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causes of signs > CVS Signs > Flashcards

CVS Signs Flashcards

1
Q

Radiofemoral delay

A

Coarctation of aorta (congenital narrowing usually distal to L SCA)

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2
Q

Radio radial delay

A 
Aortic arch aneurysm. 
Coarctation aorta
Aortic dissection
External tourniquet
Severe atherosclerosis
Compartment syndrome
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3
Q

PP changes

A 
Narrow in-
Aortic stenosis
Hypovolaemia
Wide in-
Aortic regurg
Septic shock
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4
Q

Malar flush

A

Mitral stenosis

Low CO

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5
Q

Carotid pulse character

A

Irregularly irregular in AF
Regularly irregular in 2nd degree HB
Character and volume-
-Bounding in CO2 retention, liver failure, sepsis.
-Small volume in aortic stenosis, shock, pericardial effusion.
-Collapsing water hammer (early peak then rapid descent, exaggerated by lift arm, associated with wide PP)-aortic incompetence, AV malformations, PDA.
-Ancrotic slow rising (gradual upstroke, reduced late peak)-aortic stenosis.
-Bisferiens (double systolic peak with dip in btw)-combined aortic stenosis and regurg.
-Pulsus alternans (strong to weak, normal rhythm)-LVF, cardiomyopathy, aortic stenosis.
-Pulsus paradoxus (systolic pressure falls in inspiration more than normal-over 10mmHg) in severe asthma, cardiac tamponade.
Bruits- atherosclerosis, vasculitis in young.

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6
Q

JVP

A

Raised with normal wave- fluid overload, RHF. Acute PE, COPD.
Fixed raised with absent pulsation- SVC obstruction.
A wave due to RA contraction.
Large a wave- pulmonary HTN and TV stenosis.
Cannon a wave- T3 HB, ventricular arrhythmia.
Absent a wave- AF.
V wave due to atrial filling during systole when tricuspid closed.
Large v wave- tricuspid regurg.
C wave rare- due to tricuspid closure.
High plateau- pericarditis
Kussmauls sign- paradoxical rise of JVP on inspiration in tamponade, RVF, restrictive cardiomyopathy.
Absent JVP when flat- reduced circulatory volume.

Abdominojugular test- press over liver= raise venous return to RH=raise JVP temporarily.
Normally falls with inspiration due to reduced IT pressure.
Prevent wave by occluding vein at base of ECG with finger.

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7
Q

Palpation

A

-apex beat-
Heaving (pressure loaded undisplaced)- aortic stenosis, systemic HTN.
Thrusting (pressure loaded, displaced)- AR/MR
Tapping (pressure loaded undisplaced)- MS tapping, palpable S1.
Diffuse- LVF, cardiomyopathy.
Absent DOPES- death, obesity, pericarditis, emphysema, dextrocrdia.
Deviation- mediastinal shift, cardiomegaly, scoliosis, pectus excavatum, dextrocardia.
-Left parasternal heave- RVH eg pulmonary stenosis, cor pulmonale.
-Thrills- murmurs.

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8
Q

Basal creps and pleural effusion

A

HF

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9
Q

Xanthomata, xanthelasma, corneal arcus

A

Hyperlipidaemia.

Corneal arcus common in over 60 normally.

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10
Q

Heart sounds

A

S3- loud in dilated cardiomyopathy and MV regurg. High pitch in pericarditis.
CAN BE NORMAL.
S4- NEVER normal. In stiff ventricle eg aortic stenosis, HTN.

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11
Q

murmurs

A

Ejection systolic- aortic stenosis. Quiet S2 with advancing murmur. Due tocalcified AV, bicuspid valve, rheumatic fever.
Pansystolic- MV or TV regurg, VSD. Radiates to axilla.
Early diastolic- aortic and pulmonary regurg. (High pitch easily missed).
Mid diastolic- mitral stenosis, aortic regurg, rheumatic fever. (Low and rumbling).
Aortic stenosis radiates to carotid.
Mitral regurg radites to axilla.
Expiration- increases blood to L heart so accentuates LH murmurs.
Inspiration- accentuates RH murmurs. (RILE).
Lean forward for aortic regurg L sternal edge.
Left lateral for mitral stenosis (LSITEN WITH BELL), Exercise accentuates.
Continuous murmurs- PDA, AV fistula, ruptured sinus of Valsalva.
Superficial pericardial friction rub- pericarditis.

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12
Q

Radial pulse

A

Irregularly irregular- AF
Regularly regular- 2nd degree HB, ventricular trigeminy
Collapsing- aortic regurg

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13
Q

Scars

A

Median sternotomy
PPM
Sub mammary throacotomy

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14
Q

Chest pain

A

CARDIAC-
Myocardial ischaemia- central diffuse tightening.
Pericarditis- sharp.
Aortic dissection- severe tearing pain start mid chest to back and down spine.
RESP-
Pneumonia, PE, pneumothorax- lateral pleuritic pain, worse no inspiration and cough.
GI-
Reflux oesophagitis- chest and epigastric burning
Gastric/GB/pancreatic pain.
MSK-
Trauma- injury in hx or excessive use.
Muscle pain- often localised and worse on movement.
Bone mets

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15
Q

Marfans

A

Reduced EC microfibres formation and poor elastic fibre formation due to mutated fibrillin gene.
Valve and vessel wall disease.
Aortic dissection.

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16
Q

Postural hypotension

A

Hypovolaemia
Drugs eg nitrates, diuretics, antiHTN, antiP.
Addisons
Hypopituitary

17
Q

Signs of aortic regurg

A 
Head nodding with pulse
Systolic pulsation of uvula
Visible carotid pulse
Capillary nailbed pulsation
Pistol shot femorals
To and fro diastolic murmur when compress femorals
18
Q

Route of electrical activity

A

SAN, IN tracts, AVN, bundle of his, LBB, RBB, PK
Depolarisation endo to epicardium
Repolarisation after 280ms, epi to endocardium

19
Q

Leads

A 
Limb leads coronal bipolar
Chest leads horizontal unipolar
Augmented leads coronal unipolar
Towards positive sensing electrode
-LII, III, aVF- inferior MI, RCA.
-LI, aVL, V5+6- anterolateral LV, L circumflex 
-aVR- atrial and ventricular cavities.
-V1+2- anterospetal, LAD.
-V3+4- anteroapical, distal LAD.
-LI, aVL, V2-6- extensive anterior, proximal LCA. 
-tall R in V1- true posterior, RCA.
20
Q

Section of the trace

A 
P= atrial depolarisation. 
isol electric A to V
Q=septum to ventricle L to R
R=ventricular depolarisation
S=end ventricular depolarisation
T= ventricular repolarisation epi to endo
21
Q

Timings

A

5LS= 1 second
1SS= 0.04 seconds
Rate= 300/ LS of RR interval
PR= start P to start Q, should be 0.12-0.2 sec
QRS= start Q to end S, should be under 0.12 sec
QT= start Q to end T, should be 0.45 sec
Narrow QRS= atrial/AVN origin. Wide= ventricular origin or BBB.

22
Q

Abnormal ECG

A

AF= irregularly irregular, no P, narrow QRS
1st degree HB= long PR
2nd degree mobitz 1= progressively longer PR, drop QRS
2nd degree mobile 2= normal PR, drop QRS
2rd degree= normal PR, not all cause QRS. Slow ventricular escape, wide QRS.
Ventricular ectopic= wide QRS
VT= 3+ ectopics in row
VF= fast, irregular shape QRS. NO CO or pulse.
Subendocardial ischaemia= STD
Fully evolved MI= STE, wide Q, T inversion. Pathological Q=over 1SS wise, over 2mm deep, in full thickness MI, remains after.

23
Q

Axis (direction of spread of ventricular depolarisation)

A

Normal -30 to 90
R axis deviation= over 90 eg RVH
L axis deviation= under -30 eg LVH, conduction block anterior LBB

24
Q

WiLLiaM MaRRoW

A

LBBB eg aortic stenosis, dilated cardiomyopathy, MI, CAD
RBBB eg ASD, PE, MI
-in LBBB- QRS looks like a W in V1 and an M in V6
-in RBBB- QRS looks like M in V1 and W in V6

25
Q

Coronary BF

A

Epi to endocardium to subendocardial muscle vulnerable.

Increase HR= decrease disatole more

26
Q

Cardiac enzymes

A

Mb peaks first 6-12 hours.
Trop I and T peak 18-36 hours. Start to rise after 4 hours. Slow fall.
CK-MB peak 24 hours. Falls slower.

27
Q

MI ECG over time

A
  • immediate- STE
  • hours- start of pathological Q, decrease R
  • days- T inversion, deeper Q
  • more days- ST normal, T inversion
  • weeks- ST and T normal, Q persists
28
Q

VF (most common CA)

A

Causes-
MI
K imbalance
Arrhythmia eg long QT, torsades de pointes

29
Q

HyperK ECG

A

With increasing concentration

  • normal
  • high T
  • increase PR, STD, high T
  • very wide QRS, no P
  • VF
30
Q

HypoK ECG

A

With decreasing concentration

  • normal
  • low T
  • low T, high U
  • low T, high U, low ST
31
Q 
Haemodynamic shock (poor perfusion)
Due to low CO or low TPR
A

Low CO:
-cardiogenic pump fails to empty- MI, arrhythmia, acute HF.
= low maBP, low coronary A flow, oliguria.
-mechanical shock fail to fill due to obstruction- tamponade, PE.
=high VP, low maBP
-hypovolaemic reduced venous return- haemorrhage over 30%, burn, diarrhoea and vomiting very severe, Na loss.
=low VP and low AP. SNS compensation by increase TPR for while.
Low TPR:
-distributive- toxic shock sepsis, anaphylaxis.
=low TPR. SNS compensation.

32
Q

Urinalysis for kidney hypoperfusion

A

-

33
Q

Causes of regurg

A 
CT disease eg marfans, ehlers danlos. 
Rheumatic HD
Cardiomegaly. 
Chordae tendinae damage eg MI.
Infective endocarditis.
34
Q

Causes of stenosis

A

Senile calcification
Atherosclerosis
Vegitations due to infection
Rheumatic HD scarring

causes of signs (13 decks)

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