General Cardio Tips

Examination

Viva

Hx

Completion
Observation chart
Drug chart
12-lead ECG

Presentation

Ix

Mx

Symptoms: dyspnoea, chest pain, palpitations, syncope

LVF: PND, orthopnoea

IE: fever, wt. loss, night sweats

CV Risk: smoking, DM, lipids, HTN, FH

PMH: rheumatic fever

DH: antiplatelet agents, statins

On peripheral inspection…

The pulse…

On examination of the precordium…

Significant negatives
Absence of CCF
Disease severity
Evidence of cause

Differential Dx

Hx

ECG
Evidence of ischaemia
Arrhythmia

Blood

  • FBC: anaemia exacerbates cardiac symptoms
  • U+E: renovascular disease
  • NT-proBNP: heart failure
  • Fasting lipids and glucose: cardiac risk

Imaging

CXR
Cardiomegaly
Pulmonary oedema
Valve calcification

Echo
Dx
Valve function
LV Function

Cardiac catheterisation
Evaluate coronary arteries

General

Specific

Surgical

MDT: GP, cardiologist, cardiothoracic surgeon, dietician, specialist nurses

Optimise CV risk: statins, anti-HTN, DM, anti-plat

Monitor: regular f/up and echo

Heart Sounds

Features of Pulmonary HTN
↑ JVP
Left parasternal heave
Loud P2 + PSM of TR
Pulsatile hepatomegaly
Ascites and peripheral oedema

Impalpable Apex Beat: COPD

Cardiac Causes of Clubbing

Collapsing Pulse
Caused by hyperdynamic circulation

Absent Radial Pulse

Midline Sternotomy

Metallic click Mechanical valve

Murmur
Tissue valve
Valvotomy

Vein harvest on legs CABG

Old scar, young pt. Repair of congenital defect

Immunosuppression Heart transplant

Nothing
Trauma: tamponade, aortic
IMA CABG
Tissue valve

Infective endocarditis

Congenital cyanotic heart disease

Fallot’s Tetralogy

Transposition of the Great Vessels

Atrial myxoma
A/W Carney Complex / LAME Syndrome

  • Lentigines: spotty skin pigmentation
  • Atrial Myxoma
  • Endocrine tumours: pituitary
  • Schwannomas

VSD
Pulmonary stenosis
RVH
Overriding aorta

AR
Thyrotoxicosis
Pregnancy
Anaemia

Dead

Trauma

Thrombosis or embolism

Coarctation of the aorta

Takayasu’s Arteritis

  • COPD
  • Obesity
  • Pericardial effusion
  • Dextrocardia

S1: mitral valve closure

S2: aortic valve closure

S3: rapid ventricular filling of dilated left ventricle

S4: atrial contraction against stiff ventricle