Cardio MedEd Part 2

Question 1

What scars do you look for on the inspection of the chest?

Answer 1

1. Implantable electronic device
2. Minimally invasive surgery
3. Median sternotomy
4. Left thoractomy
5. Chest drain scars
6. Right thoractomy

Question 2

What are examples of implantable electronic devices?

Answer 2

1. Pacemaker
2. Defibrillator
3. Resynchronisation device

Question 3

What are examples of minimally invasive surgeries?

Answer 3

1. Repair of septal defects
2. Tricuspid valve surgery
3. Aortic valve surgery
4. Mitral valve surgery

Question 4

What surgeries may cause of a median sternotomy scar?

Answer 4

1. Mitral valve surgery
2. Repair of the transposition of the great arteries
3. Fontan circulation with fenestration
4. Repair of tetralogy of Fallot
5. Central shunt
6. Pulmonary artery banding
7. CABG

Question 5

What may give a left thoracotomy scar?

Answer 5

1. Repair of coarcation of the aorta
2. Ligation of patent ductus arteriosus
3. Pulmonary artery banding
4. Balock-Taussing shunt
5. Mitral valve surgery

Question 6

What would cause a right thoracotomy scar

Answer 6

1. pulmonary artery banding

2. Balock-Taussing shunt

Question 7

When would you look in legs for scars?

Answer 7

If midline sternotomy scar (vein harvesting for CABG)

Question 8

What may cause a left submammary scar?

Answer 8

1. mitral valvotomy

2. pericardial window

Question 9

Where is the apex beat usually found?

Answer 9

5th intercostal space in midclavicular line

Question 10

When might the apex beat be displaced?

Answer 10

ventricular hypertrophy

Question 11

What is a parasternal heave?

Answer 11

precordial (chest) impulse that can be palpated

Question 12

How do you feel parasternal heave?

Answer 12

• heel of your handparallel to theleft sternal edge(fingers vertical)
• you should feel the heel of your hand beingliftedwith each systole

Question 13

When are parasternal heaves present?

Answer 13

right ventricular hypertrophy

Question 14

What is a thrill?

Answer 14

apalpable vibrationcaused byturbulent blood flowthrough a heart valve (a thrill is a palpable murmur)

Question 15

How do you palpate for thrills?

Answer 15

1. each of the heart valvesin turn
2. place your handhorizontallyacross the chest wall, with theflats of your fingersandpalm over thevalveto be assessed

Question 16

Where is the mitral valve?

Answer 16

5th intercostal space in mid clavicular line

Question 17

Where is the tricuspid valve?

Answer 17

4th or 5th intercostal space at the lower left sternal edge

Question 18

Where is pulmonary valve?

Answer 18

2nd intercostal space at the left sternal edge

Question 19

Where is aortic valve?

Answer 19

2nd intercostal space at the right sternal edge.

Question 20

What are the normal heart sounds?

Answer 20

LUB DUB

Question 21

What is the s1 sound?

Answer 21

lub

Question 22

What is the s2 sound?

Answer 22

dub

Question 23

What is a sound between s1 and s2 classified as?

Answer 23

systolic

Question 24

What is a sound after s2 classified as?

Answer 24

diastolic

Question 25

What is the sound of an ejection systolic murmur?

Answer 25

whoosh dub

Question 26

Where would you here an ejection systolic murmur?

Answer 26

1. Aortic valve + radiation to the carotids | 2. Patient to hold breath as you listen over the carotids

Question 27

What pathology causes an ejection systolic murmur?

Answer 27

aortic stenosis

Question 28

What does an early diastolic murmur sound like?

Answer 28

lub whoosh

Question 29

Where would you hear an early diastolic murmur?

Answer 29

listen over aortic valve, then get patient to sit forward to extenuate

Question 30

What is the pathology of an early diastolic murmur?

Answer 30

aortic regurgitation

Question 31

What does a pansystolic murmur sound like?

Answer 31

whooosh

Question 32

Where can you hear a pansystolic murmur?

Answer 32

1. mitral valve + radiation to the axilla 2. roll patient onto their left and listen during expiration 3. then move stethoscope up to axilla

Question 33

What is the pathology of a pansystolic murmur?

Answer 33

motral regurgitation

Question 34

What does a mid-diastolic murmur sound like?

Answer 34

Lub whoosh

Question 35

Where do you hear a mid diastolic murmur?

Answer 35

listen over mitral area with the bell during expiration

Question 36

What is the pathology of a mid-diastolic murmur?

Answer 36

mitral stenosis

Question 37

How do you systematically listen to hear sounds?

Answer 37

1. Listen to mitral with diphragm + move to axilla 2. Listen to mitral with bell turn to left deep breath in and out and hold + move to axilla 3. Tricuspid with D 4. Pulmonary with D 5. Aortic with D 6. Carotid D (hold breath) 7. Bell sit up and forward, breath in and out and hold 8. Then listen to lung bases and palpate for sacral oedema

Question 38

Why do you auscultate lung bases?

Answer 38

pulmonary oedema (bi-basal crackles)

Question 39

What else do you palpate for?

Answer 39

sacral oedema and ankle oedema

Question 40

What would sacral oedema and ankle oedema suggest?

Answer 40

heart failure

Question 41

How do you close the exam?

Answer 41

1. Thank patient 2. Offer to help cover up 3. Wash hands 4. Summarise findings

Question 42

What other investigations would you want to do?

Answer 42

1. Check for peripheral stigmata of cardiovascular disease 2. Check fundi 3. Abdominal examination check for AAA 4. Urine dip 5. BP 6. ECG