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Year 3 Medicine > Cardio examination findings > Flashcards

Cardio examination findings Flashcards

1
Q

Hypertrophic cardiomyopathy

A
  • Jerky carotid pulse
  • Double apex beat
  • Ejection systolic murmur
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2
Q

Mitral stenosis

A
  • Peripheral cyanosis
  • Malar flush
  • Irregularly irregular pulse
  • Undisplaced, tapping apex beat
  • Parasternal heave
  • Loud S1 with opening snap
  • Mid-diastolic murmur
  • Evidence of pulmonary oedema
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3
Q

V waves which oscillate the earlobes in raised JVP

A
  • Tricuspid regurgitation
  • R heart failure
  • Constrictive pericarditis
  • Dilated cardiomyopathy
  • Pulmonary hypertension
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4
Q

Aortic dissection, ACS (N/STEMI / unstable angina)

A
  • BP difference of >20 mmHg between arms
  • Wide PP
  • Murmur on the back (below the L scapula), descending to the abdomen
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5
Q

Narrow PP vs Wide PP

A

Narrow:
Aortic stenosis

Wide:

  • Aortic dissection
  • ACS (N/STEMI / unstable angina)
  • Aortic regurgitation
  • Infective endocarditis
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6
Q

Early diastolic murmur over aortic area (heard best at L sternal edge when sitting forward and breath held at top of expiration)

A
  • Aortic regurgitation

- Infective endocarditis

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7
Q

Wolff-Parkinson-White syndrome

A
  • Tachycardia

- Secondary cardiomyopathy (S3 gallop, RV heave, displaced apex beat)

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8
Q

Loud S1 with opening snap

A

Mitral stenosis

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9
Q

Infective endocarditis

A
  • Pyrexia
  • Signs of anaemia
  • Clubbing
  • Splinter haemorrahges
  • Osler’s nodes (on finger / toe pads)
  • Janeway lesions (macules on palms)
  • Tachycardia
  • Petechiae on pharyngeal and conjunctival mucosa
  • New regurgitant murmur (mitral > aortic > tricuspid > pulmonary) or muffled heart sounds
  • Splenomegaly
  • Roth spots on retina
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10
Q

R ventricular heave

A
  • Pulmonary hypertension

- Wolff-Parkinson-White syndrome

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11
Q

Double apex beat

A

Hypertrophic cardiomyopathy

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12
Q

Pulsus alternans (alternating strong and weak beats in arterial pulse waveform)

A
  • Acute L ventricular failure

- Acute mitral regurg

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13
Q

Acute L ventricular failure, acute mitral regurg

A
  • Cyanosis
  • Peripheral shutdown
  • Tachypnoea
  • Tachycardia
  • Pulsus alternans (alternating strong and weak beats in arterial pulse waveform)
  • Gallop rhythm
  • Wheeze
  • Fine crackles throughout lung
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14
Q

Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration

A
  • Tamponade
  • Pericarditis
  • Chronic sleep apnoea
  • Obstructive lung disease
  • Myocarditis
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15
Q

Aortic stenosis

A
  • Slow-rising pulse
  • Narrow PP
  • Forceful sustained thrusting non displaced apex beat
  • Thrill in aortic area if severe
  • Ejection systolic murmur at aortic area, radiating to carotid artery
  • 2nd heart sound may be softened or absent
  • Bicuspid valve may produce an ejection click
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16
Q

BP difference between arms

A
  • Aortic dissection

- ACS (N/STEMI / unstable angina)

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17
Q

Parasternal heave

A
  • Mitral stenosis
  • Tricuspid regurgitation
  • R heart failure
  • Constrictive pericarditis
  • Dilated cardiomyopathy
  • Pulmonary hypertension
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18
Q

Pulmonary hypertension

A
  • Raised JVP
  • R ventricular heave
  • Loud pulmonary 2nd heart sound
  • Pulmonary regurgitation murmur
  • Tricuspid regurgitation
  • Peripheral oedema
  • Ascites
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19
Q

Late systolic murmur

A

Mitral valve prolapse

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20
Q

Tricuspid regurgitation, R heart failure, constrictive pericarditis, dilated cardiomyopathy, pulmonary hypertension

A
  • Irregularly irregular pulse
  • Raised JVP with giant V waves which may oscillate the earlobes (possibly also giant A waves)
  • Parasternal heave
  • Pansystolic murmur heard best at the lower L sternal edge, louder on inspiration (Carvallo sign)
  • Loud P2 component of 2nd heart sound
  • Signs of pleural effusion
  • Pitting oedema
  • Palpable liver (tender, smooth and pulsatile)
  • Ascites
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21
Q

Pericarditis or myocarditis

A
  • Fever
  • Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)
  • Faint heart sounds
  • Pericardial friction rub heard best at the lower L sternal edge with the pt leaning forward during expiration
  • Cardiac tamponade signs
22
Q

Slow rising pulse

A

Aortic stenosis

23
Q

Mitral valve prolapse

A
  • Mid-systolic click which moves towards S1 when standing, and away when lying down
  • Late systolic murmur
24
Q

Pansystolic murmur

A
  • L heart failure
  • Heard loudest at the apex and radiating to the axilla: mitral regurgitation, dilated cardiomyopathy, infective endocarditis
  • Heart best at lower L sternal edge, louder on inspiration: tricuspid regurgitation, constrictive pericarditis, dilated cardiomyopathy, pulmonary hypertension
25
Q

Cannon A waves in raised JVP

A

Complete heart block

26
Q

Aortic regurgitation, infective endocarditis

A
  • High volume collapsing (water-hammer) pulse
  • Unequal arm pulses
  • Wide PP
  • Thrusting and heaving displaced apex beat
  • Early diastolic murmur over aortic area (heard better at L sternal edge when sitting forward and breath held at top of expiration)
  • Austin Flint mid-diastolic murmur heard over the apex
  • May hear an ejection systolic murmur
27
Q

Murmur on back (below L scapula), descending to the abdomen

A
  • Aortic dissection

- ACS (N/STEMI / unstable angina)

28
Q

Ventricular tachycardia

A
  • Respiratory distress
  • Anxiety
  • Agitation
  • Lethargy
  • Coma
  • Hypotension
  • Raised JVP
  • Bibasal crackles
29
Q

Bicuspid valve

A

Ejection click

30
Q

Complete heart block

A
  • Slow large volume pulse

- JVP may show cannon A waves in the jugular vein

31
Q

Chronic sleep apnoea

A

Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)

32
Q

Restrictive cardiomyopathy

A
  • Raised JVP (Kussmaul’s sign - paradoxical rise in JVP on inspiration)
  • Palpable apex beat
  • 3rd heart sound
  • Ascites
  • Hepatomegaly
  • Ankle oedema
33
Q

Mitral regurgitation, dilated cardiomyopathy, infective endocarditis

A
  • Irregularly irregular pulse
  • Laterally displaced, thrusting apex beat
  • Pansystolic murmur heard loudest at the apex, radiating to the axilla; soft S1; S3 may be heart
  • Signs of L ventricular failure in acute mitral regurgitation

Mitral valve prolapse (mid-systolic click which moves towards S1 when standing, and away when lying down; late systolic murmur)

34
Q

Loud pulmonary 2nd heart sound

A

Pulmonary hypertension

35
Q

(Austin Flint) mid-diastolic murmur

A
  • Aortic regurgitation
  • Infective endocarditis
  • Mitral stenosis
36
Q

S3 gallop

A
  • L heart failure

- Wolff-Parkinson-White syndrome

37
Q

3rd heart sound

A
  • Dilated or restrictive cardiomyopathy
  • Mitral regurgitation
  • Infective endocarditis
38
Q

Raised JVP

A
  • Acute cardiac tamponade
  • (Constrictive) pericarditis
  • R heart failure
  • Dilated or restrictive cardiomyopathy
  • Tricuspid regurgitation
  • Pulmonary hypertension
39
Q

L heart failure

A
  • Tachycardia
  • Tachypnoea
  • Displaced apex beat
  • S3 gallop
  • Pansystolic murmur
  • Bilateral basal crackles
40
Q

Mobitz type II and 3rd degree heart block

A

Signs of reduced cardiac output eg. hypotension, heart failure

41
Q

R heart failure or constrictive pericarditis

A
  • Raised JVP (Kussmaul’s sign - paradoxical rise in JVP on inspiration)
  • Pericardial knock
  • Pulsatile hepatomegaly
  • Ascites
  • Ankle / sacral pitting oedema
  • Signs of functional tricuspid regurg
42
Q

High volume collapsing (water-hammer) pulse

A
  • Aortic regurgitation

- Infective endocarditis

43
Q

Tamponade or pericarditis

A
  • Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)
  • Tachycardia
  • Beck’s triad (in acute cardiac tamponade) (raised JVP, low BP and muffled heart sounds)
44
Q

ACS (N/STEMI / unstable angina)

A
  • Pale
  • Sweating
  • Restless
  • Low-grade pyrexia
  • Possible aortic dissection
  • Arrhythmias
  • Disturbances of BP
  • New heart murmurs
  • Signs of complications
45
Q

Dilated cardiomyopathy

A
  • Raised JVP
  • Displaced apex beat
  • Functional mitral and tricuspid regurgitations
  • 3rd heart sound
46
Q

Displaced apex beat

A
  • L heart failure

- Wolff-Parkinson-White syndrome

47
Q

Ejection systolic murmur

A
  • Aortic regurgitation
  • Infective endocarditis
  • At aortic area, radiating to carotid artery: aortic stenosis
  • Hypertrophic cardiomyopathy
48
Q

Obstructive lung disease

A

Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)

49
Q

Thrusting and heaving displaced apex beat

A
  • Aortic or mitral regurgitation
  • Infective endocarditis
  • Dilated cardiomyopathy
50
Q

Muffled heart sounds

A
  • Acute cardiac tamponade
  • Pericarditis
  • Softened or absent 2nd heart sound: aortic stenosis
  • Infective endocarditis
  • Soft S1: mitral regurgitation, dilated cardiomyopathy, infective endocarditis
  • Myocarditis
51
Q

Unequal arm pulses

A
  • Aortic regurgitation

- Infective endocarditis

52
Q

Thrill in aortic area

A

Severe aortic stenosis

Year 3 Medicine (5 decks)

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