OSCE Flashcards
Name three investigations (bedside and imaging) which may be useful in the context of a suspected ventricular septal defect (VSD)
Pulse oximetry
Echocardiogram
Chest X-ray
ECG
What would pulse oximetry show if there is a ventricular septal defect?
VSD causes reduced oxygen saturation from the mixing of blood or from decreased cardiac output secondary to pulmonary hypertension
What might be seen on a CXR with a VSD?
: may reveal cardiomegaly and pulmonary oedema
What would an ECG show in VSD?
May show LV hypertrophy in moderate or large VSDs. Pulmonary hypertension may also cause increased RV pressure and RV hypertrophy.
What murmur is seen in VSD?
Pansystollic
Loudest at the lower-left sternal border
What is clubbing?
uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
What are the cardiac causes of clubbing?
Congenital cyanotic heart disease Infective endocarditis Atrial myxoma (very rare)
What is the test for clubbing called?
Shamroth’s Window test
What is a clamshell incision?
urvilinear ‘W’ shape that extends across the anterior chest from the mid-axillary line on either side and is located in the sub-mammary fold
What does a clamshell incision indicate?
provides complete exposure to the thoracic cavity
used procedures requiring bilateral access
e.g. malignancy, bilateral transplant
Describe the clinical relevance of jugular venous pressure
Jugular venous pressure provides an indirect measure of central venous pressure.
What are the cardiac causes of a raised JVP?
Right-sided heart failure
Tricuspid regurgitation
Constrictive pericarditis
What are some causes of right-sided HF?
left-sided HF
pulmonary hypertension
What are some causes of pulmonary hypertension?
COPD
Interstitial lung disease
What are some causes of constrictive pericarditis?
Idiopathic
Rheumatoid Arthritis
TB
Define aortic stenosis
Aortic stenosis is one of the most common and serious valve disease problems. It is a narrowing of the aortic valve opening and restricts the blood flow from the left ventricle to the aorta.
What murmur is heard with aortic stenosis?
Cresendo-decrescendo midsystolic ejection murmur
Radiates to the carotids
Louder on expiration and leaning forwards
What is a thrill?
Palpable vibration caused by turbulent blood flow through a heart valve
What are some causes of aortic stenosis?
Calcification of aortic valves
Congenital bicuspid aortic valve
Rheumatic heart disease
When does mitral regurgitation occur?
Back flow of blood from left ventricle to left atria during ventricular systole
What murmur is heard with mitral regurgitation?
Pan-systolic murmur
Loudest on expiration and when patient is leaned to the LHS and using the bell
Radiates to axilla
What are some causes of mitral regurgitation?
Infective endocarditis Acute myocardial infarction with rupture of papillary muscles Rheumatic heart disease Congenital defects of the mitral valve Cardiomyopathy
What is aortic regurgitation?
Backflow of blood from the aorta into the left ventricle during ventricular diastole.
What murmur is heard with aortic regurgitation?
Decressendo Early diastolic murmur
Loudest at the left sternal edge
What are the two main causes of aortic regurgitation?
Valvular disease
Aortic root dilatation
What are some valvular diseases?
Congenital bicuspid aortic valve
Rheumatic heart disease
Infective endocarditis
What are some causes of aortic root dilatation?
Aortic dissection
Connective tissue disease e.g. Marfans
Aortitis
What is mitral stenosis?
narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure (due to incomplete left atrial emptying)
What murmur is heard with mitral stenosis?
low-pitched, rumbling, mid-diastolic murmur
loudest over apex when manoeuvred to left
What is the most common cause of mitral stenosis?
Rheumatic heart disease
What are some clinical features of mitral stenosis?
Low-volume pulse, could be irregularly irregular (AF is common)
Loud S1 with tapping apex beat
Malar flush
When does mitral valve proplase occur?
mitral valve leaflets prolapse into the left atrium during systole
most common valvular abnormality
What are the clinical features of a mitral valve prolapse?
Mid-systolic click (prolapse of the mitral valve into left atrium)
Followed by a mid or late-systolic murmur
Heard loudest at the apex
Loudest in expiration
What is tricuspid regurgitation?
Backflow of blood from the right ventricle into the right atrium during ventricular systole
What murmur is heard in tricuspid regurgitation?
Pansystolic murmur heard loudest over the tricuspid region
What are some causes of tricuspid regurgitation?
RV dilatation secondary to pulmonary stenosis or pulmonary HTN
Rheumatic fever
Infective endocarditis
Carcinoid syndrome
Congenital
What are some signs of right-sided heart failure?
Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites
What is pulmonary stenosis?
Narrowing of the pulmonary valve
What are some causes of pulmonary stenosis?
Turner’s
Rheumatic fever
Carcinoid syndrome
What murmur is heard in pulmonary stenosis?
Ejection systolic murmur loudest on inspiration
Radiates to left shoulder/infraclavicular region
What is pulmonary regurgitation?
Backflow of blood from the pulmonary artery into the right ventricle during ventricular diastole
V rare
What are some causes of pulmonary regurgitation?
Pulmonary hypertension
Infective endocarditis
Congenital valvular heart disease
What is tricuspid stenosis?
Narrowing of the tricuspid valve
What murmur is heard in tricuspid stenosis?
Narrowing of the tricuspid valve
When do you get radio-femoral delay?
Coarctation of aorta
What is the management for an uncomplicated descending aorta dissection?
Medically - beta blockade and analgesia
How are aortic dissection’s classified?
Stanford classification
type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases
What investigations are done for aortic dissection?
Unstable patient - Transoesophageal echocardiography
Stable patient - CT angiography
For how long can you not drive post MI no angioplasty?
4 weeks
For how long can you not drive post MI with angioplasty?
1 week
For how long can you not drive following pacemaker insertion?
1 week
For how long can you not drive following CABG?
4 weeks
How is symptomatic bradycardia treated?
IV atropine
What is treatment for newly diagnose hypertension?
CCB first line for non-diabetics
Give an example of a CCB
Amplodipine
When is a ACEi first line HTN treatment?
In diabetes
Give an example of a ACEi
Ramipirl
What is the management for narrow tachycardia?
If no shock:
Vasovagal manoeuvre
Adenosine or Verapamil if asthmatic
If signs of shock:
DC cardioversion
What is the first line treatment for regular broad complex tachycardias without adverse features?
IV amiodarone
What is first-line treatment for SVT with narrow complexed tachycardia?S
IV adenosine
When are J waves seen?
Hypothermia
When are delta waves seen?
WPW
When are U-waves seen?
Hypokalaemia
What might be seen on CXR in aortic dissection?
Widened mediastinum
What is the treatment for torsades des pointes?
IV Mg
