Cardiac examination Flashcards
What murmurs can you hear in the URSB and what is the potential origin?
Ejection systolic - aortic stenosis
Continuous - right BT shunt, venous hum
How can you increase the venous hum?
Turn child’s head to the left
What is a BT shunt?
Blalock Taussig shunt in CHD
What murmurs can you hear in the ULSB and what is the potential origin?
Ejection systolic - pulmonary stenosis, ASD, innocent murmur
How can you check if a murmur is innocent?
It will not radiate to the back
What murmurs can you hear in the LLSB and what is the potential origin?
Pansystolic - tricuspid regurg, VSD
Diastolic - tricuspid stenosis, aortic regurg, Still’s murmur
What is a Still’s murmur?
A benign flow murmur across the aortic valve from high cardiac output and/or increased contractility
What murmurs can you hear in the apex and what is the potential origin?
Pansystolic - mitral regurg, VSD
Late systolic - mitral prolapse
Ejection systolic - aortic stenosis
Mid-diastolic - mitral stenosis
Which structures form the right heart border?
SVC
RA
Which structures form the left heart border?
Aorta knuckle
PA knuckle
LA appendage
LV
Which structures form the anterior heart border?
RV
Which structures form the posterior heart border?
Descending aorta
LA
What are clinical signs of RV enlargement?
LPS
Epigastric heave
What are clinical signs of pulmonary hypertension?
Palpable P2
LPS
Epigastric heave
What are clinical signs of aortic stenosis?
Displaced apex (LVH) Suprasternal thrill
Name causes of central cyanosis
- Inadequate ventilation
- pneumonia
- airway obstruction
- lung changes
- CNS depression
- - inadequate ventilatory drive
- weak resp mm - Desaturated blood bypassing lungs
- cyanotic HD
- pulmonary AVMs
- PPHN - Methaemoglobinaemia
- congenital
- toxin - Poisoning
- carbon monoxide
Discuss your approach to oedema
Low protein
- Decr intake
- PEM - Decr production
- liver failure - Incr loss
- nephrotic syndrome
- PLE
Capillary leak
- CCF
- cor pulmonale
- sepsis
- anaphylaxis
What are the features of PEM to look out for in approach to oedema?
Skin lesions
Hepatomegaly
Plot growth
Deficiency (vitamins, iron ca)
What are the features of liver failure to look out for in approach to oedema?
Decr LOC Decr albumin Decr glucose Incr NH3 Incr INR
What are the features of nephrotic syndrome to look out for in approach to oedema?
Anasarca Urine dipstix Albuminuria Prot:creat TP normal Decr albumin Decr C3, C4 Incr chol
What are the features of PLE to look out for in approach to oedema?
Diarrhoea
Decr TP
Decr albumin
Decr globulin
What are the features of CCF to look out for in approach to oedema?
Cardiomegaly Hepatomegaly Tachycardia Tachypnoea CXR ECG Sonar Bloods
Define digital clubbing
Bulbuous uniform swelling of soft tissue of terminal phalanx with loss of normal angle between nail and nail bed
Name primary causes of clubbing
Idiopathic Inherited - pachydermoperiostosis - hypertrophic osteoarthropathy - familial
