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Examination findings > Cardiac murmurs and signs > Flashcards

Cardiac murmurs and signs Flashcards

1
Q

What cardiac conditions can cause clubbing?

A
  • Cyanotic heart disease
  • IE
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2
Q

What are cardiac causes of splinter haemorrhages?

A

IE

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3
Q

What is the cause of Quincke’s sign?

https://www.youtube.com/watch?v=V7u3vaKEDCI

A

AR

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4
Q

What is the cause of the following?

A

Hypercholesterolaemia

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5
Q

What causes the following?

A

Osler’s nodes - painful purple papules on the pulp - INfective endocarditis

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6
Q

What is the cause of the following?

A

Janeway lesions - Erythematous macules on palms - IE

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7
Q

What might be the cause of a regularly irregular HR?

A

2nd degree HB

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8
Q

What would be causes of radial radial delay?

A
  • Coarctation
  • Aortic dissection
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9
Q

What would be a cause of radio-femoral delay?

A

Aortic coarctation

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10
Q

What are causes of a collapsing pulse?

A

Classically AR, but may also be:

  • PDA
  • Anaemia
  • Thyrotoxicosis
  • Pregnancy
  • Fever
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11
Q

What might a cardiac cause of a wide pulse pressure?

A

AR

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12
Q

What may be a cardiac cause of a narrow pulse pressure?

A

AS

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13
Q

What is a cardiac causes of malar flush?

A

MS

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14
Q

What cardiac condition might cause conjunctival haemorrhages?

A

IE

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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
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16
Q

What might distended veins over the precordium indicate on chest exam?

A

SVC obstruction

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17
Q

What are causes of an impalpabe Apex?

A
  • Dextrocardia
  • Obese
  • Pericardial effusion
  • Emphysema
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18
Q

What might cause a displaced apex?

A
  • AR, MR
  • Cardiomegaly
  • RV enlargement
  • Mediastinal shift
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19
Q

What is the following and what is the cause?

https://www.youtube.com/watch?v=5YQsd6di6B4

A

Corrigan’s sign - Visible carotid pulsations - AR

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20
Q

What might a heaving apex beat indicate?

A
  • LVH
  • AS
  • MS
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21
Q

What might a parasternal heave indicate?

A

RV hypertrophy - due to pulmonary HTN or PS

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22
Q

What valvular problem is de musset’s sign assocaited with?

A

AR

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23
Q

Where would you listen when listening for MR?

A

5th intercostal MC line + Axilla

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24
Q

Where would you listen for MS murmur?

A

Apex lying on L lateral in expiration with the bell

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25
Q

Where would you listen for AS?

A

2nd intercostal, R sternal ridge, and carotids for radiation

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26
Q

Where would you listen for AR murmur?

A

3rd intercostal space, L sternal edge (Erb’s point) on expiration

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27
Q

What murmurs radiate?

A

Systolic murmurs

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28
Q

What murmurs need expiration to hear?

A

Diastolic murmurs - need manoeuvre to accentuate

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29
Q

Once you have assessed face, arms, hands, neck and precordium as part of Cardio exam, what else would you look at?

A

Legs and Lung bases - oedematous changes

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30
Q

Once finished a cardio exam, what else would you do to complete a full cardiovascular examination?

A

Examine:

  • Peripheral vascular exam
  • Hepatomegaly
  • Observation chart
  • Urine - haematuria in IE
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31
Q

What causes an S4 gallop?

A

Atrial contraction into a hypertrophieed ventricle

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32
Q

What conditions might you hear an S4 gallop in?

A
  • LVH
  • Hypertension
  • AS
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33
Q

What is the pathophysiology of soft S1?

A

AV valves close with reduced velcoity

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34
Q

What are causes of a soft S1?

A
  • Severe heart failure
  • MR - valves don’t close properly
  • Prolonged PR
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35
Q

What is the pathophysiology of a soft S2 in prolonged PR interval?

A

Valves already partially closed at the end of diastole because atrial relaxation occurs before LV contraction

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36
Q

What is the pathophysiology of Loud S1?

A

AV valves close with higher velocity because they are wide open at the end of diastole

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37
Q

What are causes of a loud S1?

A
  • AF, MS - high atrial pressure
  • Short PR, Tachycardia - short diastole
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38
Q

What is the pathophysiology of split S1?

A

Asynchronous AV valve closure

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39
Q

What are causes of split S1?

A
  • Normal
  • RBBB
  • ASD
40
Q

What does S1 represent?

A

AV valves closing - mitral and tricuspid

41
Q

What does S2 represent?

A

Aortic/pulmonary valves closing

42
Q

What is the pathophysiology of a soft S2?

A

Reduced aortic/pulmonary valve mobility

43
Q

What can cause a soft S2?

A
  • AS
  • PS
44
Q

What is the pathophysiology of a loud S2?

A

Valves close with higher velocity due to high post valvular pressure

45
Q

What are causes of a loud S2?

A
  • Pulmonary HTN
  • Systemic HTN
46
Q

What is the physiology behind a split S2 on inspiration?

A

Aortic valve closes first because pulmonary valve closure delayed due to increased vlood return to the right heart due to negative intrathroacic pressure

47
Q

Is split S2 on inspiration normal?

A

Yes

48
Q

What is the pathophysiology of a wide split S2?

A

Exaggerated split - aortic valve closes before pulmonary

49
Q

What are causes of a wide split S2?

A
  • RBBB
  • PS, pulmonary HTN - increased resistance to RV ejection
50
Q

What is the pathophysiology of reverse split S2?

A

Split increases during expiration - pulmonary closes before aortic valve

51
Q

What are causes of reverse split S2?

A
  • LBBB
  • HTN, AS - increased resistance to LV ejection
52
Q

What is the pathophsyiology of a fixed split S2?

A

No change in splitting with respiration (insp/expiration)

53
Q

What are causes of a fixed split S2?

A

ASD

54
Q

What is the pathophysiology of an S3 gallop?

A

Volume overload - high volume of blood from atrium rapidly fills ventricle during passie fillinf phase of cardiac cycle

55
Q

What is the difference between an S3 and S4 gallop?

A
  • S3 = ventricular gallop - directly after S2
  • S4 = atrial gallop - directly before S1
56
Q

what are causes of an S4 gallop?

A
  • LVF
  • Hyperdynamic states - anaemia, fever, thyrotoxicosis, athlete
57
Q

Does AS radiate, and if so where to?

A

Yes - Upper right sternal edge into the carotids

58
Q

Does aortic sclerosis radiate, and if so where to?

A

No - upper right sternal edge - does not radiate

59
Q

Does mitral regurgiation radiate, and if so where does it radiate?

A

Yes - Apex to axilla

60
Q

When is mitral regurg loudest?

A

On expiration

61
Q

Does mitral valve prolapse radiate, and if so where?

A

YEs - apex to axilla

62
Q

How would you distinguish MR from mitral valve prolapse?

A
  • MR - pansystolic
  • MVP - Mid systolic click and or late systloc murmur - normal S1 then gap before murmur
63
Q

Does MS radiate, and if so where?

A

No - apex in left lateral to accentuate - DIASTOLIC MURMUR

64
Q

Does AR radiate, and if so where?

A

No - accentuate LLSE sitting forward - DIASTOLIC MURMUR

65
Q

What are signs of AS?

A
  • ESM over URSE - radiates to carotids
  • Slow-rising pulse
  • Narrow pulse pressure
  • Heaving apex
  • Soft/absent S2
  • Signs of LVF - S3, pulmonary oedema
66
Q

How would you differentiate aortic sclerosis from aortic stenosis?

A

Sclerosis has normal pulse, apex and S2

67
Q

What signs might indicate mitral regurgiation?

A
  • 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
Q

What are signs of mitral prolapse?

A
  • Murmur only
  • May have some signs of MR
69
Q

What are signs of tricuspid regurg?

A
  • Giant V waves on JVP
  • Backlow signs - peripheral oedema, ascuties, pulsatile hepatomegaly
  • Signs of lung disease
  • Signs of PHT - RV heave, loud P2
70
Q

How would you distinguish TR from MR?

A

Louder on inspiration as on the right side + giant JVP + non displaced apex

71
Q

What are signs of mitral stenosis?

A
  • Malar flush
  • AF
  • Tapping Apex
  • Loud S1
  • Signs of PHT - RV heave, Loud P2
72
Q

What are signs of AR?

A
  • 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
Q

What are causes of aortic stenosis?

A
  • Age
  • Bicuspid valve
  • Congenital
  • Rheumatic heart disease
74
Q

What are cause of mitral regurgitation?

A
  • Papillary muscle rupture
  • Dilated cardiomyopathy
  • Rheumatic heart disease
  • IE
  • COngenital
  • Connective tissue
75
Q

What are causes of mitral stenosis?

A
  • Rhematic heart disease
  • Congenital
  • Carcinoid
76
Q

What are acute causes of Aortic regurg?

A
  • Infective endocarditis
  • Aortic dissection
77
Q

What are chronic causes of aortic regurg?

A
  • Connective tissue disorders
  • Rheumatic heart disease
  • Luetic heart disease
  • Congenital/bicuspid valve
  • Longstanding hypertension
78
Q

What signs would indicate severe AS?

A
  • Slow rising pulse
  • Narrow pulse pressure
  • Intense S2
79
Q

What signs would indicate severe AR?

A
  • Collapsing pulse
  • Wide pulse pressure
  • Backflow signs
  • Displaced Apex
  • Short early diastolic murmur
80
Q

What signs would indicate severe MR?

A
  • AF
  • Displaced apex
  • Loud P2
  • RV heave
81
Q

What signs would indicate severe MS?

A
  • AF
  • Short gap between S2 and opening snap
  • Loud P2
  • RV heave
82
Q

When assessing valvular abnormalities, what would you want to assess?

A
  • Signs
  • Severity
  • Signs of cardiac decompensation - HF signs
  • Signs of infective endocarditis
83
Q

How would you assess a valve replacement?

A
  • Look - midline sternotomy
  • Assess function - signs of regurg/stenosis
  • Signs of HF
  • Signs of IE
  • Complications of anticoagulation
  • Signs of haemolysis
84
Q

What are signs of HF?

A
  • Displaced apex
  • S3 gallop
  • Pulmonary oedema
  • Peripheral oedema
  • Raised JVP
  • Cool peripheries
  • Tchypnoea
  • Tachycardia
85
Q

What are signs of an ASD?

A
  • Fixed split S2
  • RV heave
  • Soft ESM - pulmonary area
86
Q

What would you look for in someone ith a suspected ASD?

A
  • Signs of associations
  • Signs of complications - Loud P2, peripheral oedema (RHF), cyanosis (Eisenmenger)
87
Q

What are signs of a VSD?

A
  • Pansystolic murmur - LLSE
  • Assocaited thrill
  • RV heave
  • Loud P2
88
Q

What would you want to look for in someone with a suspected VSD other than signs of its existence?

A

Complications - raised JVP, periphheral oedema

89
Q

What are signs of cor pulmonale?

A
  • RV heave
  • Loud P2
  • Peripheral oedema
  • Giant V waves
  • Central cyanosis
  • Plethoric face
  • Raised JVP
90
Q

What would you want to look for in somoene with suspected cor pulmonale other than signs of its existence?

A

Signs of cause - creps, clubbing, sings of COPD

91
Q

What are signs of hypertrophic cardiomyopathy?

A
  • Pacemaker/implantable defib
  • Jerky pulse/pulsus bisiferins
  • Douple apex beat
  • ESM LLSE
  • S4
92
Q

When assessing for HOCM, what would you want to look for other than evidence of its presence?

A

Any complications - signs of HF

93
Q

What are signs of tetralogy of fallot repair?

A
  • Sternotomy
  • Lateral thoracotomy + left pulse weaker - Blalock-Taussig shunt
  • Clubbing
  • Loud PS
94
Q

What are signs of co-arctation of the aorta?

A
  • RF delay
  • Week left radial pulse - if stenosis proximal to left SC artery
  • Systolic valve murmur of region of stenosis
  • Severe hypertension
95
Q

What would you want to assess for in someone with suspected co-arctation of the aorta?

A
  • Signs of asscoiations - Turner syndrome
  • Signs of complications - IE, severe HTN, signs of HF

Examination findings (23 decks)

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