Things to know for the OSCE Cardiovascular Flashcards
What are the cardiovascular causes of Clubbing
- Congenital cyanotic heart disease
- infective endocarditis
What are Osler’s node
- red, tender nodules on fingers pulps or thenar eminence (immune complex deposition)
- seen in infective endocarditis as rare and late sing
What are Janeway lesions
- non tender macular papular lesions seen on palms or finger pulps (embolic phenomenon) - infective endocarditis - rare
What can cause radio-radial delay
- aortic correction
- aortic dissection
- subclavian artery stenosis
What can cause a collapsing pulse
- Aortic regurgitation
- PDA
- pregnancy
- fever
- thyrotoxicosis
What can cause pulses paradoxus
- cardiac tamponade (late)
- severe acute/COPD
What is pulses paradoxus
- pulse wave volume decreases significantly during inspiration
What are the signs of hypercholestrolaemia in eyes
- Corneal arcus - significant only if <50 years old
- xanthelasma
What is mitral faces suggestive of
mitral stenosis
what can cause central cyanosis
- hypoxaemia - e.g. right to left cardiac shunt
What is Kussmaul’s sign
- JVP will rise with inspiration in pericardial constriction, right ventricular infarction or cardiac tamponade
What can cause a raised JVP
- right sided heart failure - e.g. due to left sided heart failure or pulmonary hypertension
- tricuspid regurgitation
- constrictive pericarditis
What is a thrill
a palpable vibration caused by turbulent blood flow through the heart valve (palpable murmur)
What is a heave
- right ventricular hypertrophy
What can cause displacement of the apex beat
- cardiomegaly (e.g. cardiomyopathy, CCF) mediastinal shift (e.g. Pleural effusion, tension pneumothorax)
What can cause a forceful and sustained apex beat
- pressure-loaded
- e.g. left ventricular hypertrophy
What is the cause of a forceful and non sustained apex beat
- volume loaded
- e.g. hyper metabolic states, aortic/mitral regurgitation
What causes a double impulse apex beat
Hypertrophic cardiomyopathy
Where are the valves
- aortic 2nd intercostal space right sternal edge
- pulmonary 2nd intercostal space in left sternal edge
- tricuspid 4th/5th intercostal space lower left sternal edge
- mitral 5th intercostal space midclavicular line
How do you find the mitral stenosis
- mid diastolic rumble
- ask patient to roll onto their left side and ausculate the mitral area using the bell
How do you find mitral regurgitation
- pan systolic murmur
- in the same position, ausculate in the mitral area again this time using the diaphragm
- ausculate into the axilla to identify radiation of this murmur
How do you find aortic stenosis
- Ejection systolic
- with the patient back in normal seated position, auscultate int he carotid arteries using the diaphragm m
How do you find aortic regurgitation
- early diastolic murmur
- sit the patient forwards and auscultate over the aortic areas with the diaphragm
What investigations would you perform
- full set of abs
- peripheral vascular and respiratory exam
- ECG
- bloods
- CXR
- Echo
