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Cardiac Examination Flashcards

1
Q

What is indicated by a pain that is worse on inspiration?

A

Pericarditis or pleuritic pain

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2
Q

What is indicated by a pain that is relieved within minutes by GTN?

A

angina

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3
Q

What is indicated by a pain that is improved by leaning forwards?

A

Pericarditis

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4
Q

If a patient describes a pain as constricting, what is/are likely cause(s)

A

Angina
Oesophageal spasm
Anxiety

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5
Q

What is characteristic of pain felt due to MI?

A

Prolonged (>1/4 hour), dull, central crushing pain

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6
Q

What is indicated by a sharp pain?

A

Pleural or pericardial cause

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7
Q

How is the pain of aortic dissection classically described?

A

Instantaneous, tearing interscapular pain (may also be retrosternal)

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8
Q

How might you determine whether chest pain was musculo-skeletal?

A

Look for pain on specific postures or activity

Aim to reproduce the pain by movement and sometimes palpation over the structure causing it

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9
Q

What is Tietze’s syndrome?

A

Self-limiting costochondritis with or without costosternal joint swelling

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10
Q

What is the likely presenting complaint in Tietze’s syndrome?

A

Chest pain with tenderness

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11
Q

What causes pleuritic pain?

A

Inflammation of the pleura due to pulmonary infection, inflammation or infarction

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12
Q

What exacerbates pleuritic pain? How might a patient describe it?

A

Inspiration. “it causes me to catch my breath”

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13
Q

How does cardiac tamponade present?

A

Shock with raised JVP

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14
Q

What might cause dyspnoea?

A
  1. LV failure
  2. Pulmonary embolism
  3. Any respiratory cause
  4. Anxiety
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15
Q

What is orthopnoea? What might it indicate? How might you find out if a patient suffers from it?

A

Shortness of breath when lying flat
Heart failure
How many pillows do you use to sleep at night?

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16
Q

What specific symptoms are associated with heart failure?

A
  1. Orthopnoea
  2. Paroxysmal nocturnal dyspnoea
  3. Peripheral oedema
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17
Q

How might a patient who has had a PE present? What should you ask them?

A
  1. Acute onset of dyspnoea with pleuritic chest pain

2. Ask about risk factors for DVT and check if their calves are swollen

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18
Q

What might cause palpitations?

A 
Ectopics
Atrial fibrillation
SVT
VT
Thyrotoxicosis
Anxiety
(rarely) phaeochromocytoma
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19
Q

Which prodromal (early) symptoms of syncope indicate a cardiac cause?

A

Chest pain
Palpitations
Dyspnoea

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20
Q

Which prodromal (early) symptoms of syncope indicate a CNS cause?

A

Aura
Headache
Dysarthria
Limb weakness

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21
Q

How might you differentiate between a cardiac and CNS siezure if prodromal symptoms are unknown?

A

Was recovery rapid? Indicates cardiac cause e.g. arrhythmia

Was recovery prolonged with drowsiness? Indicates CNS cause

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22
Q

What questions might you ask about the seizure itself?

A

During the seizure was there:

  1. Loss of pulse
  2. Limb jerking
  3. Tongue biting
  4. Urinary incompetence
  5. How long did it take the patient to return o normal?
  6. How long did the siezure last
  7. What was the patient doing at the time
  8. Did it come on suddenly or gradually
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23
Q

What questions might you ask a patient with palpitations?

A 
When and how did it start/stop
Duration?
Onset sudden or gradual?
Is it associated with black out? If so for how long?
Is it fast or slow?
Is it regular or irregular?
Ask the patient to tap out the rhythm
Is it related to eating/drinking (particular coffee, tea, wine, chocolate
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24
Q

What is the NYHA?

A

New York classification of heart failure

I: Heart disease is present but there is no undue dyspnoea from normal activity
II: Comfortable at rest; dyspnoea activity e.g. walking up stairs
III: Most activity including ADL causes dyspnoea
IV: Dyspnoea at rest

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25
What is/are the likely cause(s) of irregular fast palpitations
AF | Atrial flutter with variable block
26
What is/are the likely cause(s) of regular fast palpitations
SVT | VT
27
What is/are the likely cause(s) of slow fast palpitations
Drugs e.g. beta-blockers | Bigeminy
28
What are the cardiovascular causes of clubbing?
``` Cyanotic congenital heart disease Endocarditis Atrial myxoma Aneurysms Infected grafts ```
29
What signs of infective endocarditis can be seen on the hands
Splinter hemorrhaging Janeway lesions Osler's nodes
30
What indication(s) of hyperlipdaemia is/are seen round the eyes?
``` Corneal arcus (can be normal in >60 years) Xanthelasma ```
31
What is the cause of a heave?
RV enlargement e.g. due to pulmonary stenosis, ASD or cor pulmonale
32
What is a thrill?
A palpable murmur felt as a vibration beneath your hand
33
What is indicated by a pansystolic murmur radiating to the axilla? Where is this best heard? Should the bell or diaphragm of the stethoscope be used?
Mitral regurgitation The apex Diaphragm
34
What is indicated by a rumbling mid-diastolic murmur heard best with the bell of the stethoscope?
Mitral stenosis
35
Where should you listen if you suspect a right sided murmur? How can you enable yourself to hear these murmurs better?
Lower left sternal edge; fourth intercostal space (tricuspid area) Left of the manubrium in the 2nd intercostal space (pulmonary valve murmur) Ask the patient to take a deep breath in and hold it
36
Where would you listen for aortic stenosis? What does it sound like?
Right of manubrium in 2nd intercostal space | Ejection systolic murmur- crescendo de-crescendo- radiating to the carotids
37
If I had more time I would...
Check for sacral and ankle oedema Check oxygen saturations Feel for an AAA Check peripheral pulses NB SOAP
38
What past surgical procedure(s) may be indicated by a median sternotomy?
CABG Valve replacement Congenital heart disease surgery
39
What should you look for round the bed in a cardiac examination?
Oxygen GTN spray Cardiac monitoring devices
40
How do you check for radio femoral delay? What does this indicate?
Check for radio-femoral delay by palpating both the radial and femoral pulses on one side of the body at the same time. The pulsation should occur at the same time, any delay may suggest coarctation of the aorta
41
What does radio-radial delay indicate?
Aortic arch aneurysm
42
In what conditions is pulse pressure narrow?
Aortic stenosis | Hypovolaemia
43
In which conditions is pulse pressure wide?
Aortic regurgitation | Septic shock
44
What is the definition of postural hypotension?
A drop in systolic BP of 10mmHg on standing
45
What is indicated by malar flush?
Mitral stenosis | Low cardiac output
46
What might cause bruit in a) elderly patients and b) young patients
a) atherosclerosis | b) vasculitis
47
What indications of right sided heart failure would be seen on examination of the abdomen?
Heptaomegaly | Ascites
48
What cardiac condition may be indicated by splenomegaly?
Infective endocarditis
49
Where are Roth spots seen? What cardiac condition do these indicate?
Fundus during fundoscopy | Infective endocarditis
50
What will be the effect of a too small cuff on BP reading?
Reading will be falsely raised
51
What is indicated by a BP differential >10mmHg?
Peripheral vascular disease Aortic aneurysm Aortic dissection
52
What are the causes of postural hypotension
1. Old age 2. Hypovolaemia 3. Drugs: nitrates, diuretics, antihypertensives, antipsychotics 4. Addison's 5. Hypopituitarism 6. Idiopathic
53
What causes the a wave in the JVP wave form?
Atrial systole
54
What causes the c wave in the JVP wave form?
Closure of the tricuspid valve, not normally visible
55
What causes the x descent in the JVP wave form?
Fall in atrial pressure during ventricular systole (as the atria are no longer contracting)
56
What causes the v wave in the JVP wave form?
Atrial filling against a closed tricuspid valve
57
What causes the y descent in the JVP wave form?
Opening of the tricuspid valve
58
What is the cause of a raised JVP with a normal waveform?
Fluid overload; right heart failure
59
What is the cause of a fixed, raised JVP with absent pulsation?
SVC obstruction
60
What is the cause of a large a wave?
Pulmonary hypertension; pulmonary stenosis
61
What is a cannon a wave?
A large a wave caused by contraction of the right atrium against a closed tricuspid valve
62
What is the cause of a large a wave?
Complete heart block Single chamber ventricular pacing Ventricular arrhythmias/ectopics
63
What is the cause of an absent a wave?
Atrial fibrillation
64
What is the cause of a large v wave?
Tricuspid regurgitation
65
What is the cause of an absent JVP?
When lying flat the jugular vein should be filled. If there is reduced circulatory volume e.g. dehydration or haemorrhage the JVP may be absent
66
What is/are the cause(s) of a bounding pulse?
CO2 retention Liver failure sepsis
67
What is/are the cause(s) of a collapsing pulse?
Aortic incompetence AV malformations Patent ductus arteriosus
68
What is pulsus paradoxus?
Systolic pressure weakens on inspiration by >10mmHg
69
What causes pulsus paradoxus?
Severe asthma Pericardial constriction Cardiac tamponade
70
What is the cause of S1?
Mitral/tricuspid valve closure
71
What causes a loud S1?
Mitral stenosis
72
What is the cause of the second heart sound?
Aortic and pulmonary valve closure
73
How is a 3rd heart sound best heard and at what point in the cycle is it heard?
With the bell of the stethoscope. Just after S2
74
At what age does a third heart sound become pathological
Over 30
75
What is/are the cause(s) of a third heart sound?
Mitral regurgitation VSD Post MI Dilated cardiomyopathy Constrictive pericarditis (early and more high pitched- 'pericardial knock) Restrictive cardiomyopathy (early and more high pitched- 'pericardial knock)
76
When does a 4th heart sound occur?
Just before the first heart sound
77
What causes a 4th heart sound?
Always pathological. Represents atrial contraction against a ventricle made stiff by any cause, e.g. aortic stenosis or hypertensive heart disease
78
When is a gallop rhythm heard?
Sinus tachycardia
79
What is the cause of an ejection systolic murmur? What does it sound like
Normal- esp. in children and high output states e.g. pregnancy and tachycardia Aortic stenosis Pulmonary stenosis Crescendo-decrescendo 'whoosh dub'
80
What causes a pansystolic murmur. What does it sound like?
Mitral or tricuspid regurgitation VSD Of uniform intensity throughout systole and merges with S2 'whoosh whoosh'
81
What is the cause of an early diastolic murmur? What does it sound like? How is it best heard?
Aortic regurgitation High pitched and easy to miss. Listen for "absence of silence" in early diastole Ask the patient to lean forward, take a deep breath in, out and then hold it. Listen with the bell of the stethoscope
82
What is the cause of an early diastolic murmur? What does it sound like? How is it best heard?
Mitral stenosis Low pitched and rumbling Ask the patient to roll on to there left side and place stethoscope just beneath the axilla on the left side Ask the patient to take a deep breath in, then a big breath out and hold it (left sided murmurs are louder on expiration)
83
Where do mitral murmers tend to be loudest?
Apex
84
Where does the ESM of aortic stenosis radiate?
The carotids
85
Where does the PSM of mitral regurgitation radiate?
The axilla
86
When might a pericardial rub be heard? What are its characteristics?
Pericarditis | A superfical scratching sound not confined to systole or diastole
87
How might you make a mitral stenosis or regurgitation murmur more audible?
1. Ask the patient to roll on to there left side and place stethoscope just beneath the axilla on the left side 2. Ask the patient to take a deep breath in, then a big breath out and hold it (left sided murmurs are louder on expiration)
88
How might you make an aortic regurgitation murmur more audible?
1. Ask the patient to lean forward 2. Ask the patient to take a deep breath in, then a big breath out and hold it (left sided murmurs are louder on expiration)
89
Which murmurs are best heard which the bell of the stethoscope?
1. Mitral stenosis 2. Aortic regurgitation 3. Third heart sound
90
How might you confirm your suspicion of an aortic systolic murmur?
Strong and forceful apex beat upon palpation- due to LV hypertrophy
91
How might you confirm your suspicion of a mitral regurgitation murmur?
Displaced apex beat due to enlarged LV
92
Which murmur is pan-systolic?
Mitral regurgitation
93
Which murmur is ejection systolic?
Aortic stenosis
94
Which murmurs are diastolic?
Mitral stenosis | Aortic regurgitation

Cardiology (18 decks)

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