Cardiovascular (Clinical Skills)

Front 1

List 5 cardinal symptoms to look for in a cardiovascular history taking

Back 1

Chest pain (on exertion)

Breathlessness

Palpitation

Claudication

Ankle swelling

Front 2

In cardiovascular history taking ask about breathlessness in these three conditions

Back 2

• lying flat
  
• at night
  
• on minimal exertion
  

Front 3

Name 3 main risk factors for cardiovascular disease

Back 3

Hypertension

Hypercholesterolaemia

Tobacco smoking

Front 4

Explain the purpose and utility of ECG

Back 4

Electrocardiogram

Detects phasic change in potential difference between two electrodes:

(i) On surface of heart

(ii) On limbs

Recorded on an oscilloscope, on computer or on paper

Useful in Dx of arrhythmias, post-MI damage, congenital/iatrogenic abnormalities

Front 5

What does the P wave signify in a typical ECG?

Back 5

Atrial depolarisation

Front 6

What does the QRS complex signify in a typical ECG?

Back 6

Ventricular depolarization

Front 7

What does the T wave signify in a typical ECG?

Back 7

Ventricular repolarisation

Front 8

What does the P-R interval signify in a typical ECG?

Back 8

Delay through AV node

Front 9

What does the S-T interval signify in a typical ECG?

Back 9

Plateau phase of action potential

Front 10

Explain the purpose and utility of echocardiography

Back 10

Ultrasound transducer beam emits high frequency sound waves through the chest wall, some are reflected at interfaces between tissues of different acoustic impedence. Signal is converted into an image seen on a monitor that allows visualisation of structures and some movement

Front 11

Name and explain 3 techniques that deploy echocardiography to visualise the heart

Back 11

Cross-sectional - 2D image that gives impression of moving picture

M-mode - single static beam appears as horizontal lines with superficial structures represented at top, deep structures represented at bottom - measures wall thickness

Doppler - Visualising blood flow velocity and direction

Front 12

Explain the purpose and utility of coronary angiography

Back 12

Specialised X-ray test that visualises coronary arteries. Invasive and uses ionising radiation.

Catheter inserted into peripheral artery and guided by low dose X-ray to main coronary artery. Requires injection of contrast medium to visualise the blood vessels - identify sites of stenosis, atheroma, assesses left ventricular function. Requires ECG to monitor electrical activity of heart as risk is arrhythmia.

Front 13

Explain the utility of chest x-ray for assessing cardiac structure and function

Back 13

Pt presents with SOB, determines if there is a problem with heart/lungs/neither.

Cardiothoracic ratio >0.5 - cardiomegaly common in heart disease/valvular defects

Diffuse shadowing and Kerley B lines - pulmonary oedema common in heart failure

Widened mediastinum - thoracic aneurysm

White streaks in heart vessels - calcifications

Front 14

Explain the utility of MRI in cardiac imaging

Back 14

Best for assessing whether cardiac myopathy present

Superior resolution for visualisation of heart and vessels - can measure blood flowNot routinely used but can identify subtle defects in structure and their consequences for blood flow i.e. aortic regurgitation

Front 15

List 7 biochemical tests to order in suspected cardiovascular disease and state why they are useful

Back 15

1. Cardiac enzymes i.e. troponin - enzyme released following MI, greater level troponin greater damage to heart and risk of future MI
2. Urea and electrolytes - High of low Na+ or K+ can cause arrhythmias
3. Full blood count - Shows levels of Hb (anaemia), WBCs (infection)
4. Natriuretic peptide - hormones produced by cardiac myocytes help Dx heart failure (if levels high)
5. Thyroid function test - palpitations, tachycardia or bradycardia can indiciate over or under active thyroid gland.
6. Cholesterol - assessment of risk for CVD, planning treatment to manage risk
7. CRP - C-reactive protein - elevated CRP indicator of infection of inflammatory process - increased risk CVD

Front 16

Name and briefly describe 3 pan systolic murmurs

Back 16

•Mitralregurgitation: Apex, Low pitched•Triscuspid regurg: Left sternal edge to apex •VSD:rough, tearing with thrill

Front 17

Name and briefly describe 2 ejection systolic murmurs

Back 17

•Aorticstenosis– aortic area (carotid+ other areas)‏

•Pulmonarystenosis: Pulmonaryarea

Front 18

Name an early diastolic murmur

Back 18

•Aortic regurgitation – best heard when ptsits forward, breath held in expiration

Front 19

Name a mid-diastolic murmur

Back 19

•Mitral stenosis – best heard withpatient on LHS