Cardiac Examination Flashcards
How to begin a CVS examination
Wash hands Bare forearms Introduce yourself Consent Comfortable 45 degrees Head support, chest exposed Good light
General inspection
Stand back Well or ill Distress Pale Sweaty Cyanosed Tachypnoeic Scars Clues
Causes of irregularly irregular pulse
Ventricular etopics, AF, A flutter, wandering atrial pacemaker
Causes of regularly irregular pulse
Sinus arrythmia or second degree heart block
Cardiac causes of clubbing
Myoma, congential cyanotic heart disease, any chronic hypoxia and endocarditis
Hand examination
Look Clubbing, splinter haemorrhages Feel the temperature Feel tendon xanthomata Feel the radial pulses bilaterally Pulse rate and rhythm
Causes of splinter haemorrhage
Endocarditis, vasculitis e.g SLE, trauma
Examine pulses
Brachial pulse for character
Lift arm and feel for waterhammer or collapsing
Palpate R carotid
How do you palpated R carotid pulse
Left thumb
Slow rising pulse causes
Aortic stenosis
Poorly functioning left ventricle
Collapsing pulse causes
Aortic regurgitation Little blood (anaemia, thyroxicosis)
Corneal arcus
Can be normal in the elderly, arcus senilis
Why wont an anaemic person be cyanosed
Not adequate Hb to have 4g deoxygenated
What are you looking at the eyes for
Conjuctival pallor, corneal arcus, eyelids for xanthelasmata
What are you looking at the cheeks for
Malar flush (mitral stenosis)
What are you checking under the tongue and inside the lower lip for
Central cyanosis
How do you examine the JVP
Head slightly to left
Assess pulsation
Fixed?
Examine height above sternal angle
Cause of high JVP
Right heart failure
Cause of exaggerated JVP
Tricuspid regurg
Cause of fixed JVP
Tamponade
How does JVP differ from JVP
Double pulse, occlude, impalpable, varies with respiration and head tilt
How does hepatojugular reflux cause
Squeezing liver sinusoids and returning blood to the heaptic and the great veins
Apex beat displaced laterally
Cardiomegaly, lung or chest wall disease
Apex beat displaced medialy
Left pneumothorax or large left pleural effusion
How do you find apex beat
5th intercostal space and mid clavicular space
How do you examine apex beat
Palpate chest for heave, thrill, tap and identify apex ebat
How to find the 5th ICS more easily
Angle of lewy then count down three
Parasternal heave is a sign of
Enlarged right ventricle
Define heave
Outward movement of the palpating hand by the cardiac contraction
Define thrill
Palpable murmurs
When to use bell
Low pitched sounds, mitral and aortic stenosis
When to use diaphragm
High pitched sounds, aortic and mitral regurgitation
What is aortic sclerosis
Thickening of the valves but not stiffening
Where do you auscultate
Diaphragm Apex Left sternal angle Right sternal angle Base Bell, repeat Carotids
How do you accentuate AR
Patient sitting forward and breath held in expiration
How do you accentuate MS
Patient in the left lateral position
Whats valvasalva maneuver
Maximum handgrip, decrease venous return and supsequently decreased LV filling. Louder murmur
1st heart sound
Mitral and tricuspid valve closure
2nd heart sound
AV and PV
Why do you raise the arm when taking pulse
Mitral regurg
What is an alternative to measuring the JVP
Raise the hand above the level of the heart and look at vein in the back of the hand
Cause of physiological splitting of heart sound
Inspiration, increased venous return to RA. RV more blood, RV longer to systole
Cause of reversed splitting of heart sound
Expiration, Aortic Stenosis or LBBB. Aortic closes after pulmonary.
Cause of fixed splitting
Atrial septal defect causes left to right shunt. Pulmonary closes after aortic, independent of breathing.
Cause of paradoxical splitting
Due to RBBB or pulmonary stenosis. P2 then A2
3rd heart sounds
Abnormal in adults over 40, LV overload
4th heart sound
increased ventricular
How to make heart sounds easier to hear with fat people
Ask them to sit forward
How to tell if its the first heart sound
Feel for the carotid pulse
What is a murmur
Turbulent blood flow through a valve or stenosed/regurgitant
AS murmur
Ejection, systolic, crescendo decrescendo
AR murmur
Early diastolic decrescendo
PDA murmur
Continuous machinery murmur
Causes of pitting bilateral lower limb oedema
Liver failure, heart failure, renal failure, hypoalbuminaemia, bilateral venous insufficiency
Causes of non pitting bilateral lower oedema
Lymphoedema
Causes of unilateral pitting oedema
DVT, pelvic mass, ruptured bakers cyst, post thrombotic syndrome, cellulitis
Non chest parts of CVS examination
Percuss and auscultate lung bases Sacral oedema Feel liver, assess ascites Examine peripheral pulses and check for radiofemoral delay Ankle oedema Blood pressure
Signs of heart failure
JVP Ankle oedema Crackles in lungs 3rd/4th heart sound Displaced apex MR
Where are you auscultating
Apex, base, aortic, pulmonic
Tennis ball sign on CT
Aortic dissection
