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Y2- CARES- Case Based Tutorials Top Hat > CVS > Flashcards

CVS Flashcards

1
Q

Give one risk factor for cardiac chest pain

A

High bp

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2
Q

What does SOCRATES stand for

A

Site = central, left, right
Onset = sudden, over time, at rest, on exertion
Character = dull, sharp, aching, pressure, heaviness, tightness, pleuritic
Radiation= shoulder, jaw, neck, back
Alleviating factors =rest, position, pain relief,
Time = duration of symptoms
Exacerbating factors = exertion, position, food
Severity = 1-10

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3
Q

Where does cardiac chest pain classically radiate to

A

The jaw or left arm

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4
Q

What can be given to treat angina symptoms

A

GTN spray = Glyceryl Trinitrate Spray

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5
Q

What is the classical cardiac chest pain in terms of SOCRATES

A 
S. Centre of the chest 
0. Sudden onset
C. Dull or crushing 
R. Left arm, neck, jaw
A. Nausea, sweating, breathlessness
T. 10 mins to an hour
E. Exertion, cold air, relieved by rest, GTN spray 
S. Mild to v severe (can be angina attack, severe angina attack, MI)

Many people, esp women, can present with atypical symptoms

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6
Q

What is stable angina usually brought on by

A

Exertion

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7
Q

What can unstable angina be brought on by

A

At rest

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8
Q

How is angina relieved

A

Rest

GTN spray

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9
Q

When can acute coronary syndrome come on

A

At rest or exertion

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10
Q

What might chest pain that is NOT relived by rest or GTN spray be caused by

A

Acute coronary syndrome

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11
Q

What is acute coronary syndrome

A

A range of conditions associated with sudden, reduced blood flow to the heart. Eg, an MI

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12
Q

What is angina

A

Chest pain caused by reduced blood flow to the heart muscles, not usually life threatening but could be a warning sign that you are at risk of heart attack or stroke

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13
Q

What kind of presentation would point towards acute coronary syndrome rather than angina

A 
Last longer than usually angina symptoms 
More severe pain 
More associated symptoms 
Not relieved by rest of GTN spray 
Can come on at rest/ exertion
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14
Q

What is dyspnoea

A

Breathlessness

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15
Q

What is orthopnoea

A

Breathlessness lying flat

Can ask about how many pillows a patient sleeps on

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16
Q

What is paroxysmal nocturnal dyspnoea

A

Sudden breathlessness waking up from sleep

Classical sign of heart failure

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17
Q

What kind of oedema may be present in patients with heart disease

A

Pitting

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18
Q

If patient is more mobile where might an oedema collect

A

Ankle

If less mobile, oedema may collect in sacral area, or abdominal wall

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19
Q

How may patients describe their palpitations

A

Rapid, regular, irregular,

Slow, feeling of missed beats, sudden thumping

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20
Q

What other common presenting symptoms in CVS disease should you ask about

A

Dyspnoea
Oedema
Palpitations
Syncope/ presyncope

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21
Q

What is the brief structure of a history

A
  1. History of presenting complaint and related SE
  2. Past medical history: active (eg, also has DM) and inactive problems (has previously had gall bladder removed with no current problems)
  3. Systematic enquiry - build this around the active problems eg, is DM well controlled
  4. Drug history - how they receive meds, allergies = and ask about the reaction
  5. Social history = eg, drugs, work, how mobile,
    Consider risk factors
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22
Q

Non CVS causes of chest pain related to respiratory system

A

cough, temperature, haemoptysis, risk factors for PE

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23
Q

Non CVS causes of chest pain related to GI

A

pain related to eating, reflux, burning, indigestion, swallowing difficulty, vomiting regurgitation

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24
Q

Non CVS causes of chest pain related to musculophrenic-skeletal system

A

Recent falls/ injury/ trauma

25
Q

Psychological factors that can cause chest pain

A

Anxiety, stress, recent life events

26
Q

Give 6 cardiovascular risk factors

A 
Diabetes
Smoking
Diet and exercise
Hypertension 
Hyperlipidaemia 
Family history (eg, of heart disease, and ask specifically about sudden death)
27
Q

What clinical observations and heart sounds and chest auscultation would support a diagnosis of angina

A

Normal for all

28
Q

What 4 main things should you check when carrying out a CVS examination

A

Hands
Face
Chest/body
Legs

29
Q

What might you be looking out for when examining hands during a CVS examination

A

Nicotine staining
Finger clubbing
Signs of endocarditis

30
Q

What might you be looking out for when examining the face during a CVS examination

A

Malar flush
Corneal Arcus (signs of hypercholestrolemia)
Xanthalasma (signs of hypercholestrolaemia)

31
Q

What can malar flush be a sign of

A

Mitral stenosis

32
Q

What might you be looking out for when examining chest/ body during a CVS examination

A

Scars

Chest wall abnormalities

33
Q

What might you be looking out for when examining legs during a CVS examination

A

Pitting oedema

Scars

34
Q

What is the first heart sound produced by

A

Closing of the mitral and tricuspid valve leaflets

35
Q

What is the second heart sound produced by

A

Closing of the aortic and pulmonic valve leaflets

36
Q

When are the first and second heart sounds heard in relation to the carotid pulse

A

When you feel the pulse on fingers = hear the first heart sound
When pulse draws away = second heart sound

37
Q

What are murmurs

A

Absence of silence between the heart sounds

Can happen in systole or diastole

38
Q

Where can the aortic valve be auscultated

A

2nd- 3rd right interspace

39
Q

Where can the pulmonic valve be auscultated

A

2nd - 3rd left interspace

40
Q

Where can the tricuspid valve be ausculatated

A

Left sternal border

41
Q

Where can the mitral valve be auscultated

A

Apex

42
Q

Why is it important to palpate the carotid pulse whilst auscultating the heart sounds

A

Because if an added sound is present to determine if this is occurring in diastole or systole by timing with the carotid pulse

43
Q

How to begin a CVS examination

A

Greet your patient
Introduce yourself and your role
Explain what you are going to do and why, and gain consent to proceed with the examination
Clean your hands
Ongoing communication to patient involves clear instructions and attention to your patient’s comfort
Demonstrate a Professional manner throughout
Examination method is structured and performed fluently and in a logical order

44
Q

What should you make a general observation of at the start of a CVS examination

A 
of patient (colour, conscious level, any pain or breathing difficulty, build)
of bedside (oxygen or other bedside equipment, GTN spray/medication)
45
Q

What to look for in hands and nails in CVS examination

A

clubbing, nicotine staining, splinter haemorrhages, tendon xanthoma, Janeway lesions, Osler’s nodes, pale palmar creases, palpate to ascertain capillary refill time which should be < 2 seconds

46
Q

How to take a pulse and what to look out for and report

A

palpate for 30 secs (60 secs if pulse irregular)
report rate, rhythm & character
Check for radio-radial delay and radio-femoral delay (aortic stenosis)
Ensure your patient does not suffer with arm or shoulder pain before examining for a collapsing pulse (present in aortic regurgitation)

47
Q

What is pallor of conjunctiva

A

Pale appearance of the conjunctiva - can be a sign of anaemia

48
Q

What is a corneal arcus

A

Deposit of cholesterol, phospholipids, and triglycerides in an ‘arc’ on either the top or bottom side of the iris inside the cornea

49
Q

What to look for in eyes, lips and tongue in CVS exam

A

Look in the eyes for xanthelasma, a corneal arcus and for pallor of conjunctivae.
Look at the lips for peripheral cyanosis and under the tongue for central cyanosis. Ascertain general dental hygiene.
High-arched palate suggestive of Marfan’s syndrome

50
Q

What is xanthelasma

A

Soft, yellowish fatty deposit that forms under the skin and can be seen around the eyes/ eyelids area

51
Q

What to observe in the neck in a CVS exam

A

Carotid pulse:palpate and listen for bruits

JVP:should be examined and measured with the patient rested at 45 degrees. (know how to demonstrate hepato-jugular reflux which may be useful in clinical practice but is not routinely performed in an OSCE)

52
Q

What to observe around chest/ praecordium during a CVS exam

A

look for scars (sternotomy, thoracotomy), a pacemaker, and for visible pulsations or heaves

53
Q

What to palpate during a CVS exam

A

Locate the Apex Beat (should know expected site is 5th intercostal space, mid-clavicular line
Heaves – use the flat of the hand to feel for parasternal heaves indicative of LVH or RVH
Thrills – use the lateral border of the hand to palpate all 4 valve areas for palpable murmurs

54
Q

What to ausculutate during a CVS exam

A

Auscultate all 4 valve areas (Aortic, Pulmonary, Tricuspid and Mitral) and carotid arteries with the diaphragm of the stethoscope – ascertain the heart sounds and for any added heart sounds or murmurs.

55
Q

How to listen for a murmur

A

If a murmur is present try to ascertain at which valve area it is heard and whether there is any radiation, for example into the carotids or into the apex.

Listen at the mitral area with the bell and the patient leaning onto their left hand side – this makes it easier to listen for the low pitched diastolic murmur of mitral stenosis.

Listen at the tricuspid area with the diaphragm of the stethoscope and your patient sat forward in held expiration which will intensify a murmur due to aortic regurgitation.

Auscultate the lungs, particularly looking for fluid at the bases which may be due to heart failure.

56
Q

What might sacral or ankle oedema indicate?

A

Right sided heart failure

57
Q

How to determine whether an oedema is a pitting oedema

A

You should press into the area of oedema for 5 seconds to establish whether an indentation remains which indicates pitting oedema.

58
Q

What other things would complete a CVS exam

A

Lying and standing BP
Abdomen
Observation
Palpation :
— Organomegaly – hepatosplenomegaly can occur due to engorgement from right sided heart failure
Abdominal Aortic Aneurysm – expansile (aorta can be palpable in thin individuals and is pulsatile)
Palpate femoral pulses

Auscultation - for renal and femoral bruits
Vascular exam of lower limbs
Fundoscopy- to check for hypertensive and diabetic retinopathy
Thank and explain

59
Q

What might be the cause of hepatosplenomegaly

A

Engorgement from right sided heart failure

Y2- CARES- Case Based Tutorials Top Hat (3 decks)

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