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OSCE > Examination - Cardiovascular > Flashcards

Examination - Cardiovascular Flashcards

1
Q

What are the potential reasons someone might be in warfarin?

A

AF

Metallic valve replacement

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2
Q

Which pathology causes a slow rising pulse and a narrow pulse pressure and why?

A

Aortic stenosis because it is an outflow obstruction of the stroke volume meaning it takes longer for the pulse to rise and there is a smaller gap between the systolic and diastolic blood pressures.

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3
Q

What sort of murmur is heard in aortic stenosis?

A

Ejection systolic murmur in the aortic region.

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4
Q

How can you differentiate between aortic stenosis and aortic sclerosis?

A

Sclerosis:

  • Ejection systolic murmur in aortic region
  • Everything else normal

Stenosis:

  • Ejection systolic murmur in aortic region
  • Murmur radiates to carotids
  • Slow rising pulse
  • Narrow pulse pressure
  • Heaving apex beat
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5
Q

What are the causes of aortic stenosis?

A

Calcification degeneraion

Bicuspid vale

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6
Q

What are the symptoms of aortic stenosis?

A
  • syncope
  • angina (because coronary arteries are not filling sufficiently
  • LV heart failure
  • sudden death
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7
Q

What are the signs of severe aortic stenosis?

A
  • heaving apex beat
  • palpable thrill
  • narrow pulse pressure/slow rising pulse
  • CCF features
  • Symptomatic

‘ASH’ - decreasing prognosis:

  • angina
  • syncope
  • heart failure
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8
Q

What are the indications for surgery of aortic stenosis?

A
  • symptomatic
  • CCF signs
  • mean transvalvular pressure gradient >40mmHg, valve area <1cm2 or jet velocity >4m/s
  • concomitant CABG
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9
Q

How do you grade heart murmurs?

A
  1. Just audible to expert
  2. Just audible to non-expert
  3. Clearly audible
  4. Clearly audible with palpable thrill
  5. Audible with stethoscope pressed lightly
  6. Audible without stethoscope on chest
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10
Q

What are the two differentials for a sternotomy scar and how do you differentiate them?

A

Valve replacement - Heart sounds

CABG - saphenous harvest, signs of RF e.g. tar staining, xanthelasma

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11
Q

What is the main differential if someone has a sternotomy scar and warfarin?

A

Metallic valve replacement

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12
Q

What does a metallic click on the first heart sound indicate?

A

Metal mitral valve replacement

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13
Q

What are the differential diagnoses for a patient with a sternotomy scar, no saphenous scar and no metallic heart sounds?

A

Tissue valve replacement
CABG
Congenital heart disease repair

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14
Q

What type of valve replacements are there?

A

Metallic or tissue

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15
Q

Do metallic or tissue valves have a higher chance of blood clots?

A

Metallic

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16
Q

What does a metallic click on the second heart sound indicate?

A

Metal aortic valve replacement

17
Q

What vessels can be used in CABG and what are their longevities?

A

Great saphenous vein - poor longevity as it becomes atherosclerosed quickly as it is a vein

Internal thoracic (mammary) artery - greater longevity

18
Q

What are the indications for CABG?

A

Left main-stem disease
2 or more vessel disease
Failure of medical management
Concomitant (aortiC) valvular replacement

19
Q

What medications would you give post-CABG?

A
  • Dual antiplatelet therapy [aspirin + clopidogrel] for 12 months then aspirin along for life
  • Cardio-selective beta blocker e.g. bisprolol
  • ACE-inhibitor or ARB
20
Q

What is the main differential for someone with no sternotomy scar, normal pulse and a pansystolic murmur?

A

Mitral valve regurgitation

21
Q

What sort of murmur would you expect to hear in mitral valve regurgitation?

A

Pansystolic murmur heard only at mitral region

22
Q

What are the differentials for a systolic murmur heard loudest in the upper chest?

A

Aortic stenosis

Aortic sclerosis

23
Q

What is the differential for a systolic murmur heard loudest at the apex?

A

Mitral regurgitation

24
Q

What is the manouvre to hear the murmur in aortic stenosis?

A

Auscultates carotids whilst patient hears breath

25
Q

What is the manouvre to hear the murmur in aortic regurgitation?

A

Listen to mitral area whilst patient sits forward on expiration

26
Q

What is the manouvre to hear the murmur in mitral regurgitation?

A

Roll patient to left side and listen to mitral region on expiration

27
Q

What is the manouvre to hear the murmur in mitral stenosis?

A

Roll patient to left side and listen to mitral region on expiration

28
Q

What are the causes of mitral regurgitation?

A
  • CHRONIC
    > Myxomatous degeneration - degeneration of extracellular matrix of valve leaflets leaving them oedematous and floppy
    > Fuctional - LV dilation weakens the papillary muscles
  • ACUTE
    > IE
    > Papillary muscle rupture following inferior or posterior MI
29
Q

What are the signs of severe mitral regurgitation?

A
  • Displaced apex beat

- LV failure

30
Q

What is the main differential of a patient with no sternotomy scar, oedema and crackles on lung bases?

A

CCF

31
Q

Which side of the heart is failing if the JVP is raised?

A

Right

32
Q

Which side of the heart is failing if a patient has a raised JVP, a hepatojugular reflex sign, hepatomegaly, pedal oedema, sacral oedema and ascites?

A

Right

33
Q

Which side of the heart is failing if a patient has pulmonaey oedema, poor peripheral perfusion, tachyopnoea and tachycardia?

A

Left

34
Q

What are the causes of right-sided HF?

A 
- ACUTE
   > MI 
   > PE
   > IE
- CHRONIC
   > LV failure 
   > Cor pulmonale
35
Q

What are the causes of left-sided HF?

A 
- ACUTE 
   > MI 
   > IE
- CHRONIC 
   > Iscahemic cardiomyopathy 
   > Hypertensive cardiomyopathy 
   > Valvular heart disease
36
Q

What is the treatment of HF?

A
  • Lifestyle - smoking cessation, long-term o2 for cor pulmonale
  • Medicine - beta blocker, ACE-inhibitor, treat cause e.g. Afib, HTN
  • Surgery - LV assist devices or transplant

OSCE (3 decks)

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