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CMS OCSE > Cardio > Flashcards

Cardio Flashcards

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1
Q

What clinical signs do you look for from the end of the bed?

A
  • Cyanosis
  • Shortness of breath
  • Pallor
  • Malar flush
  • Oedema
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2
Q

What are the causes of cyanosis in a cardio context?

A
  • Poor circulation (peripheral vasoconstriction secondary to hypovolemia)
  • Inadequate oxygenation of blood which can be caused by right to left cardiac shunting
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3
Q

What is left to right cardiac shunting?

A

Abnormal communication between the right and left side of the heart allowing blood to flow directly from one circulatory system to the other. A right-to-left shunt allows deoxygenated systemic venous blood to bypass the lungs and return to the body.

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4
Q

What does shortness of breath suggest in a cardiac context?

A

Congestive heart failure or pericarditis

can also suggest pneumonia and pulmonary embolism

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5
Q

What does pallor suggest in a cardiac context?

A
  • underlying anaemia due to haemorrhage or chronic disease

- Poor perfusion which can be caused by congestive cardiac failure

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6
Q

What is congestive heart failure ?

A

-Chronic progressive condition that affects the pumping power of your heart muscle meaning muscle is pumped insufficiently

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7
Q

What does Malar flush suggest in a cardiac context?

A

mitral stenosis

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8
Q

What is the most likely reason for oedema in a cardiac context?

A

Congestive heart failure ( as the blood is unable to pump insufficiently around the body it pools in legs, ankles and feet)

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9
Q

What objects and equipment should you look for in a cardio exam?

A
  • Medical equipment such as oxygen delivery devices, ECG leads, medications (e.g. glyceryl trinitrate spray), catheters (note volume/colour of urine) and intravenous access
  • Mobility aids
  • Pillows (those with congestive heart failure suffer from orthopnoea)
  • Vital signs
  • Fluid balance
  • Prescriptions
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10
Q

What should you inspect the hands for?

A
  • Colour
  • Tar staining
  • Xanthomata
  • Spider fingers (arachnodactyly)
  • Splinter haemorrhages
  • Janeway lesions
  • Osler nodes
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11
Q

What can the colour of the hands suggest?

A
  • Pallor cans biggest poor peripheral perfusion (CHF)

- Cyanosis can indicate hypoxaemia

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12
Q

Why is it important to look for tar staining?

A

Smoking is a significant risk factor for coronary artery disease and hypertension

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13
Q

What is xanthomata?

A
  • Raised yellow cholesterol rich deposits that are palm, tendon of wrist and elbow
  • They are associated with hyperlipidaemia (typically familial). This is a big risk for CAD
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14
Q

Why is arachnodactyly significant?

A

Features or Marfan’s syndrome which is associated with mitral/aortic valve prolapse and aortic dissection

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15
Q

What is finer clubbing?

A

Uniform soft tissue swelling of the terminal phalanx of a digit - there is loss of the normal angle between the nail and the nail bed

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16
Q

What is the most likely underlying cause of finger clubbing in a cardiac context?

A
  • congenital cyanotic heart disease
  • Infective endocarditis
  • Atrial myxoma
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17
Q

What is atrial myxoma?

A

Tumour/caner of atrium

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18
Q

What should you see when you ask patient to put nails of index fingers together?

A

Schamroth’s window

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19
Q

What are can cause splinter haemorrhages?

A
  • Local trauma
  • Infective endocarditis
  • Sepsis
  • Vasculitis
  • Psoriatic nail disease
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20
Q

What are Janeway lesions?

A

Non-tender haemorrhage lesions that occur on palms and soles

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21
Q

What are Janeway lesions associated with?

A

Infective endocarditis

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22
Q

What are Osler nodes?

A

Tender, raised lumps with a pale centre that are located on fingers and toes

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23
Q

what are Osler nodes associated with?

A

Infective endocarditis

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24
Q

What could cool hands suggest when palpating for temperature?

A

Poor perfusion

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25
What could sweaty/clammy hands suggest when palpating for temperature?
Acute coronary syndrome
26
What does a capillary refill time >2 seconds suggest?
Poor peripheral perfusion (hypovolamemia, congestive heart failure)
27
What do you asses when feeling radial pulse?
Rate and rhythm
28
what should the pulse rate be between?
60-100
29
What could cause bradycardia?
Healthy athletic individuals, supraventricular tecahycardia, hypovolaemia, hyperthyroidsim
30
What could cause tachycardia?
anxiety, supraventricular tachycardia, hypovolaemia, hyperthyroidism
31
What is the most common cause of irregular rhythm?
atrial fibirilation bit can also be caused by ectopic beats in healthy individuals and AV blocks
32
What is radio-radial delay?
Loss of synchronicity between radial pulses on each arm
33
What are the causes of radio-radial delay?
- Subclavain artery stenosis - Aortic dissection - Aortic coarctation
34
What is aortic coarctation?
Coarctation of the aorta is a narrowing, or constriction, in a portion of the aorta. The condition forces the heart to pump harder to get blood through the aorta and on to the rest of the body.
35
What is a collapsing pulse?
A forceful pulse that rapidly increases and subsequently collapses - also known as a water hammer pulse
36
what do you feel with collapsing pulse?
As blood empties from arm is diastole, you should feel a tapping pulse through the muscle bulk of the arm - this is caused by the sudden retraction of the column of blood within the arm during diastole
37
What are the causes collapsing pulse?
- Normal physiological states (fever, pregnancy) - Cardiac lesions (aortic regurgitation, patent ductus arteriosus) - High output states (anaemia, AV fistula, thyrotoxins)
38
What do you assess when you palpate the brachial pulse?
Volume and character
39
How do you palpate the brachial pulse?
Palpate medial to the biceps brachii tendon - deeper palpation is required compared to radial due tot the location of the brachial artery
40
How do can charter of pulse be described?
- Normal - Slow-rising - Bounding - Thready
41
What is a slow rising character pulse associated with?
Aortic stenosis
42
What is a bounding character pulse associated with?
Aortic regurgitation
43
What is thready character pulse associated with?
Intravascular hypvolaemia in sepsis
44
Where should you measure blood pressure?
in both arms and when lying and standing
45
What is classed as hypertension?
- greater than 140/90 mmHg if under 80 years old | - greater or equal 150/90 mmHg over 80
46
What is classed as hypotension?
less than 90/60 mmHg
47
What narrow pulse pressure?
less than 25mmHg difference in systolic and diastolic pulse pressure
48
What is wide pulse pressure?
more than 100mmHg difference between systolic and diastolic blood pressure
49
What can cause narrow pulse pressure?
Aortic stenosis, congestive heart failure and cardiac tamponade
50
What can cause wide pressure pulse?
Aortic regurgitation and aortic dissection
51
What is seen as a significant difference in blood pressure between arms?
20mmHg
52
What does a difference in blood pressure suggest?
Aortic dissection
53
Why is it important to auscultate the carotid artery before palpating?
-Auscultate to rule out the presence of a bruit which can suggest underlying carotid stenosis which could dislodging of a carotid plaque causing an ischaemic stroke
54
How do you auscultate the carotid artery?
ask patient to take deep in and hold
55
What do you assess when palpating the carotid pulse?
character and volume
56
What does the JVP give an indirect measure of?
Central venous pressure
57
What does a raised JVP indicate?
Venous hypertension
58
What are the cardiac causes of raised JVP?
- Right-sided heart failure (commonly caused by left sided heart failure and pulmonary hypertension can also cause right sided heart failure) - Tricuspid regurgitation (causes include infective endocarditis and rheumatic heart disease) - Constrictive pericarditis (idiopathic TB)
59
What is a normal finding when exciting the hepatoajugualar reflux?
In healthy individuals there should be a rise that should last for no longer than 1-2 cardiac cycles and it should fall
60
What is classed as a positive hepatoajugualar reflex?
A sustained rise that is equal or greater than 4cm
61
What does a positive hepatojugular reflux suggest?
The right ventricle is unable to accommodate an increased venous return
62
What conditions can produce a positive hepatojugular reflux?
- Constrictive pericarditis - Right ventricular failure - Left ventricular failure - Restrictive cardiomyopathy
63
what eye signs are relevant in cardio exam?
- Conjunctival pallor - Corneal Marcus - Xanthelasma - Kayser-Fleischer rings
64
What does conjunctival pallor suggest?
Anaemia
65
What does corneal arcus suggest?
suggests underlying hypercholesterolaemia
66
What is corneal arcus?
A hazy white, grey or blue opaque ring in peripheral cornea
67
What is Xanthelasma suggest?
Hypercholesterolaemia
68
What are Kayser-fleischer rings associated with?
Wilsons disease - this involves abnormal copper processing in the liver resulting in accumulation and deposition in various tissues including the heart where it can cause cardiomyopathy
69
What are Kayser-fleischer rings?
Dark rings
70
What are relevant clinical signs in the mouth in a cardio exam?
- Central cyanosis - Angular stomatitis - High arched palate - Poor dental hygiene
71
What is central cyanosis in the mouth associated with=?
hypoxameia which can be caused by a right to left cardiac shunt
72
What is angular stomatitis?
A inflammatory condition impacting the corners of the mouth - this can be caused by iron deficiency
73
What can high arched palate be a sign of?
Marfans syndrome - this can be associated with mitral/aortic valve prolapse and aortic dissection
74
why in dental hygiene important to consider in a cardiac exam?
Poor dental hygiene is a risk factor for infective endocarditis
75
What should you look for when inspecting the anterior chest?
Scars suggestive of previous thoracic surgery: see the thoracic scars section below. Pectus excavatum: a caved-in or sunken appearance of the chest. Pectus carinatum: protrusion of the sternum and ribs. Visible pulsations: a forceful apex beat may be visible secondary to underlying ventricular hypertrophy.
76
What are the important thoracic scars?
Median sternotomy scar: located in the midline of the thorax. This surgical approach is used for cardiac valve replacement and coronary artery bypass grafts (CABG). Anterolateral thoracotomy scar: located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space. This surgical approach is used for minimally invasive cardiac valve surgery. Infraclavicular scar: located in the infraclavicular region (on either side). This surgical approach is used for pacemaker insertion. Left mid-axillary scar: this surgical approach is used for the insertion of a subcutaneous implantable cardioverter-defibrillator (ICD).

CMS OCSE (2 decks)

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