Cardio examination Flashcards
Give two examples of high volume pulse
exercise, pregnancy, anaemia, thyrotoxicosis, sepsis, aortic regurg
Give one example of low volume pulse
LV failure, hypovolaemia/shock, septic shock, aortic stenosis
Name two characters that a pulse can have
collapsing
slow rising + low volume
radial radial delay
pulsus paradoxus
When would you see a slow rising + low volume pulse?
AS
When would you see a collapsing pulse?
AR
When would you observe radial radial delay?
coarctation
When would you observe pulsus paradoxus?
=inspiratory reduction in systolic blood pressure of >10mmHg
tamponade
severe asthma
What does the JVP reflect?
pressure in the right atrium
What does an elevated JVP indicate?
right HF
fluid overload
tricuspid regurgitation
pericardial effusion/tamponade
What does an absent JVP suggest?
dehydrated
hypovolaemic
List three differences between carotid and JVP?
JVP is collapsible, compressible, falls with inspiration, biphasic waveform, laterally located, hepatojugular reflex rise
Where is the JVP located?
2 heads of sternocleidomastoid- angle of the jaw
What is deemed to be elevated JVP?
> 4cm
What does an absent a wave in JVP waveform indicate and in which condition does this arise?
absent atrial contraction- AF
Cannon a waves in JVP waveform are seen in?
complete HB
Patient has midline sternotomy. What surgery could they have had?
valve replacement
CABG
transplant
Patient has subclavicular scar. What cardiac surgery could they have had?
pacemaker
Patient has posteriolateral thoracotomy scar. What surgery could they have had?
lung resection
Patient has axillar scar. What surgery could they have had?
pneumothorax
What does a parasternal heave suggest?
right ventricular hypertrophy
What effect does squatting have on preload and afterload?
increases them and therefore increases blood flow through all valves
How is mitral stenosis murmur described?
mid-diastolic
rumbling, low pitched
Which is the most common valve disease seen in pregnancy?
mitral stenosis
List two signs on examination of mitral stenosis
malar flush
right ventricular heave
Raised JVP, peripheral oedema
How is aortic regurgitation murmur described?
early diastolic murmur, decrescendo
Where is AR heard loudest?
Erb’s point= left sternal edge, 3rd intercostal space
What are the features of the pulse in AR?
collapsing=corrigan’s sign
widened pulse pressure
Name on non valvular condition that produces a murmur
septal defects- ASD, VSD
hypertrophic obstructive cardiomyopathy (HOCM)
