Physical/Cardiac signs Flashcards
What is the difference between Cox1 and Cox2?
-Celecoxib and rofecoxib, which selectively inhibit the COX-2 enzyme, are as efficacious as other non-steroidal anti-inflammatory drugs, but reduce the risk of serious gastrointestinal bleeding and ulceration. - COX-2 selective inhibitors may come at the cost of an increased risk of thrombosis in patients with ischaemic heart disease if they are not also taking aspirin. Like the older non-steroidal anti-inflammatory drugs, the COX-2 selective inhibitors can also increase blood pressure, induce or worsen cardiac failure and impair kidney function to the point of renal failure -In platelets, inhibition of COX-1 leads to inhibition of thromboxane A2 synthesis. This very effectively inhibits platelet aggregation. Low-dose aspirin irreversibly inhibits platelet aggregation via this mechanism and is therefore widely employed as prophylaxis against thrombotic cardiovascular disease. At therapeutic doses, COX-2 selective inhibitors have little effect on the COX-1 enzyme, so they do not inhibit platelet aggregation.
Heart issues based on appearance?
Marfans: Genetic condition effecting the CT. Elongated Arms, increase in flexibility of joints, scoliosis, AA and mitral valve prolapse. FBN1 gene mutation. Management often includes the use of beta blockers such as propranolol or atenolol or, if that is not tolerated, calcium channel blockers or ACE inhibitors Down Syndrome: third copy of chromosome 21. 99% have mental impairment, flexible ligaments, flattened nose, slanted eyes, congential heart disease, teeth and tonghe and palate issues.
SOB/Dysponea indicate?
LVF (exertional) , PE, pericarditis, mitral stenosis
Tachypnoa indicates?
Rapid Breathing LVF (increased pulmonary pressure), acute cardiac tamponade Severe pulmonary hypertension Valve disease, mitral stenosis, mitral regurgitation
Peripheral odema indicates ?
RVF, mitral stenosis, chronic constrictive pericarditis
Cardiac cachexia indicates?
Cardiac cachexia is unintentional severe weight loss caused by heart disease. The weight loss might be life-threatening. It can happen to people who have severe heart failure. Even with a very good appetite and high calorie intake, some people lose muscle mass. LVF, chronic constrictive pericarditis
Generalized pallor indicates?
IE (anemia)
Fatigued appearance indicates?
mitral stenosis, mitral regurgitation
Cheyne Stoke breathing indicates?
severe LVF
Face and Eye changes?
Xanthelasma or corneal arcus – hyperlipidemia Pull down lower eyelid – color changes Conjunctival pallor – anaemia, IE Conjunctival/retinal haemorrhage – IE Yellow – jaundice Mitral Facies: rosy cheeks with a bluish tinge Mitral stenosis
Hand changes?
Look at hands and get patients to turn it over Peripheral cyanosis – LVF, RVF, severe pulmonary hypertension, valve disease, cardiomyopathy, Congenital heart disease (transposition) IE- splinter haemmorhages, osler’s nodes, Janeway lesions Finger clubbing – IE, pulmonary hypertension, R to L shunt, congenital – TO Temperature of arms – cold extremities – pulmonary hyper tension – low cardiac output Capillary refill time
Changes in pulse?
Rate, rhythm and character in one wrist Tachycardia (> 100bpm) – LVF, acute cardiac tamponade, MI/ACS Bradycardia – MI/ACS, pulmonary stenosis (if cardiac output low) No repeating pattern with irregular beats - AF Feel both wrists – assess for radioradial delay Aortic Coarctation – Narrowing proximal to L subclavian a. In equality in strength of radial pulse Aortic dissection Collapsing pulse – sharp upstroke in pulse Aortic regurgitation PDA
Neck/Carotid Pulse changes?
Auscultate -Anterior part of SCM, above medial end of clavicle -Bruit: audible vascular sound associated with turbulent flow -Carotid artery stenosis: Disappears if auscultate over the chest Haemodialysis, thyrotoxicosis Soft carotid bruit – severe mitral regurgitation, pulmonary stenosis Inspect and Palpate carotid pulse -Character and volume -Pulse Alternans – LVF -Bifid pulse: Cardiomyopathy, aortic stenosis and aortic regurgitation -Weak thready pulse – shock -Inequality in bilateral carotids – atherosclerosis, aortic dissection -Pulsus parvus et Tardus – weak delayed pulse: Aortic stenosis -Pulsus paradoxus – cardiac tamponade
Blood pressure changes?
-Pulse pressure = systolic – diastolic Normal 40 – 60 mmHg, Low in aortic stenosis, Higher in aortic regurgitation >80mmHG -Blood pressure Diastolic low – PDA Hypotension – LVF, chronic constrictive pericarditis, PE (with cyanosis - shock) Postural blood pressure – drop of >15mmHg in SBP or 10mmHg in DBP
Inspect the mouth?
-Central cyanosis: LVF, Eisenmenger’s syndrome, congenital Heart disease Pulmonary hypertension -Pale Mucosa : anemia - Petechaea: IE
What are the signs/symptoms of CHD?
Hole in ventricular septum
Hole in artial septum
PDA - s a persistent embryonic vessel that connects the pulmonary artery and the aorta. Read about fetal heart
Coarction of aorta – constriction D to subclavian artery origin on left – causes obstruction to flow
Ebstein’s anomaly - is a downward displacement of the tricuspid valve apparatus into the right ventricle so that the right atrium becomes very large and consists partly of ventricular muscle, while the right ventricle becomes small. Tricuspid regurgitation can occur
First three cause a L to right shunt which is increasing pressure and volume in pulmonary circulation, cos increasing pressure on right side.
All other cause obstruction to flow
Cyanotic – first few cause a right to L shunt so oxy and deoxygenated blood mix so get cyanosis
