Auscultation Flashcards
Determine heart issues from auscultation
Cardiac surgery gives you clues during examination. If you see a midline sternotomy plus legs scar, what ops are likely?
- Simple CABG most likely
2. Possible valve replacement with CABG
Cardiac surgery gives you clues during examination. If there is a midline sternotomy with no scar what are the most likely ops?
- Valve replacement most likely
2. Possible CABG without vein graft (LIMA or radial artery graft only)
When the JVP is elevated what does this indicate?
- RHF
- Volume overload
- PE
- Constrictive pricarditis
When the JVP is elevated with low blood pressure, what does this indicate?
- Tension pneumathorax
- Cardiac tamponade
- Massive PE
- Severe asthma
What happens when the JVP is fixed and elevated?
- Superior vena cava obstruction
Obstruction of the SVC by tumour tissue or blood clot
What occurs when cannon A waves are present in the JVP?
- Complete heart block
- Ventricular ectopic beats
- Ventricular tachycardia
When there are giant V waves associated with JVP, what does this indicate?
- Tricuspid regurgitation
Look for ear wiggling and feel for pulsatile hepatomegaly
How do you differentiate between types of cyanosis?
- Pure peripheral cyanosis causes blue hands
2. Central cyanosis causes blue lips and tongue and when severe can also cause blue hands
When central cyanosis is present (blue lips and tongue) what conditions could be present?
- Hypoxic lung disease
- Right to left cardiac shunt: Cyanotic congenital heart disease, Eisenmenger’s syndrome
- Methaemoglobinaemia
When peripheral cyanosis is present (blue hands), what conditions maybe present?
- Peripheral vascular disease
- Reynaud’s syndrome
- Heart failure
- Shock
- Central cyanosis
What conditions are present when there is an irregularly irregular pulse?
- Atrial fib
- Ventricular ectopic beats (VEBs)
- Complete heart block
- Variable Ventricular escape
To differentiate between AF and VEBs, exercise patient and VEBs will disappear
What are the cause of absent radial pulse?
- Congenital
- Arterial embolism (due to AF)
- Atheroma (usually subclavian)
- Previous arterial line
- Previous coronary angiography
- Cervical rib
- Coarctation of the aorta
What are the features of the JVP vs carotid
- Double pulsation
- Non palpable
- Obliterated when pressure applied to the neck
- Height changes with respiration
- Height changes with angle of patient
- Rises with hepatojugular reflux
What are important causes of AF?
- Ischaemic heart disease
- Rheumatic heart disease
- Thyrotoxicosis
- Pneumonia
- PE
- Alcohol
What is pulsus paradoxus
An exaggeration of the normal situation on which BP falls during inspiration, to such an extent that peripheral pulse may not be felt, despite LV contracting (and heart sounds can still be heard)
