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7 Cards in this Set
- Front
- Back
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Inspection
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"Equip CAT"
-Equipment: ECG, inhaler, cannula -CAT: cyanosis, ankle edema, tachypnea = heart failure |
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Hands
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6 things in hands: "CSC NPA"
i) Clubbing = "late IE", thus other signs of IE will be more prominent ii) Splinter Hemorrhage = IE iii) Capillary refill: normal<2s; PVD or dehydration iv) Nicotine stain = brown stain between 2nd & 3rd digits v) Peripheral cyanosis/Pallor = can occur in most ppl if cold!!; so Central cyanosis (tongue&lip) is better indicator of disease vi) Asterixis ("Flap") = CO2 retention; Respiratory = if takes awhile to show; NB: don't confuse with tremor due Parkinsonian or Beta-agonists |
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Chest inspection
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i) Sternotomy scar (midline scar)
= valve replacement or bypass surgery (leg scar confirms latter) ii) Thoracotomy scar = mitra stenosis surgery -seen as: --Back: diagonal scar from the L axilla down the back --Front: L breast diagonally up to the L axilla iii) Chest deformities: "SKS displaces Apex beat & cause ESM (eject sys murmur)" -sternal depression -kyphosis -scoliosis NB: if apex is displaced with presence of chest deformities, then likely clinically INSIGNIFICANT |
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Radial Pulse
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"Radial for 2R's"
RATE -Normal: 60-100 -Bradycardia (<60): Young, Beta blcokers, Heart block, Hypothyroidism -Tachycardia (>100): in a resting pat is ALWAYS abN! -due to exercise, anxiety, pyrexia, hyperthyroidism, B2-agonists, arrhythmia, hypovolaemic shock RHYTHM = 2x"regular or irregular" -Sinus arrhythmia: normal, more noticeable in age<40 -irreg irreg: AF = WON'T disappear with exercise cf. -Ventricular ectopic beats = WILL disappear with exercise, where rhythm returns normal during exercise period PULSE DEFICIT = AF -if suspect AF, ausculate heart at same time as palpating pulse (the 2 won't match!!) -Reason: in AF ventricular filling time varies->stroke volume varies->when SV is so low no radial beat can be felt "Sinus rhythm with occasional ectopic beats" -Atrial or Ventricular atopic beat Collapsing Pulse =aortic regurgitation -"pulse vibrating back your arm" -check any pain in the shoulder, ->hold forearm with both hands: 1 on the wrist, 1 lower down 2 Delays: i) Radial-Radial delay -Aortic dissection -Proximal artery disease: atherosclerosis/scriture of the Axillary artery ii) Radio-Femoral delay =coarctation of aorta (rare, constriction of aortic arch; blood flow to arm is fine, but to the legs is poor) -Associated symptoms: weak pulse, raised BP, often 2 murmurs: Continuous murmur over the scapula, Systolic murmur at LSE (L sternal edge) |
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Face
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Anemia (pale conjunctiva)
-poor sign!! Hyperlipidemia: -Xanthelasma -Corneal arcus (for age<50; common in 50+) Malar Flush = mitral stenosis -secondary to pulmonary hypertension, which causes dilatation of cheek capillaries Mouth: -Central cyanosis (lip, under tongue) --most common cause is pulmonary edema (due acute: ischemia or MI; chronic: HF or valve defects) -Dental hygiene: poor oral hygiene & gum disease = common route for bacterial endocarditis |
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Carotid Pulse
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Volume
Character -AS: slow rising, then plateau -AR: fast rising (waterhammer) & fast falling (collapsing); may havge Bifid pulse -Mixed Aortic Valve disease - Bifid pulse (double impulse pulse) NB: -abN in the pulse character is usually due to Aortic valve problems -other cause incl. hypertrophic obstructive cardiomyopathy |
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JVP
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"Relax your neck & jaw" - JVP can't be seen if SCM is not relaxed!!
Distinguished from Carotid by: i) JVP cannot be palpated ii) JVP has a double-wave form Causes of Raised JVP i) RHF - most common ii) Fluid overload - excess intake, renal failure iii) TR - has massive V wave on JVP waveform -Reason: JVP Tricuspid valve doesn't close properly hence reflects RV pressure, and not RA pressure. iv) Complete Heart Block -irreg'ly occurring giant a wave -Reason: complete AV dissociation, so A&V contractions aren't co-ord'd, where atria can contract despite Tricuspid valve is closed v) SVC obstruction -elevated JVP without pulsation --Reason: JV will be distended -hepatojugular reflex will be Negative -Cause: usually mediastinal lymphadenopathy due lung cancer vi) AF -No a wave -Reason: no atrial systole NB: -wagglibg ear lobe indicates raised JVP! -post hepatojugular reflex, if JVP rises, becomes more prominent AND remains like this for longer than a few seconds, then most likely dx is HF!! |
