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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
What might cause a late systolic murmur?
Mitral Valve Prolapse
26
What might cause an early systolic murmur?
Acute severe MR
27
What can cause an early diastolic murmur?
Aortic Regurgitation Pulmonary Regurgitation
28
What can cause a mid-late diastolic murmur?
Mitral Stenosis Austin Flint Murmur (Severe AR)
29
Ejection Systolic Murmur, Likely AS
30
Normal
31
S4 - Severe LVH, Diastolic HF
32
Mitral Stenosis
33
Mitral Regurgitation
34
What are the peripheral features of AS?
Narrow Pulse Pressure
35
Whart are the causes of aortic stenosis?
calcific is most common (due to inflammation in the elderly) Congenital bicuspid 1-2% Rheumatic fever Supravalvular AS
36
When is a valve replacement indicated in AS?
Symptomatic patients Asymptomatic if EF40%, Need for CABG, Abnormal BP when exercising, VT, small valve area
37
What are the main indications for a pacemaker?
Persistent symptomatic bradycardia Complete/Mobitz 2/ Persistent Heart blocks Resistant tachyarrhythmias Some cardiomyopathies
38
What are the different types of pacemaker?
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
What do pacemaker codes mean?
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
What can cause heart failure?
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
How do you treat Heart Failure?
Conservative - Weight, restrict salt, fluid restrict, bed rest and exercise in balance. Medication - +ve prognosis = ACEi, BBs, Statin, Aspirin, Spironolactone Symptomatic - Digoxin? Diuretics
42
Name some causes of AF
Cardiac - Mitral/Aortic valve disease, MI, Pericarditis/Myocarditis Resp - PE, Pneumonia Metabolic - thyrotoxicosis, Alcohol, stimulant drugs Other - Idiopathic, Post surgery, sepsis
43
How do you do a cardio exam?
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
What causes a collapsing pulse?
Aortic regurg Thyrotoxicosis Anaemia Pregnancy
45
What might cause an absent radial pulse?
Unusual anatomy Trauma Coarctation of the aorta Artherosclerosis
46
Ecchymoses from anticoagulation
47
Malar Flush - Mitral Stenosis
48
High arched palate - Marfan's, associated with Mitral valve prolapse and aortic regurgitation
49
What can cause a raised JVP
CCF, RHF, Cor Pulmonale Constrictive Pericarditis Tricuspid regurgitation
50
Which other signs would help diagnosis in a pt with a midline sternotomy?
Metallci click - metallic valve Murmur - Tissue valve Vein harvest on legs - CABG Young - Congenital repair Immunosuppressed = Heart transplant Nothing = tamponade?
51
How do pacemakers work?
Usually for bradyarrhythmias Either inhibit early contractions or pace late ones.
52
Pectus Excavatum Pectus Carinatum
53
What does a displaced apex beat indicate?
Dilated cardiomyopathy Regurgitation
54
What does a heaving apex beat indicate?
Pressure overload Stenosis
55
Signs of AS?
Slow rising pulse (feel with four fingers across the pulse) Heaving apex ESM, quiet S2, radiates to carotid
56
Signs of MR?
L Parasternal heave Displaced Apex PSM, Soft S1, Quiet S2, Radiates to axilla
57
Signs of AR?
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
MS Signs
L Parasternal heave Malar flush MDM, Loud S1, early diastolic opening snap
59
How would you check a valve replacement is functioning properly?
INR and Hb check (MAHA) Echo Endocarditis advice
60
CABG scar from vein harvest Likely greater saphenous vein
61
DVT
62
How would you present a cardio exam?

Finals Elliot (12 decks)

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