The Cardiovascular System

1. The Cardiovascular System Cristina Fernandez FY1

2. Topics Spot diagnosis Previous OSCEs AF Valvular Heart Disease Chest Pain Hypertension Swollen Ankles

3. Spot Diagnoses • Open heart surgery • Always examine the legs!

4. Xanthelasma Where else do you look? What do you ask? Corneal Arcus What are the causes?

5. 10 Minute Stations Explain stroke/MI to relative CVS exam Intermittent claudication ECG: Perform & interpret Basic Life Support ± Defib Counsel: Smoking and Pregnancy Interpret results: ↑ trigs, chol Chest pain: Hx, Mx, ECG, Angina 5 Minute Stations Ankle swelling MI: ECG and Mx AF: ECG and Mx AS / MR murmur Prosthetic heart valve Xanthelasma AF Sternotomy scar Previous OSCEs

6. Atrial Fibrillation Presentation in OSCEs Causes – be systematic! Symptoms (if any) Clinical Assessment Exclude treatable causes Need for treatment

7. And don’t forget Paroxysmal AF !

8. Valvular Heart Disease: MR / AS • Usually in the 5 minute stations • Diastolic murmurs never come up • Know your land marks • MRS ASS • Remember prosthetic valves! A P T M

9. Chest Pain • History – aimed to rule out differentials • Risk Factors • Examination • ECG • Differentials • Management

10. ALWAYS ask • Age and Gender • Duration of chest pain • Previous angina / MI • Palpitations • Family history • Hypertension • Hyperlipidaemia • Smoking • Diabetes

11. ECG

12. Acute Cardiac Chest Pain

13. Management of Angina

14. MI: Acute Mx GTN (X2) ↓ High Flow Oxygen (15L) ↓ ECG ↓ 300mg Aspirin ↓ Analgesia: Morphine + Metaclopramide ↓ Reperfusion: PCI / Fibrinolysis ↓ Heparin 24-48 hours Clopidogrel for stent insertion

15. Secondary Prevention Immediately • ACEi- if intolerant give ARB • Statin • Aspirin ± PPI • ± Clopidogrel if given acutely (STEMI 4 weeks, High risk NSTEMI 12 months) When Stable • B Blocker Lifestyle • Diet • Physical Activity • Stop Smoking • Cardiac Rehab

16. Hypertension in OSCEs • Take BP • Know targets 140/90 Non DM 130/80 DM • Repeat in other arm and X3 • Investigate- exclude secondary causes • Complications • Management

17. Hypertension

18. Complications: End Organ Damage • Cerebrovascular Disease: strokes • Vascular Disease: Eyes, Kidneys, Heart • L Ventricular Hypertrophy: independent predictor of early death • Renal Failure • Malignant HTN:> 220/120 > 180/110 + papilloedema

19. HTN Mx A: ACEi B: B Blockers C: Calcium Channel Blockers D: Diuretics

20. Swollen Ankles • Examine • Differentials Heart (!) Liver Pelvic mass Previous injury Nephrotic Syndrome • History & Examination • Investigations • Plan

21. Questions ?Good luck!