Cardio Exam Flashcards
Give 2 features of AF on ECG and why AF is dangerous
Irregularly irregular rhythm
No distinct p waves
Turbulent flow pattern increases clot risk
Describe 2nd degree heart block mobitz I
Gradual prolongation of PR interval until a beat is skipped
Regularly irregular
Describe 2nd degree heart block mobitz II
P waves regular, but only some followed by QRS
No PR prolongation
Regularly irregular
Describe 3rd degree heart block
P waves regular, QRS regular, no relationship
Atria + ventricles beat asynchronously
Describe ventricular fibrilation
Rate irregular + >250 bpm
Asynchronous ventricular contraction, no filling
Describe ventricular tachycardia
Rate regular + fast
p waves hidden- dissociated atrial rhythm
What characterises ST elevation? What is it caused by?
ST segment >2mm above isoelectric line
Infarction
What characterises ST depression? What is it caused by?
ST segment >2mm below isoelectric line
Ischaemia
What 4 features are seen in the hands of a patient with infective endocarditis?
Janeway lesions: haemorrhagic lesions on thenar eminence
Clubbing
Osler’s nodes: painful, raised lesions
Splinter haemorrhages
List 4 defining features of clubbing
Loss of Lovibonds angle
Increased longitudinal curvature of nail
Boggy nail bed
Drumsticking of finger nails
Give 4 CVS causes of clubbing
Congenital cyanotic heart disease e.g. teratology of fallot
Atrial myxoma
Infective endocarditis
Malignancy
What stigmata may be present in the hands of a patient with hypercholesterolaemia?
Tendon xanthomata
Name a condition that can cause radio-radial delay
Aortic dissection
Name a condition that can cause a collapsing pulse. What other hyper kinetic states may this arise in?
Aortic regurgitation
Thyrotoxicosis
Fever
Anaemia
What is Quincke’s pulse? What causes it?
Visible capillary pulsations on compression to fingernail bed
Aortic regurgitation
What causes an irregularly irregular pulse?
Atrial fibrillation
What causes a slow rising pulse?
Aortic stenosis
What causes a bounding pulse?
CO2 retention
Give 2 features of a CO2 retention flap. What causes this?
Bilateral
Symmetrically timed
Hypercapnia: COPD/ T2 respiratory failure
Describe the abnormality of a collapsing pulse
On lifting their arm, pulse gets REALLY strong (like hammer hitting arm)
State 2 causes of a collapsing pulse
Aortic regurgitation
Patent ductus arteriosis
Give 3 causes of a narrow pulse pressure
HF
Blood loss
Aortic stenosis
Give 3 causes of a wide pulse pressure
Aortic regurgitation
PDA
Aortic coarctation
What is pulsus paradoxus? Give 2 causes
varied pulse strength with each inspiration + expiration
Sever asthma
Cardiac tamponade
What is pulsus alternans? Name a cause
regular alterations in force of pulse (not varying with respiration)
Severe LVF
What is bisferiens pulse?
Double pulse- 2 systolic peaks
First: pressure increase related to LV ejection
Second: reflected wave from periphery due to an artery’s recoil effect
What are the most common causes of a bisferiens pulse?
Mixed aortic valve disease (AR + AS)
HOCM
When may a jerky pulse be felt?
HOCM
Give 3 causes of a molar flush
Mitral stenosis (CO2 retention causes vasodilation)
SLE
Polycythaemia rubra vera
What causes corneal arcus in under 50s?
Hypercholesteralaemia
What causes xanthelasma?
Hypercholesteralaemia
In which syndrome may you see a high arched palate?
Marfan’s
List 4 causes of raised JVP
Fluid overload
Cardiac tamponade
RHF + Cor pulmonale
Constrictive pericarditis
What should happen to the JVP on inspiration?
Fall due to reduced intrathoracic pressure
What are cannon A waves in the JVP? What causes these?
Large A waves from simultaneous contraction of RA + RV
3rd degree heart block
What causes large V waves in the JVP?
Tricuspid regurgitation
What is Kussmaul’s sign? What causes this?
JVP rise on inspiration
Impaired RV function
Cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy
What can cause displacement of the apex beat?
Left/ Right ventricular hypertrophy
What causes a heaving apex beat?
Pressure overload in Aortic stenosis
What causes a tapping apex beat?
Mitral stenosis
What causes S4?
Atrial contraction against a stiff ventricle
What causes S3?
Turbulent ventricular filling
What manoeuvre is recommended for hearing aortic regurgitation? Where?
Lean forward
Left 3rd ICS parasternal
What manoeuvre is recommended for hearing mitral stenosis? Where?
Roll onto left side
5th ICS MCL with bell
Which heart murmur radiates to the cartoids?
Aortic stenosis
