Cardiac Examination Flashcards
Osler’s nodes
Painful purple papules on pulps
Jane way lesions
Erythematous macules on palms
Radio-radial delay
Aortic dissection
Aortic coarctation
Radio-femoral delay
Aortic coarctation
Collapsing pulse
AR
Patent ductus asteriosus
High output states eg. Anaemia, thyrotoxicosis
Physiological states eg. Pregnancy, fever
Wide pulse pressure
AR
Narrow pulse pressure
AS
Mallar Flush
MS
Impalpable apex beat
DOPE
Dextrocardia
Obesity
Pericardial effusion
Emphysema
Mitral valve manoeuvre
Listen at 45 degrees
Listen to axilla for radiation
Roll patient onto left side and listen with bell over the apex on expiration
Aortic valve manoeuvre
Listen at 45 degrees
Listen over right carotid with breath held (AS)
Sit patient forward and listen at Erb’s point on expiration (AR)
Cardiac auscultation tips
Right valves heard better at full inspiration
Left valves heard better at full expiration
Never put the stethoscope on top of the best- listen in inframammary fold
Systolic murmurs radiate (MR, AS)
Diastolic murmurs need accentuating (MS, AR)
Auscultation positions
G
Erb’s point
3rd ICS on the LHS
Systolic murmurs
AS
Aortic sclerosis
MR
Mitral valve prolapse
Ventricular septal defect
TR
Diastolic murmurs
MS
AR
Aortic stenosis
Ejection systolic murmur heard best at 2nd ICS RHS sternum. Appropriate manoeuvre
Lead to LV hypertrophy (heaving apex beat)
Aortic valve thrill
Exertion also dyspnoea, syncope, angina
Slow rising pulse, narrow pp, heaving apex beat, pulmonary oedema (crackles)
Causes- ABC’s
Age
Bicuspid aortic valve (Turner’s)
Congenital
Strep-associated (rheumatic heart disease)
Aortic sclerosis
Ejection systolic
Valve not narrowed- turbulence only
No symptoms
No abnormal signs
Cause: senile calcification
Mitral regurgitation
Pansystolic
Leads to pulmonary hypertension
Orthopnoea, PND, fatigue, palpitations
AF, RV heave, pulmonary oedema
Cause: papillary muscle dysfunction, dilated cardiomyopathy, rheumatism heart disease, congenital, Marfan’s
Mitral valve prolapse
Mid systolic click or late systolic murmur
Leads to MR
Atypical chest pain
Murmur only
Associations: congenital, Marfan’s, PKD, congestive cardiomyopathy, HOCM, myocarditis, Ehlers-Danlos, SLE, MD
Ventricular septal defect
Pansystolic murmur
No symptoms usually
Signs of pulmonary hypertension eg. RV heave
Cause: congenital, complication post-MI
Tricuspid regurgitation
Pansystolic murmur (loudest on inspiration- RHS)
Fatigue, ascites, peripheral oedema, hepatic pain
Signs of venous congestion eg. JVP, hepatomegaly
Cause: pulmonary hypertension, rheumatic heart disease, IE (IVDU)
Mitral stenosis
Opening snap diastolic murmur
Leads to pulmonary hypertension
Dyspnoea, fatigue, haemoptysis, chest pain
Malar flush, AF, signs of pulmonary hypertension
Cause: rheumatic heart disease, congenital
Aortic regurgitation
Early diastolic
Increased LV volume
Fatigue, SOB, palpitations
Collapsing pulse, wide PP, displaced apex, corrigans sign, de Mussets sign, Quinckes sign
Cause: aortic dissection, IE, Marfan’s, long-standing HTN, bicuspid aortic valve
Differentiating the JVP from the carotid pulsation
JVP has a double waveform
JVP not palpable
JVP descends with inspiration
Hepatojugular reflex increases the JVP
Focused Exam- AS
Dyspnoea
Pulsus parvus et tardus
Postural hypotension
Narrow pulse pressure
Slow rising carotid pulse
Displaced apex beat
Systolic murmur best heard at right sternal edge of 2nd ICS
Radiates to the carotids
Aortic valve thrill
Pulmonary crepitations
Focus Exam- Aortic Regurgitation
Dyspnoea
Quinkes sign- throbbing nail bed on light palpitation
Wide pulse pressure
Collapsing pulse
De Mussets sign- head bobbing with the heart beat
Landolfi sign- systolic contraction and diastolic relaxation of the pupil
Displaced apex beat
Diastolic murmur best heard at Erb’s point, sat forward with full expiration
Aortic valve thrill
Pulmonary crepitations
Focused Exam- Mitral Regurgitation
Dyspnoea
Displaced apex beat
Systolic Murmur best heard at apex point
Radiates to the axilla
Mitral valve thrill
Pulmonary crepitations
Focused Exam- Mitral Stenosis
Dyspnoea
Atrial fibrillation
Raised JVP
Mallar flush
Displaced apex beat
Diastolic murmur best heard at apex point with the bell and the patient lying on their LHS
Mitral valve thrill
Pulmonary crepitations
Focused Exam- RHS HF
Oedema- ankles, sacrum, ascites
Dyspnoea
Facial engorgement
Raised JVP
Right parasternal heave
Hepatomegaly
S3 heart sound
Focused Exam- LHS HF
Dyspnoea
Wheeze
Bibasal crackles on auscultation
Displaced apex beat
S3 heart sound
Focused Exam- infective endocarditis
Splinter haemorrhages, Jane way lesions (palms) Oslers nodes (fingers)
Poor dentition
Fever
New murmur or change to an existing one
Embolic phonomenae- ask about any pain/ neurological Sx
Focused exam- atrial fibrillation
Irregularly irregular pulse
Tachycardia
Irregular heart sounds on auscultation
Dyspnoea
Causes of a third heart sound
Physiological;
-healthy young adults
-athletes
-pregnancy
-fever
Pathological;
-mitral regugitation
-poorly contracting left ventricle (ie. LVF)
Causes of a split S2
RBBB
LBBB
ASD
VSD
Pulmonary HTN
HOCM
PS
AS
