OSCE Flashcards
(65 cards)
Name three investigations (bedside and imaging) which may be useful in the context of a suspected ventricular septal defect (VSD)
Pulse oximetry
Echocardiogram
Chest X-ray
ECG
What would pulse oximetry show if there is a ventricular septal defect?
VSD causes reduced oxygen saturation from the mixing of blood or from decreased cardiac output secondary to pulmonary hypertension
What might be seen on a CXR with a VSD?
: may reveal cardiomegaly and pulmonary oedema
What would an ECG show in VSD?
May show LV hypertrophy in moderate or large VSDs. Pulmonary hypertension may also cause increased RV pressure and RV hypertrophy.
What murmur is seen in VSD?
Pansystollic
Loudest at the lower-left sternal border
What is clubbing?
uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
What are the cardiac causes of clubbing?
Congenital cyanotic heart disease Infective endocarditis Atrial myxoma (very rare)
What is the test for clubbing called?
Shamroth’s Window test
What is a clamshell incision?
urvilinear ‘W’ shape that extends across the anterior chest from the mid-axillary line on either side and is located in the sub-mammary fold
What does a clamshell incision indicate?
provides complete exposure to the thoracic cavity
used procedures requiring bilateral access
e.g. malignancy, bilateral transplant
Describe the clinical relevance of jugular venous pressure
Jugular venous pressure provides an indirect measure of central venous pressure.
What are the cardiac causes of a raised JVP?
Right-sided heart failure
Tricuspid regurgitation
Constrictive pericarditis
What are some causes of right-sided HF?
left-sided HF
pulmonary hypertension
What are some causes of pulmonary hypertension?
COPD
Interstitial lung disease
What are some causes of constrictive pericarditis?
Idiopathic
Rheumatoid Arthritis
TB
Define aortic stenosis
Aortic stenosis is one of the most common and serious valve disease problems. It is a narrowing of the aortic valve opening and restricts the blood flow from the left ventricle to the aorta.
What murmur is heard with aortic stenosis?
Cresendo-decrescendo midsystolic ejection murmur
Radiates to the carotids
Louder on expiration and leaning forwards
What is a thrill?
Palpable vibration caused by turbulent blood flow through a heart valve
What are some causes of aortic stenosis?
Calcification of aortic valves
Congenital bicuspid aortic valve
Rheumatic heart disease
When does mitral regurgitation occur?
Back flow of blood from left ventricle to left atria during ventricular systole
What murmur is heard with mitral regurgitation?
Pan-systolic murmur
Loudest on expiration and when patient is leaned to the LHS and using the bell
Radiates to axilla
What are some causes of mitral regurgitation?
Infective endocarditis Acute myocardial infarction with rupture of papillary muscles Rheumatic heart disease Congenital defects of the mitral valve Cardiomyopathy
What is aortic regurgitation?
Backflow of blood from the aorta into the left ventricle during ventricular diastole.
What murmur is heard with aortic regurgitation?
Decressendo Early diastolic murmur
Loudest at the left sternal edge
