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Finals Elliot > PACES - Cardio > Flashcards

PACES - Cardio Flashcards

1
Q

What should you look for on inspection from the edge of the bed?

A

Resting state, oedema, scars, deformities, colour, ECG, O2, GTN, fluids

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2
Q

What should be assessed on examination of the hands

A

Colour, Temperature, Cap refill, Clubbing

Signs:
Splinter Haemorrhages
Osler Nodes
Janeway Lesions
Tar Staining
Tendon Xanthomata
Quinke’s Sign

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3
Q

What are the main cardiac causes of clubbing?

A

Cyanotic Congenital HD
Infective Endocarditis
Atrial Myxoma

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4
Q

How would you check for a collapsing pulse?

A

Any pain in arm/shoulder?

Raise arm above head whilst gripping forearm musculature

+ve = pulsation in forearm in AR, PDA

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5
Q

Causes of raised JVP

A

CHF/RVF
FLuid Overload
Constrictive Pericarditis
Tamponade
Pericardial Effusion

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6
Q

Which signs might you observe in the eyes?

A

Conjunctival Pallor (ask pt to pull down eyelid)
Corneal Arcus
Xanthelasma
Jaundice

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7
Q

Which signs might you observe in the face?

A

Malar Flush
Dysmorphia
De Musset’s Sign (Bobbing in AR)

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8
Q

Which signs might you observe in the mouth?

A

Cyanosis
Poor Dentition
Muller’s Sign (Bobbing of uvula in AR)

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9
Q
A

Midline Sternotomy

CABP
Open valve surgery
Cardiac Transplant
Correction of congenital cardiac defects

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10
Q
A

Anterior Thoracotomy

Lobectomy
Pneumonectomy

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11
Q
A

Clamshell Incision

Bilateral Lung Transplant
Widespread traumatic chest injury (incl large malignancy/ mediastinal malignancy resection)

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12
Q
A

Sub-Clavicular

Pacemaker Insertion

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13
Q

What can cause a displaced apex beat?

A

Cardiomegaly
LV Dilation (MR/AR)
Displacement due to RV Hypertrophy

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14
Q

What if you can’t feel the apex beat?

A

Ask patient to roll to left and exhale.
Check right in case pt dextrocardic

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15
Q

How do you feel for heaves?

A

Place the heel of your right hand over the left lower parasternal edge with a straight elbow

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16
Q

How do you assess for thrills?

A

Palpate over valve areas with pads of fingers

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17
Q

Manoeuvres for MR pansystolic murmur radiation

A

Ask patient to hold breath in expiration and listen to the axilla for radiation

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18
Q

Manoeuvre for Mitral Regurgitation

A

Listen at apex with bell
Hold expo
Roll to left lateral side

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19
Q

Manoeuvres for TR

A

Listen at Tricuspid area with bell, then diaphragm, then ask for inspiration

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20
Q

Auscultation at pulmonary area

A

Listen mainly to second heart sound
See if radiates to the back

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21
Q

Manoeuvre for listening to ejection systolic murmur (AS)

A

Louder on expiration,
Check radiation to the carotids

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22
Q

Manoeuvre for AR?

A

Early diastolic murmur
Sit pt up, lean them forward, listen for murmur when breath held in exp at aortic and tricuspid areas.

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23
Q

Name 4 causes of an ejection systolic murmur

A

AS
PS
Coarctation of the Aortic
HOCM

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24
Q

Name 3 causes of a pansystolic murmur

A

MR
TR
VSD

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25
Q

What might cause a late systolic murmur?

A

Mitral Valve Prolapse

26
Q

What might cause an early systolic murmur?

A

Acute severe MR

27
Q

What can cause an early diastolic murmur?

A

Aortic Regurgitation
Pulmonary Regurgitation

28
Q

What can cause a mid-late diastolic murmur?

A

Mitral Stenosis
Austin Flint Murmur (Severe AR)

29
Q
A

Ejection Systolic Murmur, Likely AS

30
Q
A

Normal

31
Q
A

S4 - Severe LVH, Diastolic HF

32
Q
A

Mitral Stenosis

33
Q
A

Mitral Regurgitation

34
Q

What are the peripheral features of AS?

A

Narrow Pulse Pressure

35
Q

Whart are the causes of aortic stenosis?

A

calcific is most common (due to inflammation in the elderly)

Congenital bicuspid 1-2%

Rheumatic fever
Supravalvular AS

36
Q

When is a valve replacement indicated in AS?

A

Symptomatic patients
Asymptomatic if EF40%, Need for CABG, Abnormal BP when exercising, VT, small valve area

37
Q

What are the main indications for a pacemaker?

A

Persistent symptomatic bradycardia

Complete/Mobitz 2/ Persistent Heart blocks

Resistant tachyarrhythmias

Some cardiomyopathies

38
Q

What are the different types of pacemaker?

A

Unipolar - Cases where AV conduction is likely to return

Dual-Chamber - RA/RV, Allows paced heart to follow rate increase with exercise

Dual site Atrial - RA, Coronary SInus, RV

Biventricular - RA, RV, LV, Severe HF

ICD - Directly treats cardiac tachyarrhythmias

39
Q

What do pacemaker codes mean?

A

1st Letter = chamber paced
2nd Letter = chamber sensed
3rd letter = response to sensed event
4th letter = rate-responsive features (exercise responsive)
5th Letter = Anti-tachycardia facilities

40
Q

What can cause heart failure?

A

Cardiac = Preload (Fluid overload), Cardiac muscle damage (MI, cardiomyopathy, infection, CHD etc), Afterload (HTN, PE, Dissection) High output (anaemia, thyrotoxicosis, haemochromatosis, sepsis)

non-Cardiac - ARDS, PE, PHTN, Renal failure/Artery stenosis

41
Q

How do you treat Heart Failure?

A

Conservative - Weight, restrict salt, fluid restrict, bed rest and exercise in balance.

Medication - +ve prognosis = ACEi, BBs, Statin, Aspirin, Spironolactone
Symptomatic - Digoxin? Diuretics

42
Q

Name some causes of AF

A

Cardiac - Mitral/Aortic valve disease, MI, Pericarditis/Myocarditis

Resp - PE, Pneumonia

Metabolic - thyrotoxicosis, Alcohol, stimulant drugs

Other - Idiopathic, Post surgery, sepsis

43
Q

How do you do a cardio exam?

A

Inspect
Hands - Temp, CRT
Radial Pulse, RR Delay
Collapsing Pulse
OFFER BP both arms lying standing
Face, eyes, mouth
Neck - JVP, HJR, Carotid (Bruit)

Inspect chest with arms up, look for chest wall deformities and scars

Palpation - Heaves, Thrills, Apex beat

Auscultate all valves
Mitral area, roll onto bell breathe out
Aortic area, sit forwards, breathe out

Lung bases
Sacral Oedema
Legs

44
Q

What causes a collapsing pulse?

A

Aortic regurg
Thyrotoxicosis
Anaemia
Pregnancy

45
Q

What might cause an absent radial pulse?

A

Unusual anatomy
Trauma
Coarctation of the aorta
Artherosclerosis

46
Q
A

Ecchymoses from anticoagulation

47
Q
A

Malar Flush - Mitral Stenosis

48
Q
A

High arched palate - Marfan’s, associated with Mitral valve prolapse and aortic regurgitation

49
Q

What can cause a raised JVP

A

CCF, RHF, Cor Pulmonale
Constrictive Pericarditis
Tricuspid regurgitation

50
Q

Which other signs would help diagnosis in a pt with a midline sternotomy?

A

Metallci click - metallic valve

Murmur - Tissue valve

Vein harvest on legs - CABG

Young - Congenital repair

Immunosuppressed = Heart transplant

Nothing = tamponade?

51
Q

How do pacemakers work?

A

Usually for bradyarrhythmias
Either inhibit early contractions or pace late ones.

52
Q
A

Pectus Excavatum
Pectus Carinatum

53
Q

What does a displaced apex beat indicate?

A

Dilated cardiomyopathy

Regurgitation

54
Q

What does a heaving apex beat indicate?

A

Pressure overload

Stenosis

55
Q

Signs of AS?

A

Slow rising pulse (feel with four fingers across the pulse)

Heaving apex

ESM, quiet S2, radiates to carotid

56
Q

Signs of MR?

A

L Parasternal heave

Displaced Apex

PSM, Soft S1, Quiet S2, Radiates to axilla

57
Q

Signs of AR?

A

Aortic thrill

Displaced apex

EDM at LLSE

Collapsing pulse, wide PP, LVF

De Musset’s (Head bobbing)
Muller’s (Uvula)
Quincke’s Sign (Pulsating nail beds)

58
Q

MS Signs

A

L Parasternal heave

Malar flush

MDM, Loud S1, early diastolic opening snap

59
Q

How would you check a valve replacement is functioning properly?

A

INR and Hb check (MAHA)
Echo
Endocarditis advice

60
Q
A

CABG scar from vein harvest
Likely greater saphenous vein

61
Q
A

DVT

62
Q

How would you present a cardio exam?

A

Finals Elliot (12 decks)

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