2. Cardio examiantion Flashcards
general inspection cardio
(colour, breathing, comfort, position,
build)
cardiac signs in the hands
- Tar staining
o Vasodilatation/constriction, temperature
o Sweating (suggests increased sympathetic drive)
o Pallor of palmar creases
o Peripheral cyanosis
o Clubbing
o Splinter haemorrhages
o Osler’s nodes and Janeway lesions
o Tendon xanthomas
what does sweating suggest cardiac
- pain –> sympathetic drive
- HF/MI - inadequate circualtion –> sympathetic drive
what does pallor of palmar crease suggest
anaemia
causes of clubbing
Causes of clubbing can be divided into: cardiac, repsiratory and other
Cardiac causes:
cyanotic congenital heart disease (Fallot’s, TGA)
bacterial endocarditis
Respiratory causes
interstitial pulmonary fibrosis
lung cancer
cystic fibrosis, bronchiectasis
lung abscess, empyema, tuberculosis
asbestosis, mesothelioma
fibrosing alveolitis
Other causes
Crohn’s, to a lesser extent UC
cirrhosis,
Graves’ disease
examination findings infective endocarditis
inspection:
- splinter haemorrhages
- janeway lesions
- oslers nodes
- finger clubbing in long standing disease
auscultation:
- new or changing murmur
to complete:
- fundoscopy - roth spots
what are janeway lesions
painless red flat macules on the palms of the hands and soles of the feet
suggestive of infective endocarditis
what are oslers nodes
tender red/purple nodules on the pads of the fingers and toes
O = Ow
suggestive of infective endocarditis
what are roth spots
haemorrhages on the retina seen during fundoscopy
suggestive of infective endocarditis
what are tendon xanthomas
They commonly affect the tendons of the dorsal surface of the hands
Tendon xanthomas are cholesterol deposits in tendons.
what is the waterhammer pulse
testing the brachial pulse for ‘collapsing pulse’ associated with aortic regurgitation
cardiac signs in the eyes
o Subconjunctival pallor
o Corneal arcus
o Xanthelasmata
what is corneal arcus
Corneal arcus is characterized by a white or grey opaque ring around the iris. Most often this affects both eyes (i.e., bilateral)
can be benign in older adults
however in ppl <40 arcus juvenilis may occur due to a lipid metabolism disorder, such as familial hyperlipidemia (i.e., elevated blood lipid levels), hypercholesterolemia (i.e. elevated cholesterol levels), or dyslipidemia (i.e., atypical lipid levels).
cardiac face sign
o Malar flush (mitral stenosis)
cardiac signs in the mouth/lips
o Central cyanosis (under tongue or on mucous membranes inside lips)
o High-arched palate (Marfan’s)
o Dental caries (may predispose to infective endocarditis)
what vein is best to look at as a proxy fir central venous pressure
internal jugular vein
how to distinguish between jvp and carotid pulsation
Number of pulses: the JVP has a double waveform pulse (i.e. 2 pulses) whereas the carotid artery has a single pulsation for each cardiac cycle.
Palpability: the pulse of the JVP is not easily palpable, whereas the carotid pulse is typically easy to feel.