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