Cardio Exam Flashcards
Splinter haemorrhages
Description
-linear haemorrhages in nail beds
Correlation
- Trauma/manual labour
- Septic emboli in IE
Osler’s nodes
Description
- red
- raised
- tender
- nodules
- pulps of fingers/toes
- thenar/hypothenar eminence
Correlation
-rare finding in IE
Janeway lesion
Description
- non-tender
- erythematous
- maculopapular lesions
- palms or pulps of fingers
Correlation
-rare finding in IE
Tendon xanthomata/xanthelasmata
Description
- yellow/orange deposits
- xanthomata
- > in tendons of hands/arm/elbows/knees
- xanthelasmata
- > around eyes
Correlation
-hyperlipidaemia
Unequal/delayed pulses
Radio-radial
- atherosclerosis
- coarctation of the aorta
- aortic aneurysm
- aortic dissection
- subclavian artery stenosis
Radio-femoral
-coarctation of the aorta
Pulsus alternans
Description
- alternating strong and weak pulse
- palpated peripherally
- during BP measurement
- > Korotkoff 1 initially only appears with strong beat
- > release pressure and hear Korotkoff 1 with every beat
Correlation
- LV heart failure (HFrEF)
- > alternating contractile force of LV
- > changing preload/afterload with each beat
Bounding pulse
Description
- large upstroke with rapid collapse
- water hammer pulse
- > place hand over radial and ulnar pulse
- > raise arm
- > feel bounding pulse
- > occasionally visible as well
- corrigan’s pulse
- > visualisation of bounding pulse at carotids
Correlation
- full LV emptying into low resistance aorta
- aortic regurgitation
- increased SV
- > PDA
- > AVM
- > thyrotoxicosis
Pulsus parvus et tardus with anacrotic pulse
Description
- pulsus parvus et tardus
- > parvus = small/weak
- > tardus = late/delayed
- anacrotic
- > slow upstroke with notch
Correlation
-aortic stenosis
pulsus paradoxus
Description
- BP drop of more than 10mmHg with inspiration
- may be palpable
- > pulse disappears with inspiration
- BP measurement
- > note BP when Korotkoff 1 appears during expiration
- > release pressure
- > note BP when Korotkoff 1 appears during inspiration
Correlation
- tamponade
- constrictive pericarditis
- asthma/COPD exacerbation
Postural hypertension
Description
-drop >15mmHg for SBP or >10mmHg for DBP
Correlations (HAAND)
- hypovolaemia
- age (decreased baroreceptor sensitivity)
- adrenal insufficiency (Addisons)
- neurological
- > synucleinopathies (parkinson’s/lewy body dementia)
- > peripheral neuropathies
- drugs
- > vasodilators/anti HTN
- > tri-cyclics
- > diuretics
- > antipsychotics
arcus senilis
Description
-grey circle around pupil
Correlation
- normal in elderly
- familial hyperlipidaemia in young
mitral facies
Description
-rosy cheeks with bluish tinge
Correlation
- pulmonary HTN
- mitral stenosis
Causes of raised JVP
PQRST
- pericarditis/pericardial effusion
- quantity (fluid overload)
- right heart failure
- SVC syndrome
- tricuspid regurgitation/stenosis
Kussmaul’s sign
Description
-paradoxical rise in JVP with inspiration
Correlation
- impaired filling of RV causing jugular veins to engorge
- > RV infarction
- > RV failure
- > restrictive cardiomyopathy
- > constrictive pericarditis
- > tricuspid stenosis
hepatojugular reflex
Description
- hold hand over liver for 10 seconds
- > positive = elevation of JVP for 10 seconds
- > negative = brief elevation
Correlation
- inability to increase CO with high venous return
- > heart failure