Cardiac murmurs and signs Flashcards
1
Q
What cardiac conditions can cause clubbing?
A
- Cyanotic heart disease
- IE
2
Q
What are cardiac causes of splinter haemorrhages?
A
IE
4
Q
What is the cause of the following?
A
Hypercholesterolaemia
5
Q
What causes the following?
A
Osler’s nodes - painful purple papules on the pulp - INfective endocarditis
6
Q
What is the cause of the following?
A
Janeway lesions - Erythematous macules on palms - IE
7
Q
What might be the cause of a regularly irregular HR?
A
2nd degree HB
8
Q
What would be causes of radial radial delay?
A
- Coarctation
- Aortic dissection
9
Q
What would be a cause of radio-femoral delay?
A
Aortic coarctation
10
Q
What are causes of a collapsing pulse?
A
Classically AR, but may also be:
- PDA
- Anaemia
- Thyrotoxicosis
- Pregnancy
- Fever
11
Q
What might a cardiac cause of a wide pulse pressure?
A
AR
12
Q
What may be a cardiac cause of a narrow pulse pressure?
A
AS
13
Q
What is a cardiac causes of malar flush?
A
MS
14
Q
What cardiac condition might cause conjunctival haemorrhages?
A
IE
15
Q
What might cause a raised JVP?
A
PQRST
- Pulmonary HTN/PE/PS/Pericardial effusion
- Quantity of fluid - Overload, RVF, SVC obstruction
- Tamponade/TR
16
Q
What might distended veins over the precordium indicate on chest exam?
A
SVC obstruction
17
Q
What are causes of an impalpabe Apex?
A
- Dextrocardia
- Obese
- Pericardial effusion
- Emphysema
18
Q
What might cause a displaced apex?
A
- AR, MR
- Cardiomegaly
- RV enlargement
- Mediastinal shift
19
Q
What is the following and what is the cause?
A
Corrigan’s sign - Visible carotid pulsations - AR
20
Q
What might a heaving apex beat indicate?
A
- LVH
- AS
- MS
21
Q
What might a parasternal heave indicate?
A
RV hypertrophy - due to pulmonary HTN or PS
22
Q
What valvular problem is de musset’s sign assocaited with?
A
AR
23
Q
Where would you listen when listening for MR?
A
5th intercostal MC line + Axilla
24
Q
Where would you listen for MS murmur?
A
Apex lying on L lateral in expiration with the bell
25
Where would you listen for AS?
2nd intercostal, R sternal ridge, and carotids for radiation
26
Where would you listen for AR murmur?
3rd intercostal space, L sternal edge (Erb's point) on expiration
27
What murmurs radiate?
Systolic murmurs
28
What murmurs need expiration to hear?
Diastolic murmurs - need manoeuvre to accentuate
29
Once you have assessed face, arms, hands, neck and precordium as part of Cardio exam, what else would you look at?
Legs and Lung bases - oedematous changes
30
Once finished a cardio exam, what else would you do to complete a full cardiovascular examination?
Examine:
* **Peripheral vascular exam**
* **Hepatomegaly**
* **Observation chart**
* **Urine** - haematuria in IE
31
What causes an S4 gallop?
Atrial contraction into a hypertrophieed ventricle
32
What conditions might you hear an S4 gallop in?
* **LVH**
* **Hypertension**
* **AS**
33
What is the pathophysiology of soft S1?
AV valves close with reduced velcoity
34
What are causes of a soft S1?
* **Severe heart failure**
* **MR** - valves don't close properly
* **Prolonged PR**
35
What is the pathophysiology of a soft S2 in prolonged PR interval?
Valves already partially closed at the end of diastole because atrial relaxation occurs before LV contraction
36
What is the pathophysiology of Loud S1?
AV valves close with higher velocity because they are wide open at the end of diastole
37
What are causes of a loud S1?
* **AF, MS** - high atrial pressure
* **Short PR, Tachycardia** - short diastole
38
What is the pathophysiology of split S1?
Asynchronous AV valve closure
39
What are causes of split S1?
* **Normal**
* **RBBB**
* **ASD**
40
What does S1 represent?
AV valves closing - mitral and tricuspid
41
What does S2 represent?
Aortic/pulmonary valves closing
42
What is the pathophysiology of a soft S2?
Reduced aortic/pulmonary valve mobility
43
What can cause a soft S2?
* **AS**
* **PS**
44
What is the pathophysiology of a loud S2?
Valves close with higher velocity due to high post valvular pressure
45
What are causes of a loud S2?
* **Pulmonary HTN**
* **Systemic HTN**
46
What is the physiology behind a split S2 on inspiration?
Aortic valve closes first because pulmonary valve closure delayed due to increased vlood return to the right heart due to negative intrathroacic pressure
47
Is split S2 on inspiration normal?
Yes
48
What is the pathophysiology of a wide split S2?
Exaggerated split - aortic valve closes before pulmonary
49
What are causes of a wide split S2?
* **RBBB**
* **PS, pulmonary HTN** - increased resistance to RV ejection
50
What is the pathophysiology of reverse split S2?
Split increases during expiration - pulmonary closes before aortic valve
51
What are causes of reverse split S2?
* **LBBB**
* **HTN, AS** - increased resistance to LV ejection
52
What is the pathophsyiology of a fixed split S2?
No change in splitting with respiration (insp/expiration)
53
What are causes of a fixed split S2?
ASD
54
What is the pathophysiology of an S3 gallop?
Volume overload - high volume of blood from atrium rapidly fills ventricle during passie fillinf phase of cardiac cycle
55
What is the difference between an S3 and S4 gallop?
* S3 = ventricular gallop - directly after S2
* S4 = atrial gallop - directly before S1
56
what are causes of an S4 gallop?
* **LVF**
* **Hyperdynamic states** - anaemia, fever, thyrotoxicosis, athlete
57
Does AS radiate, and if so where to?
Yes - Upper right sternal edge into the carotids
58
Does aortic sclerosis radiate, and if so where to?
No - upper right sternal edge - does not radiate
59
Does mitral regurgiation radiate, and if so where does it radiate?
Yes - Apex to axilla
60
When is mitral regurg loudest?
On expiration
61
Does mitral valve prolapse radiate, and if so where?
YEs - apex to axilla
62
How would you distinguish MR from mitral valve prolapse?
* **MR** - pansystolic
* **MVP** - Mid systolic click and or late systloc murmur - normal S1 then gap before murmur
63
Does MS radiate, and if so where?
No - apex in left lateral to accentuate - DIASTOLIC MURMUR
64
Does AR radiate, and if so where?
No - accentuate LLSE sitting forward - DIASTOLIC MURMUR
65
What are signs of AS?
* **ESM over URSE - radiates to carotids**
* **Slow-rising pulse**
* **Narrow pulse pressure**
* **Heaving apex**
* **Soft/absent S2**
* **Signs of LVF** - S3, pulmonary oedema
66
How would you differentiate aortic sclerosis from aortic stenosis?
Sclerosis has normal pulse, apex and S2
67
What signs might indicate mitral regurgiation?
* **AF**
* **Displaced apex**
* **Pansystolic murmur** - apex radiating to axilla
* **Soft S1**
* **Signs of PHT** - RV heave, loud P2
* **Signs of LVF** - S3, Pulmonary oedema
68
What are signs of mitral prolapse?
* **Murmur only**
* **May have some signs of MR**
69
What are signs of tricuspid regurg?
* **Giant V waves on JVP**
* **Backlow signs** - peripheral oedema, ascuties, pulsatile hepatomegaly
* **Signs of lung disease**
* **Signs of PHT** - RV heave, loud P2
70
How would you distinguish TR from MR?
Louder on inspiration as on the right side + giant JVP + non displaced apex
71
What are signs of mitral stenosis?
* **Malar flush**
* **AF**
* **Tapping Apex**
* **Loud S1**
* **Signs of PHT** - RV heave, Loud P2
72
What are signs of AR?
* **Collapsing pulse**
* **Wide pulse pressure**
* **Very displaced thrusting apex**
* **Backflow signs**
* Corrigans - visible carotid pulsation
* De mussts - head bobbing
* Quinckes - Pulsatile nails
* Austin flint murmur
73
What are causes of aortic stenosis?
* **Age**
* **Bicuspid valve**
* **Congenital**
* **Rheumatic heart disease**
74
What are cause of mitral regurgitation?
* **Papillary muscle rupture**
* **Dilated cardiomyopathy**
* **Rheumatic heart disease**
* **IE**
* **COngenital**
* **Connective tissue**
75
What are causes of mitral stenosis?
* **Rhematic heart disease**
* **Congenital**
* **Carcinoid**
76
What are acute causes of Aortic regurg?
* **Infective endocarditis**
* **Aortic dissection**
77
What are chronic causes of aortic regurg?
* **Connective tissue disorders**
* **Rheumatic heart disease**
* **Luetic heart disease**
* **Congenital/bicuspid valve**
* **Longstanding hypertension**
78
What signs would indicate severe AS?
* **Slow rising pulse**
* **Narrow pulse pressure**
* **Intense S2**
79
What signs would indicate severe AR?
* **Collapsing pulse**
* **Wide pulse pressure**
* **Backflow signs**
* **Displaced Apex**
* **Short early diastolic murmur**
80
What signs would indicate severe MR?
* **AF**
* **Displaced apex**
* **Loud P2**
* **RV heave**
81
What signs would indicate severe MS?
* **AF**
* **Short gap between S2 and opening snap**
* **Loud P2**
* **RV heave**
82
When assessing valvular abnormalities, what would you want to assess?
* **Signs**
* **Severity**
* **Signs of cardiac decompensation** - HF signs
* **Signs of infective endocarditis**
83
How would you assess a valve replacement?
* **Look** - midline sternotomy
* **Assess function** - signs of regurg/stenosis
* **Signs of HF**
* **Signs of IE**
* **Complications of anticoagulation**
* **Signs of haemolysis**
84
What are signs of HF?
* **Displaced apex**
* **S3 gallop**
* **Pulmonary oedema**
* **Peripheral oedema**
* **Raised JVP**
* **Cool peripheries**
* **Tchypnoea**
* **Tachycardia**
85
What are signs of an ASD?
* **Fixed split S2**
* **RV heave**
* **Soft ESM** - pulmonary area
86
What would you look for in someone ith a suspected ASD?
* **Signs of associations**
* **Signs of complications** - Loud P2, peripheral oedema (RHF), cyanosis (Eisenmenger)
87
What are signs of a VSD?
* **Pansystolic murmur** - LLSE
* **Assocaited thrill**
* **RV heave**
* **Loud P2**
88
What would you want to look for in someone with a suspected VSD other than signs of its existence?
Complications - raised JVP, periphheral oedema
89
What are signs of cor pulmonale?
* **RV heave**
* **Loud P2**
* **Peripheral oedema**
* **Giant V waves**
* **Central cyanosis**
* **Plethoric face**
* **Raised JVP**
90
What would you want to look for in somoene with suspected cor pulmonale other than signs of its existence?
**Signs of cause** - creps, clubbing, sings of COPD
91
What are signs of hypertrophic cardiomyopathy?
* **Pacemaker/implantable defib**
* **Jerky pulse/pulsus bisiferins**
* **Douple apex beat**
* **ESM LLSE**
* **S4**
92
When assessing for HOCM, what would you want to look for other than evidence of its presence?
Any complications - signs of HF
93
What are signs of tetralogy of fallot repair?
* **Sternotomy**
* **Lateral thoracotomy + left pulse weaker** - Blalock-Taussig shunt
* **Clubbing**
* **Loud PS**
94
What are signs of co-arctation of the aorta?
* **RF delay**
* **Week left radial pulse** - if stenosis proximal to left SC artery
* **Systolic valve murmur of region of stenosis**
* **Severe hypertension**
95
What would you want to assess for in someone with suspected co-arctation of the aorta?
* **Signs of asscoiations** - Turner syndrome
* **Signs of complications** - IE, severe HTN, signs of HF
