The Cardiovascular System Cristina Fernandez FY1 Topics Spot

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The Cardiovascular System

• Cristina Fernandez
• FY1

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Topics

• Spot diagnosis
• Previous OSCEs
• AF
• Valvular Heart Disease
• Chest Pain
• Hypertension
• Swollen Ankles

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Spot Diagnoses

• Open heart surgery
• Always examine the legs!

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

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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

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Atrial Fibrillation

• Presentation in OSCEs
• Causes be systematic!
• Symptoms (if any)
• Clinical Assessment
• Exclude treatable causes
• Need for treatment

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And dont forget Paroxysmal AF !
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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
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Chest Pain

• History aimed to rule out differentials
• Risk Factors
• Examination
• ECG
• Differentials
• Management

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ALWAYS ask

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

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ECG
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Acute Cardiac Chest Pain
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Management of Angina
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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

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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

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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

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Hypertension
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Complications End Organ Damage

• Cerebrovascular Disease strokes
• Vascular Disease Eyes, Kidneys, Heart
• L Ventricular Hypertrophy independent predictor
  of early death
• Renal Failure
• Malignant HTNgt 220/120
• gt 180/110 papilloedema

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HTN Mx
A ACEi B B Blockers C Calcium Channel
Blockers D Diuretics
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Swollen Ankles

• Examine
• Differentials Heart (!)
• Liver
• Pelvic mass
• Previous injury
• Nephrotic Syndrome
• History Examination
• Investigations
• Plan

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Questions ?Good luck!