OSCE - Cardio Exam Flashcards
What is radio-radial delay and what does it indicate?
- loss of synchronicity between radial pulse on each up, pulse occurring at different times.
How to assess for radio-radial delay?
- palpate both radial pulses simultaneously.
- NORMAL –> both pulses occur at the same time
- ABNORMAL –> pulses out of sync
What causes radio-radial delay? (3)
- Subclavian artery stenosis (e.g. compression by a cervical rib)
- Aortic dissection
- Aortic coarctation
What is a collapsing pulse?
Pulse which rapidly increases and subsequently collapses.
How to assess for collapsing pulse?
- Ask if there is any pain in the right shoulder
- palpate radial pulse (with right hand wrapped around patients wrist)
- palpate brachial pulse (with left hand)
- Raise patients arm above their head briskly
- palpate for collapsing pulse: blood rapidly empties during diastole - should feel tapping impulse through muscle bulk of arm .
Causes of collapsing pulse?
- Normal physiological states (fever, pregnancy)
- cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)
- high output states (e.g. anaemia, arteriovenous fistulae, thyrotoxicosis)
Types of pulse character and their associations? (4)
- Normal
- Slow rising
–> aortic stenosis - bounding
–> aortic regurgitation
–> CO2 retention - Thready
–> intravascular hypovolaemia (e.g. sepsis)
What is a NARROW pulse pressure?
less than 25mmHg of difference between systolic and diastolic blood pressure.
Causes of NARROW pulse pressure? (3)
- aortic stenosis
- congestive heart failure
- cardiac tamponade
What is a wide pulse pressure ?
More than 100mmHg difference between systolic and diastolic.
Causes of WIDE pulse pressure?
- aortic regurgitation
- aortic dissection
What condition might a difference between blood pressure in both arms indicate?
- if difference if more than 20mmHg
- AORTIC DISSECTION
What does a raised JVP indicate?
- Venous hypertension
Causes of raised JVP? (3)
- Rught sides heart failure
–> due to pulmonary HTN, from COPD or ILD - Tricuspid regurgitation
–> infective endocarditis
–> rheumatic heart disease - Constrictive pericarditis
–> often idiopathic
–> some possible underlying causes: rheumatoid arthritis, TB
What does a positive hepatojugular reflux result suggest?
- right ventricle unable to accommodate an increased venous return?
Examples of conditions that may frequently produce a positive hepatojugular reflux test?
- constrictive pericarditis
- RV failure
- LV failure
- restrictive cardiomyopathy
Hazy white, grey or blue opaque ring located in the peripheral cornea
Corneal arcus
- presence in patients under 50 may suggest hypercholesteromaemia
Common inflammatory condition affecting corners of mouth
Angular stomatitis
- wide range of causes
- may indicate iron deficiency
High arched palate is a feature of what condition?
Marfan’s syndrome
- associated with mitral / aortic valve prolapse and aortic dissection
Valve locations
Mitral valve: 5th intercostal space in the midclavicular line.
Tricuspid valve: 4th or 5th intercostal space at the lower left sternal edge.
Pulmonary valve: 2nd intercostal space at the left sternal edge.
Aortic valve: 2nd intercostal space at the right sternal edge.
Coarse crackles are suggestive off:
Pulmonary oedema
–> associated with left ventricular failure
Absent air entry and stony dullness on percussion are suggestive of:
–> underlying pleural effusion
—-> associated with left ventricular failure
Summary of further assessments and investigations you might do?
- BP
- Peripheral vascular examination
- ECG (arrhythmia or MI)
- Dipstick urine (proteinuria, haematuria –> HTN)
- Cap blood glucose (underlying DM, risk factor CVD)
- Fundoscopy (if concerns about malignancy HTN, papilloedema)
Typical signs seen with aortic regurgitation?
- Corrigan’s sign
–> visible distention and collapse of carotid arteries in the neck - De Musset’s sign
–> head bobbing with each heartbeat - Quincke’s sign
–> pulsations in nail bed with each heart beat, when nail bed lightly compressed - Traube’s sign
–> pistol shot sound heart when stethoscope over femoral artery during systole and diastole - Muller’s sign
–> uvula pulsations seen with each heart beat - Wide pulse pressure
Causes of aortic regurgitation?
Diseases affecting valve:
- congenital bicuspid aortic valve
- rheumatic heart disease
- infective endocarditis
Aortic root dilatation:
- aortic dissection
- connective tissue diseases (e.g. Marfans)
- aortitis
Management of aortic regurgitation?
- Vasodilator therapy (BB, CCB)
- Aortic valve replacement
–> TAVI if high risk
