorded as two figures. For example, 150/95 mm Hg. This is said as 150 over 95. The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart contracts to move blood out into the arteries.The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat and is filling with blood from the veins.
risk factor for heart disease and stoke, and kidney damage- renal failure.

33
Q

pharmacological tment of hypertension in a patient aged <55yrs?

A

1st line= ACEIs/AngII receptor antagonists, or beta blockers
2nd line= Ca2+ blocker
3rd line= thiazide-related diuretic
4th= add low-dose spironolactone or high dose thiazide-related, or alpha or beta blocker if don’t want additional diuretic therapy.

if you have angina, may also be given aspirin to reduce risk of blood clots forming in areas of fatty deposits (atheroma) which could cause heart attacks and stroke.

34
Q

pharmacological tment of hypertension in a patient aged 55yrs or over, or of african or caribbean descent?

A

1st line= Ca2+ blcoker or thiazide-related
2nd= ACEI/Ang II blocker
3rd and 4th same as for <55yrs.

35
Q

non-pharmacological tment of hypertension?

A 
smoking cessation
decrease alcohol
healthy diet
lose weight
regular aerobic exercise
low salt and caffeine

it’s all about controlling risk factors, as the more you have, the more likely it is that you will suffer a disease e.g. CVD.

36
Q

how is hypertension diagnosed?

A

A one-off blood pressure reading that is high does not mean that you have ‘high blood pressure’. Your blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising.

You have high blood pressure if you have several blood pressure readings that are high, and which are taken on different occasions, and when you are relaxed

37
Q

what causes hypertension?

A

often unknown= essential hypertension. The pressure in the blood vessels (arteries) depends on how hard the heart pumps, and how much resistance there is in the arteries. It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure. The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute
non-essential= known cause, most common= CKD.

38
Q

cardiovascular disease caused by atheroma?

A 
angina
MI
TIA
stroke
peripheral vascular disease
39
Q

tests you may have if diagnosed with hypertension?

A

A urine test to check if you have protein or blood in your urine.
A blood test to check that your kidneys are working fine, and to check your cholesterol level and sugar (glucose) level.
A heart tracing, called an electrocardiogram (ECG).

We can then Rule out (or diagnose) a secondary cause of high blood pressure, such as kidney disease.
To check to see if the high blood pressure has affected the heart.
To check for other risk factors such as a high cholesterol level or diabetes

40
Q

differentials for HF?

A 
MI
COPD
acute renal failure
cirrhosis
nephrotic syndrome
41
Q

differentials for IHD?

A 
MI= PE
pneumothorax
stable/unstable angina
asthma, COPD
pericarditis
42
Q

symptoms and signs of HF?

A

dyspnoea- breathless worse on exertion e.g. walking up a hill, when lying flat, wake up in middle of night?- may help to go and open a window? episodic- not present all time during day?, progressive
breathlessness assoc with cough- pink frothy sputum?- typically on a night
tiredness
dizziness
loss of appetite
swelling of ankles and legs and sacrum (peripheral oedema), still able to put on socks easily?, ascites

oedema
raised JVP
displaced apex beat
heaves
cold peripheries
43
Q

symptoms of angina?

A

The common symptom is a pain, ache, discomfort or tightness that you feel across the front of the chest when you exert yourself. For example, when you walk up a hill or against a strong, cold wind. You may also, or just, feel the pain in your arms, jaw, neck or stomach.

An angina pain does not usually last long. It will usually ease within 10 minutes when you rest. If you take some glyceryl trinitrate (GTN) - it should go within 1-2 minutes

Angina pain may also be triggered by other causes of a faster heart rate. For example, when you have a vivid dream or an argument. The pains also tend to develop more easily after meals.

Some people have nontypical pains - for example, pains that develop when bending or eating. If the symptoms are not typical then it is sometimes difficult to tell the difference between angina and other causes of chest pain, such as a pulled muscle in the chest or heartburn.

Some people with angina also become breathless when they exert themselves. Occasionally, this is the only symptom and there is no pain.

44
Q

explain myocardial infarction to a patient

A

The heart is mainly made of special muscle (myocardium). The heart pumps blood into arteries (blood vessels) which take the blood to every part of the body that needs it to function normally. Like any other muscle, the heart muscle needs a good blood supply, which is provided by the coronary arteries.
If you have a myocardial infarction (heart attack), a coronary artery or one of its smaller branches is suddenly blocked so blood and O2 can’t get to the part of the heart muscle normally supplied by this artery. This part of the heart muscle is subsequently damaged, and unable to function as can’t contract without a good O2 supply. This part of the heart muscle is said to be infarcted. The term myocardial infarction (MI) means damaged heart muscle.

If a main coronary arteries is blocked, a large part of the heart muscle is affected. If a smaller branch artery is blocked, a smaller amount of heart muscle is affected. After an MI, that damaged area of the heart muscle is replaced by scar tissue because that part of the muscle is unable to regain its function.

45
Q

character of carotid pulse if aortic stenosis?

A

slow-rising

46
Q

explain anaemia to a patient

A

normal physiology= blood= made up of different cells with different functions= rbc- for taking O2 from the air we breathe in to all the different areas of the body that need it to work, wbc to fight infection, platelets to help clot blood if we hurt ourselves so that we don’t bleed continuously, and proteins with different functions- can help with transport if hormones and drugs around the body.
rbc produced by bone marrow- region of our bones, and these need to be released continuously into blood to replace those which are lost through breakdown- must break down rbc when no longer able to carry out their function effectively. rbc contain a protein known as Hb and it is this which binds O2 for transport. for constant rbc production, the bm must be working effectively and nutrients such as iron and vitamins are needed.
Anaemia means that the amount of this important protein haemoglobin in the blood is less than normaly, which may mean there is less of it in each rbc, or that there is less rbc. Both of these mean that less O2 can carried to the different areas of the body as Hb needed to carry it and is reduced.

47
Q

symptoms of anaemia?

A

breathlessness, reduced ability to exercise- trying to get more O2
tired, muscle aches, little energy- less O2 to provide energy
feeling faint- less O2 to brain
headaches
ringing in ears
thumping heart, aware of its beating
may notice you are pale

48
Q

why have I got iron deficiency anaemia?

A

need iron to form red blood cells for transport of oxygen, iron is part of the red blood cells
menorrhagia- heavy menstrual periods- blood being lost so losing red blood cells and iron, may not be then taking in enough iron for making new rbc to replace the iron being lost in the blood.
Poor absorption of iron may occur with some gut diseases - for example, coeliac disease and Crohn’s disease.
Bleeding from the gut (intestines). Some conditions of the gut can bleed enough to cause anaemia. You may not be aware of losing blood this way. The bleeding may be slow or intermittent, and you can pass blood out with your stools without noticing.
If you eat a poor or restricted diet, it may not contain enough iron

can give iron tablets to treat
try and eat more meat if not vegetarian, and animal products e.g. milk, cheese and eggs.
if vegetarian, can try and eat a well balanced diet with other foods that contain lots of iron e.g. Fortified breakfast cereals
Green leafy vegetables
Dried beans, such as black and kidney beans, and lentils
Whole grains
Enriched rice or pasta
Pumpkin seeds
Prune juice
Dried fruit, especially raisins

49
Q

PE symptoms?

A

acute onset of dyspnoea
pleuritic chest pain= sharp, worse on breathing in.
hamoptysis

50
Q

causes of 2nd degree heart block which may cause a regularly irregular pulse?

A

Mobitz type II

Wenkebach phenomenon

51
Q

what is the JVP?

A

vertical height of pulse in right internal jugular vein as it passes just medial to clavicular head of SCM, height above sternal angle (at 2nd IC space), so is measured from angle of Louis to upper part of JVP pulsation. Rasied if >4cm.

52
Q

what is a positive abdominojugular reflux sign?

A

pressing on abdomen (liver) causes a rise in JVP, which persists throughout a 15s compression, sign of RVF causing inability of heart to eject increased venous return.

53
Q

what causes a bounding pulse?

A

CO2 retention- also causes warm hands and CO2 retention flap
liver failure
sepsis

54
Q

what causes a small volume pulse?

A

aortic stenosis

shock

55
Q

what causes a slow-rising pulse?

A

aortic stenosis

56
Q

what type of pulse occurs with combined aortic stenosis and regurge?

A

bisferiens

57
Q

what causes alternating strong and weak beats with pulse (pulsus alternans)?

A

LVF
aortic stenosis
cardiomyopathy

58
Q

what causes pulsus paradoxus?

A

systolic pressure weakens in inspiration
severe asthma
cardiac tamponade

Systems Review (8 decks)

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