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Y2- CARES- Case Based Tutorials Top Hat > CVS > Flashcards

CVS Flashcards

1
Q

Give one risk factor for cardiac chest pain

A

High bp

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2
Q

What does SOCRATES stand for

A

Site = central, left, right
Onset = sudden, over time, at rest, on exertion
Character = dull, sharp, aching, pressure, heaviness, tightness, pleuritic
Radiation= shoulder, jaw, neck, back
Alleviating factors =rest, position, pain relief,
Time = duration of symptoms
Exacerbating factors = exertion, position, food
Severity = 1-10

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3
Q

Where does cardiac chest pain classically radiate to

A

The jaw or left arm

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4
Q

What can be given to treat angina symptoms

A

GTN spray = Glyceryl Trinitrate Spray

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5
Q

What is the classical cardiac chest pain in terms of SOCRATES

A 
S. Centre of the chest 
0. Sudden onset
C. Dull or crushing 
R. Left arm, neck, jaw
A. Nausea, sweating, breathlessness
T. 10 mins to an hour
E. Exertion, cold air, relieved by rest, GTN spray 
S. Mild to v severe (can be angina attack, severe angina attack, MI)

Many people, esp women, can present with atypical symptoms

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6
Q

What is stable angina usually brought on by

A

Exertion

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7
Q

What can unstable angina be brought on by

A

At rest

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8
Q

How is angina relieved

A

Rest

GTN spray

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9
Q

When can acute coronary syndrome come on

A

At rest or exertion

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10
Q

What might chest pain that is NOT relived by rest or GTN spray be caused by

A

Acute coronary syndrome

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11
Q

What is acute coronary syndrome

A

A range of conditions associated with sudden, reduced blood flow to the heart. Eg, an MI

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12
Q

What is angina

A

Chest pain caused by reduced blood flow to the heart muscles, not usually life threatening but could be a warning sign that you are at risk of heart attack or stroke

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13
Q

What kind of presentation would point towards acute coronary syndrome rather than angina

A 
Last longer than usually angina symptoms 
More severe pain 
More associated symptoms 
Not relieved by rest of GTN spray 
Can come on at rest/ exertion
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14
Q

What is dyspnoea

A

Breathlessness

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15
Q

What is orthopnoea

A

Breathlessness lying flat

Can ask about how many pillows a patient sleeps on

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16
Q

What is paroxysmal nocturnal dyspnoea

A

Sudden breathlessness waking up from sleep

Classical sign of heart failure

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17
Q

What kind of oedema may be present in patients with heart disease

A

Pitting

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18
Q

If patient is more mobile where might an oedema collect

A

Ankle

If less mobile, oedema may collect in sacral area, or abdominal wall

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19
Q

How may patients describe their palpitations

A

Rapid, regular, irregular,

Slow, feeling of missed beats, sudden thumping

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20
Q

What other common presenting symptoms in CVS disease should you ask about

A

Dyspnoea
Oedema
Palpitations
Syncope/ presyncope

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21
Q

What is the brief structure of a history

A
  1. History of presenting complaint and related SE
  2. Past medical history: active (eg, also has DM) and inactive problems (has previously had gall bladder removed with no current problems)
  3. Systematic enquiry - build this around the active problems eg, is DM well controlled
  4. Drug history - how they receive meds, allergies = and ask about the reaction
  5. Social history = eg, drugs, work, how mobile,
    Consider risk factors
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22
Q

Non CVS causes of chest pain related to respiratory system

A

cough, temperature, haemoptysis, risk factors for PE

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23
Q

Non CVS causes of chest pain related to GI

A

pain related to eating, reflux, burning, indigestion, swallowing difficulty, vomiting regurgitation

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24
Q

Non CVS causes of chest pain related to musculophrenic-skeletal system

A

Recent falls/ injury/ trauma

25
Psychological factors that can cause chest pain
Anxiety, stress, recent life events
26
Give 6 cardiovascular risk factors
``` Diabetes Smoking Diet and exercise Hypertension Hyperlipidaemia Family history (eg, of heart disease, and ask specifically about sudden death) ```
27
What clinical observations and heart sounds and chest auscultation would support a diagnosis of angina
Normal for all
28
What 4 main things should you check when carrying out a CVS examination
Hands Face Chest/body Legs
29
What might you be looking out for when examining hands during a CVS examination
Nicotine staining Finger clubbing Signs of endocarditis
30
What might you be looking out for when examining the face during a CVS examination
Malar flush Corneal Arcus (signs of hypercholestrolemia) Xanthalasma (signs of hypercholestrolaemia)
31
What can malar flush be a sign of
Mitral stenosis
32
What might you be looking out for when examining chest/ body during a CVS examination
Scars | Chest wall abnormalities
33
What might you be looking out for when examining legs during a CVS examination
Pitting oedema | Scars
34
What is the first heart sound produced by
Closing of the mitral and tricuspid valve leaflets
35
What is the second heart sound produced by
Closing of the aortic and pulmonic valve leaflets
36
When are the first and second heart sounds heard in relation to the carotid pulse
When you feel the pulse on fingers = hear the first heart sound When pulse draws away = second heart sound
37
What are murmurs
Absence of silence between the heart sounds | Can happen in systole or diastole
38
Where can the aortic valve be auscultated
2nd- 3rd right interspace
39
Where can the pulmonic valve be auscultated
2nd - 3rd left interspace
40
Where can the tricuspid valve be ausculatated
Left sternal border
41
Where can the mitral valve be auscultated
Apex
42
Why is it important to palpate the carotid pulse whilst auscultating the heart sounds
Because if an added sound is present to determine if this is occurring in diastole or systole by timing with the carotid pulse
43
How to begin a CVS examination
Greet your patient Introduce yourself and your role Explain what you are going to do and why, and gain consent to proceed with the examination Clean your hands Ongoing communication to patient involves clear instructions and attention to your patient’s comfort Demonstrate a Professional manner throughout Examination method is structured and performed fluently and in a logical order
44
What should you make a general observation of at the start of a CVS examination
``` of patient (colour, conscious level, any pain or breathing difficulty, build) of bedside (oxygen or other bedside equipment, GTN spray/medication) ```
45
What to look for in hands and nails in CVS examination
clubbing, nicotine staining, splinter haemorrhages, tendon xanthoma, Janeway lesions, Osler’s nodes, pale palmar creases, palpate to ascertain capillary refill time which should be < 2 seconds
46
How to take a pulse and what to look out for and report
palpate for 30 secs (60 secs if pulse irregular) report rate, rhythm & character Check for radio-radial delay and radio-femoral delay (aortic stenosis) Ensure your patient does not suffer with arm or shoulder pain before examining for a collapsing pulse (present in aortic regurgitation)
47
What is pallor of conjunctiva
Pale appearance of the conjunctiva - can be a sign of anaemia
48
What is a corneal arcus
Deposit of cholesterol, phospholipids, and triglycerides in an ‘arc’ on either the top or bottom side of the iris inside the cornea
49
What to look for in eyes, lips and tongue in CVS exam
Look in the eyes for xanthelasma, a corneal arcus and for pallor of conjunctivae. Look at the lips for peripheral cyanosis and under the tongue for central cyanosis. Ascertain general dental hygiene. High-arched palate suggestive of Marfan's syndrome
50
What is xanthelasma
Soft, yellowish fatty deposit that forms under the skin and can be seen around the eyes/ eyelids area
51
What to observe in the neck in a CVS exam
Carotid pulse:palpate and listen for bruits JVP:should be examined and measured with the patient rested at 45 degrees. (know how to demonstrate hepato-jugular reflux which may be useful in clinical practice but is not routinely performed in an OSCE)
52
What to observe around chest/ praecordium during a CVS exam
look for scars (sternotomy, thoracotomy), a pacemaker, and for visible pulsations or heaves
53
What to palpate during a CVS exam
Locate the Apex Beat (should know expected site is 5th intercostal space, mid-clavicular line Heaves – use the flat of the hand to feel for parasternal heaves indicative of LVH or RVH Thrills – use the lateral border of the hand to palpate all 4 valve areas for palpable murmurs
54
What to ausculutate during a CVS exam
Auscultate all 4 valve areas (Aortic, Pulmonary, Tricuspid and Mitral) and carotid arteries with the diaphragm of the stethoscope – ascertain the heart sounds and for any added heart sounds or murmurs.
55
How to listen for a murmur
If a murmur is present try to ascertain at which valve area it is heard and whether there is any radiation, for example into the carotids or into the apex. Listen at the mitral area with the bell and the patient leaning onto their left hand side – this makes it easier to listen for the low pitched diastolic murmur of mitral stenosis. Listen at the tricuspid area with the diaphragm of the stethoscope and your patient sat forward in held expiration which will intensify a murmur due to aortic regurgitation. Auscultate the lungs, particularly looking for fluid at the bases which may be due to heart failure.
56
What might sacral or ankle oedema indicate?
Right sided heart failure
57
How to determine whether an oedema is a pitting oedema
You should press into the area of oedema for 5 seconds to establish whether an indentation remains which indicates pitting oedema.
58
What other things would complete a CVS exam
Lying and standing BP Abdomen Observation Palpation : — Organomegaly – hepatosplenomegaly can occur due to engorgement from right sided heart failure Abdominal Aortic Aneurysm – expansile (aorta can be palpable in thin individuals and is pulsatile) Palpate femoral pulses Auscultation - for renal and femoral bruits Vascular exam of lower limbs Fundoscopy- to check for hypertensive and diabetic retinopathy Thank and explain
59
What might be the cause of hepatosplenomegaly
Engorgement from right sided heart failure

Y2- CARES- Case Based Tutorials Top Hat (3 decks)

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