cardio Flashcards
where is aortic valve listened to
upper right sternal border at level of 2nd right intercostal space
where is pulmonary valve listened to
upper left sternal border at level of 2nd left intercostal space
where is tricuspid valve listened to
lower left sternal border at level of 4ths left intercostal space
where is mitral valve listened to
apex beat point - mid-clavicular line at level of 5th left IC spce
differences between JVP and carotid pulse
JVP is multiphasic JVP not palpable JVP is occludable JVP varies with with head up tilt (HUT) JVP varies with respiration - decreases with deep inspiration
what does JVP reflect
right atrial pressure
when we say JVP is multiphasic what do we mean
it beats twice in quick succession in the cardiac cycle
first is ‘a’ wave then second ‘v’ wave
when is JVP elevated
fluid overload + heart failure (esp right ventricular failure)
acute PE
COPD
what heart sound is heard same time carotid pulse
S1
what does S1 correlate with
beginning systole
when atrioventricular valves (mitral and tricuspid) close
what does S2 correlate with
closure of semilunar (aortic and pulmonary) valves
3rd heart sound
in diastole - after S2
can be physiological but >40yrs more likely pathological - left ventric failure, mitral regurg
4th heart sound
just before S1
left ventric hypertrophy
pericardial friction rub sound
coarse scratching sound
hands
colour tar staining cyanosis clubbing splinter haemorrhages janeway lesions osler's nodes temp cap refill
hand signs of infective endocarditis
splinter heamorrhages
Janeway lesions
osler’s nodes
what do need to comment on when taking radial pusle
rate
rhythm: regular, irregularly irregular, regularly irregular
volume: normal, bounding, thready
character: normal, slow rising, collapsing
face
malar flush: mitral stenosis anaemia eyes corneal arcus xanthelasmata central cyanosis red tongue (anaemia) angular stomatitis
chest
back chest lung bases for crackles - left sided heart failure
sacral oedema if bes bound
lower limbs
pitting oedema (15 secs pressure) temp hair loss cap refill ulcers varicose veins
measuring JVP
verticla distance between sternal angle and top of pulsation JVP
normally <4cm
inspection of precordium
chest deformities - pectus excavatum
scars
pacemaker
visible pulsation
palpation of precordium
tracheal position cardiac pacemaker apex beat heaves thrill
what is a heave and where do you feel for them
hand easily lifted with chest wall mocement - ventricular hypertrophy
L of sternum
what is a thrill and where do you feel for them
palpable murmur
both sides of sternum
apex point
auscultation of precodrium
4 valve areas with diaphragm and bell
left sided systolic murmurs
left sided diastolic murmurs
what are the left sided systolic murmurs
aortic stenosis
mitral regurgitation
what are the left sided diastolic murmurs
mitral stenosis
aortic regurgitation
listening for aortic stenosis
aortic valve area and carotid arteries
listening for mitral regurgitation
mitral valve area (apex) and L axilla for radiation
listening for mitral stenosis
patient rolled onto left side, listen at apex with bell of stethoscope, breath held in expiration
listening for aortic regurgitation
patient sit up leaning forwards, breath held in expiration, listen lower left sternal edge
which peripheral pulses need to be felt
radial brachial carotid femoral (+ radiofemoral delay) popliteal posterior tibial dorsalis pedis
also ascultate for bruits carotid and femoral a
where is radial pulse
proximal to wrist joint on radial side of flexor surface wrist
lateral to tendon of flexor carpi radialis
where is brachial pusle
antecubital fossa medial to biceps tendon
where is carotid pulse
in neck medial to SCM muscle
where is femoral pusle
inferior to inguinal ligament, half-way between anterior superior iliac spine and symphysis pubis
where is popliteal pulse
behind knww joint deep in popliteal fossa
where is posterior tibial pulse
behind and ~2cm below medial
where is dorsalis pedis pulse
dosrum of foot lateral to tendon of extensor hallucis longus
CVS systemic enquiry
chest pain dyspnoea palpitations ankle oedema varicose veins claudicatoin
CVS causes syncope
postural changes: postural hypotension
exertion: aortic stenosis
random: arrhythmia
