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Cardiovascular > cardiac examination > Flashcards

cardiac examination Flashcards

1
Q

What does fever indicate?

A

infective endocarditis and pericarditis and may occur after MI

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2
Q

what do splinter haemorrhages indicate

A

infective endocarditis and some vasculitic disorders

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3
Q

what do Janeway lesions, Oslers nodes, nail fold infarcts and finger clubbing indicate

A

endocarditis

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4
Q

Why is urinalysis useful?

A

haematuria (endocarditis, vasculitis)
glucose (diabetes)
protein (hypertension and renal disease)

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5
Q

What does central cyanosis indicate

A

may be due to heart failure or congenital heart disease where it is associated with right-to-left shunting and finger clubbing

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6
Q

what does xanthelasmata indicate

A

predicts cardiovascular disease (MI and coronary heart disease)

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7
Q

what is corneal arcus

A

discolouration at the boundary of the iris and cornea caused by cholesterol deposition

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8
Q

what conditions is clubbing found in?

A 
cyanotic congenital heart disease
infective endocarditis
lung carcinoma
chronic lung suppurations (bronchiectasis, abscess, empyema)
idiopathic pulmonary fibrosis
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9
Q

When taking a pulse, what should you assess?

A

rate
rhythm
volume
character

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10
Q

when is it especially important to assess the carotid pulse

A

if the patient has had a cardiac arrest

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11
Q

common causes of bradycardia?

A

medication
athletic conditioning
sinoatrial or atrioventricular node dysfunction

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12
Q

most common cause of an irregularly irregular pulse

A

atrial fibrillation

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13
Q

most common cause of a large pulse pressure

A

arteriosclerosis which is seen in patients with widespread vascular disease, hypertension and advanced age

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14
Q

common causes of a low pulse volume

A

reduced stroke volume due to left ventricular failure, hypovolaemia or peripheral arterial disease

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15
Q

what is coarctation and what are the the clinical signs

A

congenital narrowing of the aorta

children: upper limbs are usually normal with reduced and delayed volume lower limb pulses
adults: hypertension and heart failure

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16
Q

what are the causes of pulsus bisferiens

A

aortic regurgitation and concomitant aortic stenosis and regurgitation

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17
Q

how does normal a normal pulse change with inspiration and expiration

A

increases in expiration
decreases during inspiration
this occurs due to intrathoracic pressure changes affecting venous return to the heart

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18
Q

what is normal BP defined as?

A

<130/85mmHg

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19
Q

causes of secondary hypertension

A 
renal artery disease
phaeochromotocytoma
conn's syndrome
cushings 
coarctation of the aorta
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20
Q

what are korotkoff sounds

A

sounds produced between systole and diastole because the artery collapses and reopens with each heart beat, producing a snapping or knocking sound

21
Q

what does a difference in BP of more than 10mmHg in each arm indicate?

A

presence of aortic or subclavian artery disease

22
Q

when do you find an elevated JVP

A

as JVP is a sign of right ventricular function, it is elevated in cases of fluid overload (heart failure) and in conditions with right heart dilatation (acute PE and chronic obstructive pulmonary disease/cor pulmonale)

23
Q

what is Kussmaul’s sign?

A

a paradoxical rise of JVP on inspiration seen in pericardial constriction, tamponade, severe right ventricular failure and restrictive cardiomyopathy

24
Q

what does a midline sternotomy scar indicate

A

previous coronary artery bypass surgery or aortic valve replacement

25
Q

what does a left submammary scar indicate

A

mitral valvotomy

26
Q

what do infraclavicular scars indicate

A

pacemaker or defibrillation implantation

27
Q

in what patients may the apex beat be impalpable?

A

overweight/muscular people

patients with asthma or emphysema because lungs are hyperinflated

28
Q

when may the apex beat be displaced?

A

interiorly and laterally displaced in left ventricular dilatation (after MI, aortic stenosis)

29
Q

where is the apex in people with dextrocardia

A

right side

30
Q

what does right ventricular heave indicate?

A

right ventricular hypertrophy or dilatation, most often accompanying pulmonary hypertension

31
Q

what is the apex beat like in mitral stenosis?

A

tapping

32
Q

what is a double apical impulse characteristic of?

A

hypertrophic cardiomyopathy

33
Q

what is the first heart sound caused by and where is it best heard?

A

closure of the mitral and tricuspid valves at the onset of ventricular systole. It is best heard at the apex

34
Q

what is the third heart sounds caused by and where is it best heard?

A

closure of the pulmonary and aortic valves at the end of ventricular systole. Best heard at the left sternal edge

35
Q

why does splitting of the second heart sound occur?

A

left ventricular contraction slightly precedes that of the right ventricular so that the aortic valve closes before the pulmonary valve.

36
Q

when is the intensity of S1 increased?

A

mitral stenosis

37
Q

when is S2 quiet or absent?

A

calcific aortic stenosis and regurgitation

38
Q

when does wide splitting of s2 occur?

A

right BBB

39
Q

what are the common causes of third heart sounds?

A

left ventricular failure

mitral regurgitation

40
Q

what are the signs of heart failure?

A 
acute breathlessness
third heart sound
raised JVP
peripheral oedema
basal lung crackles
41
Q

what is a pericardial (friction) rub and when is it heard?

A

coarse scratching sound.

acute viral pericarditis and 24-72 hours after an MI

42
Q

what are heart murmurs produced by?

A

turbulent flow across an abnormal valve, septal defect or outflow obstruction

43
Q

when do murmurs of aortic regurgitation start

A

early diastole and extend into mid-diastole

44
Q

when do murmurs of mitral or tricuspid stenosis start

A

after mid-diastole

45
Q

what are early diastolic murmurs usually caused by and how are they best heard?

A

aortic regurg. patient leaning forward holding their breath in expiration

46
Q

what are mid-diastolic murmurs usually caused by and how are they best head?

A

mitral stenosis. when patients are rolled to the left side

47
Q

causes of continuos murmurs

A

patent ductus arteriosus

48
Q

How is an enlarged heart identified on an Xray and what is indicative of?

A

judged by the cardiothoracic ratio and is common in valvular heart disease and heart failure (often accompanied by distention of the upper lobe pulmonary veins, diffuse shadowing within the lungs due to pulmonary oedema and Kerley B lines.

Cardiovascular (7 decks)

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