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MEDICINE FOR FINALS. DR INDER MAINIE MAY 2002. CARDIOVASCULAR. INTRODUCTION MAY I EXAMINE YOU? 45 DEGREES INSPECTION (SOB, SCARS, MALAR FLUSH, ANKLE OEDEMA) ALWAYS LOOK AROUND THE BED, INHALERS, OXYGEN, DIET DRINKS ETC. EXAMINATION. LOOK AT THE HANDS FINGER CLUBBING CYANOSIS
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MEDICINE FOR FINALS DR INDER MAINIE MAY 2002
CARDIOVASCULAR • INTRODUCTION • MAY I EXAMINE YOU? • 45 DEGREES • INSPECTION (SOB, SCARS, MALAR FLUSH, ANKLE OEDEMA) • ALWAYS LOOK AROUND THE BED, INHALERS, OXYGEN, DIET DRINKS ETC
EXAMINATION • LOOK AT THE HANDS • FINGER CLUBBING • CYANOSIS • SPLINTER HAEMORRAGES • PALE
PULSE • RATE • RHYTMN • CHARACTER BRACHIAL/CAROTID • VOLUME • COLLAPSING PULSE
CAUSES OF IRREGULAR IRREGULAR PULSE • ATRIAL FIBRILLATION, VE’S, ATRIAL FLUTTER WITH VAR BLOCK, CHB • CAUSES OF AF • ISCHAMIC HEART DISEASE • RHEUMATIC HEART DISEASE • THYROID • NO CAUSE • CARDIOMYOPATHY • WPW • INFECTION • ASD
COLLAPSING PULSE • AORTIC REGURG LOOK FOR CORRIGAN’S SIGN • PDA • PAGETS • PREGNANCY • RUPTURED ANEURYSM OF AORTIC SINUS • FEVER • ANAEMIA
RADIO-FEMORAL DELAY • COARCTATION OF THE AORTA • ASK WHILE EXAMINING THE PULSE CAN YOU CHECK FOR THIS
BLOOD PRESSURE • ALWAYS REMEMBER TO ASK IF YOU CAN CHECK THE BLOOD PRESSURE
JVP • INTERNAL JUGULAR • BETWEEN THE TWO HEADS • EQUAL TO PRESSURES IN THE RIGHT ATRIUM • a WAVE = ATRAL CONTRACTION • v WAVE= ATRIAL FILLING DURING VENTRICLAR SYSTOLE,TRICUSPID VALVE IS CLOSED
CAUSES OF A RAISED JVP • HEART FAILURE –ELEVATION, SUSTAINED HJR • PE – ELEVATED • PERICARDIAL EFFUSION-ELEVATED, PROMINENT Y DESCENT • CONSTRICTIVE PERICARDITIS-ELEVATED KUSSMAULS, PARADOXICAL RISE ON INSPIRATION • AF NO a WAVES • TRICUSPID STENOSIS- GIANT a WAVES • TRICUSPID REGURG- GIANT v WAVES • COMPLETE HEART BLOCK- CANNON WAVES
APEX BEAT • LOOK FOR STERNOTOMY SCARS • LOOK FOR THORACOTOMY SCARS • POSITION AND CHARACTER • CHECK FOR HEAVES OR THRILLS
HEART SOUNDS • PALPATE THE CAROTID SIMULTANEOUSLY • COMMENT ON I AND II OR ADDITIONAL • MURMURS
MURMURS STENOSIS- APEX LEFT LATERAL USE THE BELL • REMEMBER CHANGES IN BREATHING • INSPIRATION RIGHT HEART MURMURS GET LOUDER • EXPIRATION LEFT SIDE MURMURS GET LOUDER • PANSYSTOLIC MURMUR APEX, AXILLA • EARLY DIASTOLIC AORTIC REGURG 3RD ICS SIT FORWARD ON EXP
GRADING OF MURMURS • 1. FAINT • 2. FAINT BUT EASILY DETECTED • 3. POMINENT BUT NOT LOUD • 4. LOUD THRILL • 5. VERY LOUD • 6. LOUD WITHOUT CONTACT
REMEMBER • LUNG BASES • SACRAL OEDEMA • HEPATOSPLENOMEGALY FAILURE • PERIPHERAL PULSES
MITRAL STENOSIS • MALAR FLUSH • PULSE- IRREGULR IRREGULAR • RAISED JVP • TAPPING APEX NOT DISPLACED • LEFT PARASTERNAL HEAVE(RIGHT VENTRICULAR ENLARGEMENT) • LOUD 1ST HS • OPENING SNAP
MITRAL STENOSIS • CAUSES- RHD • TAPPING APEX BEAT -DUE TO ACCENTUATED 1ST HS • OPENING SNAP OPENING OF A STENOSED VALVE – PLIABLE, ABSENT IN DIFFUSELY CALCIFIED VALVE • LOUD 1ST – VALVES ARE MOBILE • PRESYSTOLIC ACCENTUATION- SINUS RHYTMN DUE TO THE ATRIAL SYSTOLE WHICH INCREASES FLOW ACROSS A STENOTIC VALVE
COMLICATIONS • LEFT ATRIAL ENLARGEMENT • AF • PULMONARY HTN • TR • RHF
SEVERITY • NARROWER DISTANCE BETWEEN 2ND HS AND OS • LONGER THE DIASTOLIC MURMUR
MITRAL REGURG • PERIPHERAL PULSES- NORMAL JERKY DUE TO REDUCED SYSTOLIC EJECTION TIME SECONDARY TO A LARGE VOLUME OF BLOOD REGURG INTO LEFT ATRIUM • APEX BEAT- DISPLACED • 1ST HS SOFT • 3RD HS • PSM -> AXILLA LOUDER ON EXP
CAUSES OF MR • MITRAL VALVE PROLAPSE • RHD • LEFT VENTRICLAR DILATATION • CORONARY DISEASE • ANNULAR CALCIFICATION • ENDOCARDITIS • PAPILLARY MUSCLE RUPTURE • CARDIOMYOPATHY • CONNECTIVE TISSUE DISORDER • TRAUMA • MYXOMATOUS DEGENERATION
CAUSES OF PSM • MR • TR • VSD • HOCM
AORTIC REGURG • PULSE- LARGE VOLUME, COLLAPSING • CORRIGAN’S • APEX DISPLACED OUTWARDS, FORCEFUL • EDM- LSE SIT FORWARD EXPIRATION
Aortic Regurgitation • WIDE PULSE PRESSURE • FEMORALS- PISTOL SHOTS(TRAUBE’S) • TO AND FRO MURMUR (DUROZIEZ’S) • CORRIGANS – CAROTID PULSATION • QUINCKE’S • UVULA PULSATIONS (MULLER’S) • ARGYLL ROBERTSON PUPIL • MARFANS • ANK SPOND, RA
Causes Of Aortic Regurgitation • RF • HTN • ATHEROSCLEROSIS • ENDOCARDITIS • SYPHILIS • MARFANS • RA • ANK SPOND • TRAUMA • AORTIC DISSECTION
SEVERITY • WIDE PULSE PRESSURE • SOFT 2ND HS • 3RD HS • AUSTIN FLINT MURMUR • LVF • LONGER + LOUDER
AORTIC STENOSIS • LOW VOLUME SLOW RISING • APEX- HEAVING, NOT DISPLACED • SOFT 2ND • EJECTION CLICK • S4 MAY BE HEARD • ESM • NARROW PULSE PRESSURE • REVERSE SPLITTING
CAUSES OF AORTIC STENOSIS • RHEUMATIC • DEGENERATIVE CALCIFICATION OF A BICUSPID VALVE
OTHER CAUSES OF ESM • PULM STENOSIS • HOCM • SUPRAVALVULAR STENOSIS
SYMPTOMS • FATIGUE • ANGINA • DYSPNOEA • SYNCOPE • DEATH
INVESTIGATIONS • ECG • CXR • ECHO • CATH • EST BE CAREFUL IF SYMPTOMATIC
TRICUSPID REGURGITATION • CAUSES • FUNCTIONAL • PULMONARY HTN • CCF • RHD • ENDOCARDITIS – DRUG ADDICTS
VSD • PSM AT LSE • LOUD P2 OF PULM HTN • MAY HAVE CCF • LOUDNESS DOES NOT MEAN SEVERE
CAUSES OF VSD • CONGENITAL • RUPTURE AFTER MI • 50% MAY CLOSE SPONTANEOUSLY • COMPLICATIONS ARE • CCF • AORTIC REGURG • SBE • PULM HTN
INFECTIVE ENDOCARDITIS • ANAEMIA • CLUBBING • SPLINTER HAEMORRAGES- EMBOLISM • OSLER NODES- INFLAMMATION OF EMBOLI • JANEWAY LESIONS • PETECHIAE • ROTH SPOTS • SPLENOMEGALY • HAEMATURIA • DENTAL • FBP- NORMOCYTIC NORMOCHROMIC • ESR • BLOOD CULTURES • ECHO/ TOE
COMLICATIONS OF SBE • CARDIAC FAILURE • RENAL PAIN • CEREBRAL ANEURYSMS • MYCOTIC ANEURYSMS • VALVE ABSCESS
HOCM • PULSE JERKY • DOUBLE APICAL- LEFT VENTRICULAR HEAVE WITH PROM PRESYSTOLIC PULSE • PSM- SOFTER ON SQUATTING • 4TH HS • FAMILY HISTORY
RESPIRATORY • INTRO • SITTING POSITION • SPUTUM CUP • BREATHLESS • WASTING • ASYMMETRICAL BREATHING • COUNT RESP
HANDS • CLUBBING • CYANOSIS • TAR • BOUNDING PULSE • ASTERIXIS • TONGUE – CYANOSIS • EYES- PALLOR, HORNERS
EXAMINATION • LOOK FOR NECK VEINS • CERVICAL LYMPH • TRACHEA DEVIATION • PALPATE • MOVEMENTS OF BOTH SIDES • VOCAL FREMITUS • PERCUSSION • AUSCULTATION
PLEURAL EFFUSION • LOOK FOR DECREASED MOVEMENT • TRACHEAL DEVIATION • ASPIRATION MARKS • STONY DULL • DECREASED VOCAL RESONANCE • FIND THE UPPER LEVEL • BRONCIAL BREATHING • SIGNS OF RA, TAR, LYMPH NODES, RADIATION BURNS, MASTECTOMY
CAUSES OF DULLNESS • PLEURAL EFFUSION • PLEURAL THICKENING • CONSOLODATION • COLLAPSE • RAISED HEMIDIAPHRAGM
INVESTIGATIONS • CXR • TAP • SEND FOR PROTEIN, LDH, GLUCOSE, BACTERIOLOGY, CYTOLOGY • PH IF EMPYEMA • AMYLASE IN NG, PANCREATITIS, OESOPHAGEAL RUPTURE • RHEUMATOID FACTOR
TRANSUDATE • NEPHROTIC SYNDROME • CARDIAC FAILURE • LIVER FAILURE • HYPOTHYROID • CONSTRICTIVE PERICARDITIS • MEIGS
EXUDATE • CA • SECONDARIES • PNEUMONIA • PE • TB • RA • SLE • LYMPHOMA • MESOTHELIOMA
PROGNOSIS • POOR IN NG PEURAL FLUID • LOW GLUCOSE • LOW pH
HAEMORRAGIC FLUID • PE • NG • TB
REMEMBER OCCUPATION EG SHIP BUILDING
BRONCHIECTASIS • LOOK FOR SPUTUM CUP • FINGER CLUBBING • BILATERAL COARSE CREPS • LATE INSP CREPS
BRONCHIECTASIS • DEF - CHRONIC NECROTIZING INFECTION OF THE BRONCHI AND BRONCHIOLES LEADING TO ABNORMAL, PERMANENT DILATATION OF THE AIRWAYS