Cardiovascular Flashcards
(64 cards)
usual position for assessment JVP
Position the patient at 45 degrees.
Cachectic.
Causes
Definition:(severe loss of weight and muscle wasting.
Cause:
1- severe malignancy
2- Severe cardiac failure (cardiac cachectic).
- This resuit from:
1- Anorexia : due to congestive enlargement of the liver.
2- Impaired intestinal absorption : due to congestive intestinal
veins.
Most common causes of clubbing
Common:
CVS:
1- Cyanotic congenital heart disease.
2- Infective endocarditis.
Respiratory:
1 Lung carcinoma.
2 Chronic pulmonary suppuration: infecti..
- Bronchiectasis.
- Lung abscess.
- Empyema. T B
- Idiopathic pulmonary fibrosis.
2) Uncommon:
Respiratory:
1 Cystic fibrosis.
2 Asbestosis.
3 Pleural mesothelioma.
GIL:
1 Cirrhosis
Inflammatory bowel disease. 3- Celiac disease.
3) Rare:
1- Neurogenic diaphragmatic tumours. 2- Pregnancy.
Unilateral clubbing :
1- Bronchial arteriovenous aneurysm.
2- Axillary artery aneurysm.
Grades of clubbing:
1- Bogginess at the nail base.
2- Increased transverse diameter than the AP diameter.
3- Parrot beak appearance.
4- HPOA - Hypertrophic Pulmonary Osteo Arthropathy.
Splinter Hemorrhage:
• Causes:
• Definition: linear hemorrhages lying parellel to the long axis of the nail.
1- Trauma (mostly).
2- infective endocarditis due to vasculitis in the nail bed.
3- Other rare causes:
(A) Vasculitis.
B) Rheumatoid arthritis.
C) Polyarteritis nodosa.
D) Sepsis.
E) Hematological malignancy.
F) Profound anemia.
Osler’s nodes:
• Definition:
• They are rare manifestation of
These are red raised tender nodules on the pulps of the
fingers or toes or in the thenar or hypothenar eminence.
infective endocarditis.
4) Janeway lesions :
• Definition:
Non tender erythromatous maculopopular lesions containing bacteria occur rarely in palms or pulps of the fingers in patient with infective endocarditis.
Tendon xanthomata :
• Definition:
Palmar xanthomata and tuboeruptive xanthomata.
• Occur in the
1-Yellow or orange deposits of lipid in tendons of the hand or arms which occur in type II hyperlipidemia.
2-elbow and knee and it’s character of type III
hyperlipidemia.
• Normal resting heart rate:
about 60 - 100 beats per min.
Bradycardia → HR< 60 beats/min.
Tachycardia → HR ≥ 100 beats/min.
Arterial- pulse
rate
rhytum (regular.or Not only
Volum (good Valum or low Valum) ( low in HF with low cardiac output, elderly patients, dehydration)
character
Symchronictry
Method: palpate the radial artery of the wrist. The pulse usually felt medial to the radius using forefinger and middle finger pulps of the
examining hand:
* For Brachial and corotid arteries use the thumbs.
* Brachial artery → medial to biceps muscle.
* Carotid artery → between the larynx and the anterior border of sternocleidomastoid muscle. NEVER palpates arotid arteries
simultaneously.
femoral pulse (below inguinal ligament 1/3 of the way up from pubic tubercle).
- Radial-radial delay occurs in :
large arterial occlusion by an
atherosclerosis plaque or aneurysm. Subelavian/ brachial Artery
• Radiofemoral delay occurs in:
when there is coarctation of the
aorta.
Pulsus alternans : (rare)
Definition:
Occur in:
A regular alternate of strong and weak beats (in volume).
Mechanism: unknown.
Occur in: Severe myocardial disease and heart failure.
Pulsus paradoxus :
Definition:
A pulse that increases in volume on expiration and decreases in volume in inspiration. Note: This phenomenon is physiological and not detectable in normal individuals. It is considered abnormal if the pulse pressure decrease, on inspiration, below 10 mmHg.
Mechanism: During inspiration , the systolic and diastolic blood
pressure normally decrease (because intrathoracic pressure becomes more negative, blood pools in the pulmonary vessels, so left heart filling is reduced).
Occur in: constrictive pericarditis, pericardial effusion and severe asthma.
D) Character and volume :
• Method: Use the
brachial and carotid arteries’
‘They are more better in determining the character and volume than radial artery. But for collapsing pulse and
pulsus alternans, used the radial artery.
Collapsing (bounding) pulse :
Definition:
Occur in:
High volume but ill sustained pressure wave form.
Aortic regurgitation.
Bisferiens pulse: MODEST
Definition:
Occur in:
Slow rise, with normal or high volume, with sudden collapse.
Occur in: combined aortic stenosis and regurgitation.
Postural blood pressure :
• Take BP of the patient on lying and standing positions.
• Postural hypotension is considered when :
1 - Systolic fall more than 15 mmHg or
2- Diastolic fall more than 10 mmHg.
Corneal arcus:
Cause: Precipitation of cholesterol crystals at the periphery of the
cornea.
hyperlipidemn thypercakem
1) Jaundice
CHF, hepatic congestion or prosthetic heart valve’).
4) Mitral faces (Malar flush):
Occur in:
Appearance: Rosy cheeks with bluish tinge.
Cause: dilatation of malar capillaries.
Occur in:
1) pulmonary HTN.
2) low cardiac output as in mitral stenosis.
5) The mouth:
A) for any high arched palate. This occurs in
Marfan’s syndrome
which is associated with congestive heart disease.
The abdomen..
Physical signs to be noticed:
1) Enlarged tender liver :
2) Pulsatile liver ‹
3) Ascites :
4) Splenomegaly:
5) Implanted cardioverter-defibrillator.
1-in the presence of Right heart failure.
2) tricuspid regurgitation (because the right ventricular systolic pressure wave is transmitted to the hepatic veins).
3-may occur in severe right heart failure.
4-may indicates infective endocarditis.
