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PPE OSCE > CVS General > Flashcards

CVS General Flashcards

1
Q

What is Beck’s triad?

What is it a sign of?

A
  • Hypotension
  • Raised JVP
  • Muffled heart sounds
    Sign of cardiac tamponade
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2
Q

What would you hear in pericardial effusion?

A

Pericardial friction rub

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3
Q

Which artery supplies the SA node in most people?

What about in the other 40%?

A
  • 60% - RCA

- 40% - LCA

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4
Q

Which artery (or arteries) supplies the AV node?

A

AV nodal branch from posterior RCA

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5
Q

Which artery supplies the RA?

A

RCA

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6
Q

Which arteries supply the RV?

A
  • Right marginal

- LAD

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7
Q

Which artery supplies the LA?

A

Circumflex branch of LCA

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8
Q

Which arteries supply the LV?

A
  • Left marginal

- LAD

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9
Q

Where is S1 heard best?

What about S2?

A
  • Apex - using bell

- Pulmonary area - diaphragm

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10
Q

What are the 4 defects found in Tetralogy of Fallot?

What is the anatomical anomaly underlying all 4?

A

1) RV hypertrophy
2) Over-riding aorta
3) Pulmonary stenosis
4) VSD
Due to IV septum being too anterior

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11
Q

What is the difference between aortic stenosis and coarctation of the aorta?

A

Aortic stenosis = narrowing of the aortic valve

Coarctation of the aorta = narrowing of the aorta in the region of the ligamentum arteriosum

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12
Q

What signs relating to the pulses would you see in coarctation of the aorta? Why?

A

Radial-radial pulses synchronous, but radial-femoral delay as blood flow to upper limbs/head fine as subclavian/carotid arise before narrowing, but blood flow to rest of body compromised

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13
Q

What are the 3 classic symptoms of aortic stenosis?

A
  • Chest pain
  • Dyspnoea
  • Syncope
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14
Q

Give two signs of aortic stenosis apart from murmur

A

Slow-rising pulse

Thrill

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15
Q

What would be the character of the pulse in aortic regurgitation?

A

Collapsing

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16
Q

Give some clinical features of mitral stenosis

A
  • Dyspnoea
  • Palpitations
  • Malar flush
  • Tapping apex beat
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17
Q

Why might mitral stenosis lead to AF?

A

Increased LA pressure due to resistance to flow into LV

Therefore LA hypertrophy - can cause AF

18
Q

What is systolic blood pressure a measure of?

What about diastolic?

A
  • Systolic = max arterial pressure

- Diastolic = min arterial pressure

19
Q

How is mean arterial pressure calculated?

A

Diastolic pressure + 1/3rd pulse pressure

20
Q

What is stroke volume?

How is it calculated?

A

Volume of blood leaving LV with each contraction

End diastolic volume minus end systolic volume

21
Q

What influences BP?

A

TPR and CO as BP = TPR x CO

22
Q

Describe Starling’s law of the heart

A

In basic terms, the more blood in, the more blood out
Hence stroke volume increases with end diastolic volume (up to a point)
The greater the stretch, the harder the myocytes can contract - hence greater output

23
Q

What is contractility?

A

The extent by which SV increases with venous pressure

24
Q

What is preload?

What is afterload?

A 
Preload = end diastolic stretch
Afterload = resistance against which the LV has to pump
25
Q

What is a murmur?

A

Extra/abnormal sound during the heartbeat cycle, caused by turbulent blood flow

26
Q

What causes S1?
What about S2?
What are their characters?

A
  • AV valves closing at the beginning of ventricular systole - crescendo-decrescendo
  • Outflow valves closing at the end of ventricular systole - shorter duration, higher frequency
27
Q

Which sound does the pulse occur with?

A

S1

28
Q

What ECG changes would you see in stable angina?

A

At rest, none!

29
Q

How would you determine whether someone was having unstable angina or an NSTEMI?

A
  • Unstable angina - ST depression but no necrosis biomarkers

- NSTEMI - ST depression with necrosis biomarkers

30
Q

What are the diagnostic criteria for a STEMI?

A

Rise of necrosis biomarkers, PLUS one or more of:

  • Ischaemic symptoms
  • Pathological Q waves on ECG
  • ECG changes indicative of ischaemia
  • Coronary artery intervention
31
Q

What ECG changes would you expect to see in a STEMI?

A
  • Tall T waves
  • ST elevation
  • Prolonged PR interval
  • T wave inversion after a couple of days
  • Long-term - pathological Q waves
32
Q

What changes on an ECG would be seen in hypokalaemia?

A
  • ST depression

- U waves

33
Q

What changes would you expect to see on an ECG in hyperkalaemia?

A
  • Tall (tented) T waves
  • Prolonged PR interval
  • Widened QRS
  • Absent P wave
34
Q

Give some changes you would see in AF on an ECG

A
  • Irregularly irregular rhythm
  • Tachycardia
  • Absent P waves
  • Oscillating baseline
35
Q

Where would you place the 6 chest leads for a 12 lead ECG?

A
  • V1 - 4th ICS, right sternal edge
  • V2 - 4th ICS, left sternal edge
  • V3 - Between V2 and V4
  • V4 - 5th ICS, MCL
  • V5 - Between V4 and V6
  • V6 - 5th ICS, MAL
36
Q

What is the difference between systolic and diastolic heart failures?
Which is more likely to occur alone?

A
  • Systolic - problem with ventricular contraction
  • Diastolic - problem with filling
  • Diastolic more likely to occur alone
37
Q

What is congestive heart failure?

A

HF where both right and left sides are affected

38
Q

What is the major cause of RHF?

A

Secondary to lung conditions - cor pulmonale

39
Q

Give some clinical features of RHF

A
  • Fatigue
  • Dyspnoea
  • Increased JVP
  • Ascites, hepatomegaly
  • Peripheral oedema
40
Q

What is the major cause of LHF?

A

Ischaemic heart disease - results in hypertension which increases afterload on LV

41
Q

List some clinical features of LHF

A 
Pulmonary oedema
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
Minial peripheral oedema

PPE OSCE (8 decks)

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