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The Cardiovascular System. Cristina Fernandez FY1. Topics. Spot diagnosis Previous OSCEs AF Valvular Heart Disease Chest Pain Hypertension Swollen Ankles. Spot Diagnoses. Open heart surgery Always examine the legs!. Xanthelasma Where else do you look? What do you ask?

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the cardiovascular system

The Cardiovascular System

Cristina Fernandez

FY1

topics
Topics

Spot diagnosis

Previous OSCEs

AF

Valvular Heart Disease

Chest Pain

Hypertension

Swollen Ankles

spot diagnoses
Spot Diagnoses
  • Open heart surgery
  • Always examine the legs!
slide4
Xanthelasma

Where else do you look?

What do you ask?

Corneal Arcus

What are the causes?

previous osces
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
atrial fibrillation
Atrial Fibrillation

Presentation in OSCEs

Causes – be systematic!

Symptoms (if any)

Clinical Assessment

Exclude treatable causes

Need for treatment

valvular heart disease mr as
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

chest pain
Chest Pain
  • History – aimed to rule out differentials
  • Risk Factors
  • Examination
  • ECG
  • Differentials
  • Management
always ask
ALWAYS ask
  • Age and Gender
  • Duration of chest pain
  • Previous angina / MI
  • Palpitations
  • Family history
  • Hypertension
  • Hyperlipidaemia
  • Smoking
  • Diabetes
mi acute mx
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

secondary prevention
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
hypertension in osces
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
complications end organ damage
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

htn mx
HTN Mx

A: ACEi

B: B Blockers

C: Calcium Channel Blockers

D: Diuretics

swollen ankles
Swollen Ankles
  • Examine
  • Differentials Heart (!)

Liver

Pelvic mass

Previous injury

Nephrotic Syndrome

  • History & Examination
  • Investigations
  • Plan