Head to toe- Cardiology Flashcards
1
Q
General inspection- clinical signs
A
- Cyanosis- bluish discolouration a result of poor circulation (peripheral vasocontriction 2’ hypovolaemia) or inadequate oxygenation of the blood (right-to-left cardiac shunting)
- SOB- may indicate underlying CVD (CCF, pericarditis) or respiratory (PE, pneumonia)
- Pallor- A pale colour suggesting anaemia (e.g. Haemorrhage, chronic disease) or poor perfusion (e.g. CCF)
- Malar flush- plum-red discolouration of the cheeks associated with mitral stenosis
- Oedema- ascities, CCF
2
Q
Hands- general observations
A
- Colour- pallor suggests poor peripheral perfusion (CCF) and cyanosis may indicate underlying hypoxaemia
- Tar staining
- Xanthomata- Cholesterol depositis
- Arachnodactyly- Fingers and toes are abnormally long and slender, in comparison to the palm of the hand. This is a feature of Marfan’s syndrome, which is associated with Mitral/Aortic valve prolapse and aortic dissection
3
Q
Finger clubbing
A
- Congenital cyanotic heart disease
- Infective endocarditis
4
Q
Signs in the hands associated with endocarditis
A
- Splinter haemorrhages- septic emboli
- Janeway lesions- Non-tender lesions occur on the thenar and hypothenar eminences of the palms
- Osler Nodes- Red-purple, raised, tender lumps often with a pale centre found on the finger/toes
5
Q
Palpation of hands
A
- Temperature- Poor perfusion (HF/ACS)
- Cool/sweaty/clammy- ACS
- CRT- >2s- poor perfusion as a result of hypovolaemia, CCF, shock)
6
Q
Collapsing pulse
A
- Briskly moving the patients arm above their head with your hand around the patients wrist
- As the blood empties from the arm in diastole, you should be able to feel a tapping impulse through the muscle bulk of the arm. This is caused by the sudden retraction of the column of blood within the arm during diastole
7
Q
Causes of collapsing pulse
A
- Normal physiological states- fever, pregnancy
- Caridac lesions- Aortic regurg
- High output states- Anaemia, AV fistula, thyrotoxicosis
8
Q
JVP + causes
A
- Assess the JVP by looking at the distance between the sternal angle and the top of the IJV (should be no greater than 3cm)
- Right sided heart failure- this is caused by left sided heart failure, pulmonary HTN, COPD, ILD
- Tricuspid regurgitation- caused by IE, rheumatic heart disease
- Constrictive pericarditis- often idiopathic byt can be caused by RA, TB
9
Q
Eyes
A
- Conjuctival Pallor
- Corneal Arcus
- Xanthalasma
- Kayser-Fleischer rings
10
Q
Mouth
A
- Central cyanosis- Hypoxaemia
- Angular stomatitis
- High arched palate- Marfans syndrome which is assocaited with mitral/aortic valve prolapse and aortic dissection
- Dental hygene- high risk factor for endocarditis
11
Q
Palpation
A
- Apex beat- displacement caused by ventricular hypertrophy
- Heaves- Parasternal heaves are typically associated with RV hypertrophy
- Thrills- palpable murmur will depend on the location of the thrill (APTM)
12
Q
Aortic stenosis clinical feature
A
- Calcification of the aortic valve
- Ejection systolic murmurs heard loudest over the aortic area and can radiate through the carotids
- Loudest when pt leaning forward
- Can have reduced or absent S1
13
Q
Mitral regurgitation
A
- Backflow of blood from left ventricle to left atria
- Is associated with a pansystolic murmur can radiate to axilla
- Caused by IE, Acute MI, Rheumatic heart disease, cardiomyopathy
14
Q
Aortic regurgitation
A
- Back flow of blood from aorta into the L ventricle during diastole
- Early diastolic murmer heard loudest at L sternal edge
- Causes affecting valve: Congential, Rheumatic heart disease, IE
- Causes affective aortic root dilation- Aortic disection, Connective tissue disorder (e.g. Marfan’s), Aortitis
15
Q
Mitral stenosis
A
- narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure (due to incomplete left atrial emptying)
- Causes- Rheumatic heart disease, Marfans, L atria myxoma
- Low pitched rumbling mid-diastole murmer with an opening click
