The Cardiovascular System

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The Cardiovascular System Cristina Fernandez FY1

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Topics Spot analysis Previous OSCEs AF Valvular Heart Disease Chest Pain Hypertension Swollen Ankles

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Spot Diagnoses Open heart surgery Always look at the legs!

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

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10 Minute Stations Explain stroke/MI to relative CVS exam Intermittent claudication ECG: Perform & decipher Basic Life Support ± Defib Counsel: Smoking and Pregnancy Interpret comes about: ↑ trigs, chol Chest torment: Hx, Mx, ECG, Angina 5 Minute Stations Ankle swelling MI: ECG and Mx AF: ECG and Mx AS/MR mumble Prosthetic heart valve Xanthelasma AF Sternotomy scar Previous OSCEs

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Atrial Fibrillation Presentation in OSCEs Causes – be precise! Side effects (assuming any) Clinical Assessment Exclude treatable causes Need for treatment

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And remember Paroxysmal AF !

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Valvular Heart Disease: MR/AS Usually in the 5 minute stations Diastolic mumbles never come up Know your property marks MRS ASS Remember prosthetic valves! A P T M

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Chest Pain History – planned to preclude differentials Risk Factors Examination ECG Differentials Management

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ALWAYS solicit Age and Gender Duration from mid-section torment Previous angina/MI Palpitations Family history Hypertension Hyperlipidaemia Smoking Diabetes

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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 addition

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Secondary Prevention Immediately ACEi-if bigoted give ARB Statin Aspirin ± PPI ± Clopidogrel if given intensely (STEMI 4 weeks, High hazard 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-avoid optional causes Complications Management

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Complications: End Organ Damage Cerebrovascular Disease: strokes Vascular Disease: Eyes, Kidneys, Heart L Ventricular Hypertrophy: free indicator of early demise Renal Failure Malignant HTN:> 220/120 > 180/110 + papilloedema

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HTN Mx An: ACEi B: B Blockers C: Calcium Channel Blockers D: Diuretics

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Swollen Ankles Examine Differentials Heart (!) Liver Pelvic mass Previous harm Nephrotic Syndrome History & Examination Investigations Plan

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Questions ? Good fortunes!