CVS Flashcards
1
Q
general inspection
A
cyanosis SOB pallor malar flush - mitral stenosis oedeoma
2
Q
assess environment around patient
A
medical equipment - ECG leads, O2, GTN spray mobility aids pillows vital signs fluid balance prescriptions
3
Q
hands inspection
A
colour - peripheral cyanosis tar staining xanthomata arachnodactyly - spider fingers (Marfans) finger clubbing pale palmar creases
4
Q
hands signs associated with endocarditis
A
splinter haemorrhages
Janeway lesions - thenar and hypothenar
Olser’s nodes - front of fingers
5
Q
2 main systolic murmurs
A
aortic stenosis
mitral regurgitation = whoosh whoosh
6
Q
2 main diastolic murmurs
A
aortic regurgitation
mitral stenosis
7
Q
hands palpation
A
temp - bilateral, check symmetry
CRT
8
Q
pulses - rate, rhythm and character
A
radial
check radio-radial delay - aortic dissection, aortic coarctation, subclavian artery stenosis
check radio-femoral delay collapsing pulse brachial carotid - palpate and listen for bruits JVP hepato-jugular reflux?
9
Q
JVP
A
patient positioned at 45 degrees, vertical distance between sternal angle and top of pulsation point on IJV, should not be more than 3cm, internal jugular vein only
10
Q
eyes exam
A
conjunctival pallor = anaemia
corneal arcus = high cholesteral
xanthelesma
Kayer-Fleishcer rings = Wilson’ disease > copper
11
Q
mouth exam
A
central cyanosis
angular stomatitis > iron deficiency
high arched palate > Marfans syndrome
dental hygiene
12
Q
anterior chest inspection
A
scars chest wall deformities pectus excavatum pectus carinatum visible pulsations or heaves pacemaker?
13
Q
chest palpation
A
apex beat = 5th intercostal space, mid-clavicular line
parasternal heaves = flat of hand, LVH or RVH
thrills each heart valve = lateral border of hand
14
Q
auscultation of 4 heart valves
A
right - left top
right - left bottom
aortic - pulmonary = 2nd intercostal space sternal edge
tricuspid - mitral (apex) = 5th intercostal space, mitral is midclavicular line
15
Q
posterior chest wall inspection
A
deformities or scars
16
Q
posterior chest wall ausultation
A
coarse crackles
dull percussion
17
Q
leg exam
A
oedema
saphenous vein harvesting
18
Q
sacral oedema
A
check bottom of back for pitting oedema
19
Q
further investigations
A
measure BP peripheral vascular exam record an ECG urine dipstick test bedside CBG fundoscopy
20
Q
order of exam
A
intro general inspection bedside environment hands neck - JVP face - eyes, mouth, cheeks anterior chest posterior chest sacrum legs final assessments
21
Q
pallor
A
pale skin - underlying anaemia, haemorrhage, chronic disease, poor perfusion
22
Q
malar flush = butterfly rash as seen in SLE
nose and across cheeks
A
plum-red cheek discolouration = mitral stenosis
23
Q
oedema indicates
A
congestive heart failure
24
Q
pillows?
A
congestive heart failure patients often have orthopnoea so use pillows to prop themselves up
25
xanthomata
raised yellow cholesterol deposits on palm, tendons of hand and elbow
26
arachnodactyly
spider fingers = abnormally long and slender, feature of Marfan's syndrome
27
Marfan's syndrome associated with
mitral/aortic valve prolapse and aortic dissection
28
finger clubbing indicates ... in CVS
congenital cyanotic heart disease, infective endocarditis and atrial myxoma
29
finger clubbing assessment
look for Schamroth's window, clubbing has loss of normal angle between nail and nail bed
30
splinter haemorrhages
longitudinal red-brown haemorrhage under nail looks like wood splinters > infective endocarditis, sepsis, vasculitis
31
Janeway lesions
non-tender haemorrhagic lesions on thenar and hypothenar eminences of palms and soles > infective endocarditis
32
Osler's nodes
red-purple slightly raised lumps often with pale centre on fingers and toes > infective endocarditis
33
temp hand assessment
dorsal aspect
symmetry
warm or cold
dry or clammy
34
CRT procedure
5 seconds of pressure to end of finger
| how long to return to initial pallor should be less than 2 seconds
35
CRT greater than 2 secs
poor peripheral perfusion - hypovolaemia, congestive heart failure
36
healthy adult PR
60-100bpm
37
tachycardic PR
>100bpm
38
irregular PR measure
have to record pulse for full 60 seconds
| AF indicated
39
radio-radial delay
loss of synchronicity between radial pulse on each arm
40
causes of radio-radial delay
subclavian artery stenosis, aortic dissection, aortic coarctation
41
collapsing pulse
aortic valve regurgitation = leaking
think of blood going back into valve
reduced pulse with arm up
in health should be the same
palpate radial pulse with right hand wrapped around patients wrist
palpate brachial pulse with left hand
raise patients arm above head briskly
should feel a tapping impulse in muscle bulk of arm as blood empties
collapsing pulse = when arm is raised and pulse is a lot weaker
42
pulse rhythms = check rate and rhythm
regular
regularly irregular
irregularly irregular
43
CVS causes of collapsing pulse
aortic regurgitation, patent ductus arteriosus, anaemia
44
slow rising pulse indicates
aortic stenosis
45
bounding pulse indicates
aortic regurgitation and co2 retention
46
thready pulse indicates
intravascular hypovolaemia - sepsis
47
first step in investigating carotid pulse
auscultate artery to detect presence of a bruit - indicates carotid stenosis which makes palpation of vessel dangerous due to dislodging of carotid plaque causing an ischaemic stroke
48
raised JVP indicates
venous hypertension - right sided HF, tricuspid regurgitation, constrictive pericarditis
49
conjunctival pallor
underlying anaemia
50
corneal arcus
hazy white/grey/yellow/blue opaque ring around cornea
51
xanthelasma
yellow cholesterol rich deposits around eyes
52
Kayser-Fleischer rings
dark rings around iris in Wilson's disease = abnormal processing of copper in liver results in deposition
53
angular stomatits
inflammation around sides of mouth
| anaemia
54
high arched palate
feature of Marfan syndrome
55
poor dental hygiene can be a risk factor for
infective endocarditis
56
infective endocarditis
infective of heart valves or endocardium
57
pectus excavatum
caved in/sunken chest
58
pectus carinatum
protrusion of sternum and ribs
59
saphenous vein harvesting leg inspection
performed as part of coronary artery bypass graft
60
mitral valve located
5th intercostal space at midclavicular line
61
tricuspid valve located
4th or 5th intercostal space at lower left sternal edge
62
aortic valve located
2nd intercostal space at right sternal edge
63
pulmonary valve located
2nd intercostal space at left sternal edge
64
thrill
palpable murmur = turbulent blood flow,
| test each valve by placing horizontal hand across chest wall above
65
how to assess for parasternal heave
heel of hand parallel to LHS/RHS of sternal angle, if there is a heave then should feel hand being lifted - right ventricular hypertrophy
66
apex beat bottom corner of heart
5th intercostal space midclavicular line
| normally next to nipple
67
hepatojugular reflux test
pressure on liver whilst observing JVP
positive result = if JVP rise is sustained and equal to or greater than 4cm
68
irregularly irregular pulse caused by
AF - often patients go in and out of fibrillation, when heart gets back into rhythm can fire off clots
69
ventricular fibrillation
cardiac arrest = no pulse
70
regularly irregular pulse caused by
arrhythmias:
ectopics = missed heart beat
bigeminy
trigeminy
71
JVP
right sided heart problem - fluid backs up
shown in raised JVP
how visible is the vein
72
pulse in a vein?
veins should never have a pulse!
| you can press them and it should stop filling
73
sternotomy scar
down the sternum = open heart surgery
74
infraclavicular scar
pacemaker insertion
75
GTN spray
for angina
76
displacement of apex beat
lots of reasons for big floppy heart can find apex beat in midclavicular line (in line under armpit)
77
narrow or regurgitation in valve causes
```
thrill = where you can feel murmur with your hand over the valve
heave = can feel how hard heart is having to pump with hand due to narrowing (aortic stenosis with LV pumping against resistance)
```
78
cardiac cycle revision = 3 stages
1. Atrial and Ventricular diastole (chambers are relaxed and filling with blood)
2. Atrial systole (atria contract and remaining blood is pushed into ventricles)
3. Ventricular systole (ventricles contract and push blood out through aorta and pulmonary artery)
79
murmur is caused by
turbulence in valve as blood struggles to go through
80
murmur is caused by
turbulence in valve as blood struggles to go through
81
mitral regurgitation murmur
pansystolic murmur
back pressure from ventricles damages and weakens mitral valve, blood leaks back into atria
turbulence around valve during whole of systole phase
82
mitral regurgitation valve murmurs pitch
often higher pitched so can use bell of stethoscope to hear better if needed
83
aortic stenosis murmur
ejection systolic = crescendo-decrescendo
84
aortic regurgitation murmur
early diastolic murmur
85
mitral stenosis murmur
mid-diastolic murmur
86
systolic murmur
aortic and pulmonary stenosis
| mitral and tricuspid regurgitation
87
early diastolic murmur
aortic or pulmonary regurgitation
88
murmurs that radiate
aortic stenosis = radiates to carotid arteries
| mitral regurgitation = radiates to axilla
89
ventricular systole
contraction and ejection
90
ventricular diastole
relaxation and filling
91
s1 heart sound
lub = closure of mitral and tricuspid valves
| signals start of systole
92
s2 heart sound
dub = closure of aortic and pulmonary valves
| signals end of systole
93
mid-late diastolic murmur
mitral or tricuspid stenosis
94
murmurs heard better on expiration = increased intrathoracic pressure
inc pressure constricts pulmonary vessels so blood is forced into left atrium and through left side of heart so aortic and mitral valves heard better
95
murmurs heard better on inspiration = decreased intrathoracic pressure
right side heart fills with more blood so can hear pulmonary and tricuspid valves better
96
tendon xanthoma
papules and nodules found in the tendons of the hands, feet, and heel. Also associated with familial hypercholesterolemia (FH)
97
end pieces
Fundoscopy: this is to check for hypertensive and diabetic retinopathy
Ausculation for renal and femoral bruits
Palpate: AAA, organomegaly (liver + spleen enlarged from right sided heart failure), femoral pulses
