Cardio examination findings Flashcards
Hypertrophic cardiomyopathy
- Jerky carotid pulse
- Double apex beat
- Ejection systolic murmur
Mitral stenosis
- 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
V waves which oscillate the earlobes in raised JVP
- Tricuspid regurgitation
- R heart failure
- Constrictive pericarditis
- Dilated cardiomyopathy
- Pulmonary hypertension
Aortic dissection, ACS (N/STEMI / unstable angina)
- BP difference of >20 mmHg between arms
- Wide PP
- Murmur on the back (below the L scapula), descending to the abdomen
Narrow PP vs Wide PP
Narrow:
Aortic stenosis
Wide:
- Aortic dissection
- ACS (N/STEMI / unstable angina)
- Aortic regurgitation
- Infective endocarditis
Early diastolic murmur over aortic area (heard best at L sternal edge when sitting forward and breath held at top of expiration)
- Aortic regurgitation
- Infective endocarditis
Wolff-Parkinson-White syndrome
- Tachycardia
- Secondary cardiomyopathy (S3 gallop, RV heave, displaced apex beat)
Loud S1 with opening snap
Mitral stenosis
Infective endocarditis
- 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
R ventricular heave
- Pulmonary hypertension
- Wolff-Parkinson-White syndrome
Double apex beat
Hypertrophic cardiomyopathy
Pulsus alternans (alternating strong and weak beats in arterial pulse waveform)
- Acute L ventricular failure
- Acute mitral regurg
Acute L ventricular failure, acute mitral regurg
- Cyanosis
- Peripheral shutdown
- Tachypnoea
- Tachycardia
- Pulsus alternans (alternating strong and weak beats in arterial pulse waveform)
- Gallop rhythm
- Wheeze
- Fine crackles throughout lung
Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration
- Tamponade
- Pericarditis
- Chronic sleep apnoea
- Obstructive lung disease
- Myocarditis
Aortic stenosis
- 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
BP difference between arms
- Aortic dissection
- ACS (N/STEMI / unstable angina)
Parasternal heave
- Mitral stenosis
- Tricuspid regurgitation
- R heart failure
- Constrictive pericarditis
- Dilated cardiomyopathy
- Pulmonary hypertension
Pulmonary hypertension
- Raised JVP
- R ventricular heave
- Loud pulmonary 2nd heart sound
- Pulmonary regurgitation murmur
- Tricuspid regurgitation
- Peripheral oedema
- Ascites
Late systolic murmur
Mitral valve prolapse
Tricuspid regurgitation, R heart failure, constrictive pericarditis, dilated cardiomyopathy, pulmonary hypertension
- 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
Pericarditis or myocarditis
- 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
Slow rising pulse
Aortic stenosis
Mitral valve prolapse
- Mid-systolic click which moves towards S1 when standing, and away when lying down
- Late systolic murmur
Pansystolic murmur
- 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
Cannon A waves in raised JVP
Complete heart block
Aortic regurgitation, infective endocarditis
- 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
Murmur on back (below L scapula), descending to the abdomen
- Aortic dissection
- ACS (N/STEMI / unstable angina)
Ventricular tachycardia
- Respiratory distress
- Anxiety
- Agitation
- Lethargy
- Coma
- Hypotension
- Raised JVP
- Bibasal crackles
Bicuspid valve
Ejection click
Complete heart block
- Slow large volume pulse
- JVP may show cannon A waves in the jugular vein
Chronic sleep apnoea
Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)
Restrictive cardiomyopathy
- Raised JVP (Kussmaul’s sign - paradoxical rise in JVP on inspiration)
- Palpable apex beat
- 3rd heart sound
- Ascites
- Hepatomegaly
- Ankle oedema
Mitral regurgitation, dilated cardiomyopathy, infective endocarditis
- 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)
Loud pulmonary 2nd heart sound
Pulmonary hypertension
(Austin Flint) mid-diastolic murmur
- Aortic regurgitation
- Infective endocarditis
- Mitral stenosis
S3 gallop
- L heart failure
- Wolff-Parkinson-White syndrome
3rd heart sound
- Dilated or restrictive cardiomyopathy
- Mitral regurgitation
- Infective endocarditis
Raised JVP
- Acute cardiac tamponade
- (Constrictive) pericarditis
- R heart failure
- Dilated or restrictive cardiomyopathy
- Tricuspid regurgitation
- Pulmonary hypertension
L heart failure
- Tachycardia
- Tachypnoea
- Displaced apex beat
- S3 gallop
- Pansystolic murmur
- Bilateral basal crackles
Mobitz type II and 3rd degree heart block
Signs of reduced cardiac output eg. hypotension, heart failure
R heart failure or constrictive pericarditis
- 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
High volume collapsing (water-hammer) pulse
- Aortic regurgitation
- Infective endocarditis
Tamponade or pericarditis
- 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)
ACS (N/STEMI / unstable angina)
- Pale
- Sweating
- Restless
- Low-grade pyrexia
- Possible aortic dissection
- Arrhythmias
- Disturbances of BP
- New heart murmurs
- Signs of complications
Dilated cardiomyopathy
- Raised JVP
- Displaced apex beat
- Functional mitral and tricuspid regurgitations
- 3rd heart sound
Displaced apex beat
- L heart failure
- Wolff-Parkinson-White syndrome
Ejection systolic murmur
- Aortic regurgitation
- Infective endocarditis
- At aortic area, radiating to carotid artery: aortic stenosis
- Hypertrophic cardiomyopathy
Obstructive lung disease
Pulsus paradoxus (abnormally large decrease in SBP >10 mmHg and pulse wave amplitude during inspiration)
Thrusting and heaving displaced apex beat
- Aortic or mitral regurgitation
- Infective endocarditis
- Dilated cardiomyopathy
Muffled heart sounds
- Acute cardiac tamponade
- Pericarditis
- Softened or absent 2nd heart sound: aortic stenosis
- Infective endocarditis
- Soft S1: mitral regurgitation, dilated cardiomyopathy, infective endocarditis
- Myocarditis
Unequal arm pulses
- Aortic regurgitation
- Infective endocarditis
Thrill in aortic area
Severe aortic stenosis