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aall osce > Cardiovascular detailed > Flashcards

Cardiovascular detailed Flashcards

1
Q

Examining hands (nails) (3)

A

Nails: clubbing, koilonychia, splinter haemorrhages

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2
Q

Examining hands (fingers) (4)

A

capillary refill time (hypovolaemia if less than 2 secs)
Peripheral cyanosis (hypoxia)
Oslers node (IE)
tar staining

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3
Q

Examining palms (1)

A

Janeway lesions (macules)

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4
Q

Pulses (4) and ______

A 
Palpate and check the rate
Palpate both pulses simultaneously for radial-radial delay
Collapsing pulse
Brachial pulse (inner elbow)
and mention BP
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5
Q

What is after hands and pulses before face?

A

BP

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6
Q

What comes directly after examining hands?

A

Pulses

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7
Q

What is after BP?

A

face

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8
Q

Examining face (4)

A
  1. General face - malar flush (MS)
  2. Eyes - conjuctival pallor (anaemia), xanthelasma, corneal arcus (hypercholestrolaemia)
  3. Mouth (central cyanosis, dentition)
  4. Tongue top and under
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9
Q

What is after face?

A

neck

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10
Q

How to examine tongue?

A

look at top and underneath

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11
Q

Neck exam (4)

A

Carotid pulse- character
Carotid pulse- volume (listen)
JVP (head 45 degrees, look) fuid overload, right ventricular failure, tricuspid regurg.
JVP press on liver and look

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12
Q

Chest Inspection (4)

A

scars
pacemaker
muscle wasting
visible pulsation (hypertension, ventricular hypertrophy)

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13
Q

Chest palpation (3)

A

Apex beat - (all prostitutes take money) aortic, pulmonary, tricuspid, mitral
heaves- place palm on left sternal edge of heart (right ventricular hypertrophy if hand lifts on systole)
thrills- light touch of palm for all 4 valves

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14
Q

Chest auscultation (10)

A
  1. Palpate appropriate pulse during aucultation
  2. Aortic valve ( diaphragm and bell)
  3. Pulmonary valve ( diaphragm and bell)
  4. Tricuspid valve (diaphragm and bell)
  5. Mitral valve (diaphragm and bell)
  6. Auscultate axilla on left side
  7. Roll patient left, listen over mitral area with bell
  8. Carotid arteries- listen with bell holding breath
  9. Sit patient forward, listen over 5th intercostal space, left sternal edge during expiration (aortic regurg)
  10. Lung bases- crackles (Pulmonary oedema)
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15
Q

three chest steps after neck

A

inspection
palpation
auscultation

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16
Q

What is after auscultation of chest?

A

Peripheries

17
Q

Peripheries (

A

.

18
Q

What would you do after peripheries?

A

Check liver- palpate, for mitral regurg. (liver fills with blood)

19
Q

What would further investigations be? 3 essentials, 4 extras for HF generally

A

3 essentials: ECG, CXR, BNP

ECG

Should be performed on all suspected heart failure patients
May indicate the underlying cause of the heart failure such as;
Myocardial infarction/ischemia
Bundle Branch Block
Ventricular hypertrophy
Pericardial disease
Arrhythmias
A normal ECG makes heart failure unlikely (sensitivity 89%)

CXR

Recommended for all suspected HF patients
Look for signs of pulmonary congestion, and rule out an alternative cause
Cardiomegaly [CTR (cardiothoracic ratio)>50% on PA]
L or RVH
Pericardial effusion if cardiac silhouette has a global appearance
Kerley B lines
Upper lobe diversion (prominent upper lobe veins)
Pleural effusions
Fluid in fissures
A normal CXR does not exclude the possibility of Heart Failure

BNP (B-type natriuretic peptide)

BNPs are peptides that cause natriuresis, diuresis and vasodilation. They are the body’s “natural defence” against hypervolaemia
BNP levels have been proven to be correlated with cardiac filling pressures
Recommended in all patients with suspected HF (UK guidelines) to stratify how urgently they need to see a specialist

Other Blood Tests

FEB – for anaemia
U+E for Hyponatremia [in severe disease due to dilution] and Hypokalemia / Hyperkalemia
LFT’s to detect extent of liver congestion/damage
TFT’s to rule out thyrotoxicosis or myxedema
HbA1c to check for co-existing T2DM

Echocardiogram

Recommended in all patients with suspected heart failure
Can confirm the diagnosis
Can calculate the ejection fraction, ventricular wall thickness and other cardiac kinetics
An ejection fraction (EF) of <40% strongly indicated heart failure
EF of 41-49% is not diagnostic, but suggestive of heart failure
Can confirm any underlying structural abnormalities – such as valve disease
Filling pressures can be estimated by doppler echocardiography
Helps to stratify the type of HF present and therefore guides management

Angiography – can be used to assess the extent of IHD

Pulmonary function tests – to exclude lung disease causing breathlessness

Urinalysis- (hypertension-proteinuria, haematuria)

Fundoscopy (hypertension-papilloedema)

20
Q

management of HF

A

https://almostadoctor.co.uk/encyclopedia/heart-failure

aall osce (3 decks)

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