Cardiology physical exam causes

Question 1

Loud S1

Answer 1

• Mitral stenosis, Tricuspid stenosis
• Left to right shunts
• Short PR interval, atrial premature beats
• Hyperdynamic states
• Atrial myxoma

Question 2

Soft S1

Answer 2

• Long PR
• Mitral regurgitation
• Severe MS,
• LBBB,
• DCM

Question 3

Causes of S1 splitting (not S2)

Answer 3

• RBBB
• ASD
• Ebstein anomaly

Question 4

Loud S2

Answer 4

• Hypertension: systemic (loud A2), pulmonary (loud P2)
• Hyperdynamic states
• Atrial septal defect without pulmonary hypertension

Question 5

Soft S2

Answer 5

• Aortic stenosis

Question 6

Fixed split S2

Answer 6

• Atrial septal defect

Question 7

Widely split S2

Answer 7

• Deep inspiration
• RBBB
• Pulmonary stenosis
• Severe mitral regurgitation

Question 8

Reversed (paradoxical) split S2 (P2 occurs before A2)

Answer 8

• LBBB
• Severe aortic stenosis
• Right ventricular pacing
• WPW type B (causes early P2)
• Patent ductus arteriosus

Question 9

S3

Answer 9

• Considered normal if < 30 years old (may persist in women up to 50 years old)
• Left ventricular failure (e.g. dilated cardiomyopathy)
• Constrictive pericarditis (called a pericardial knock)
• Physiological: in normal children and young adults
• Pathological: Heart failure (third heart sound gallop is relatively specific for elevated left ventricular end-diastolic pressure and left ventricular dysfunction)
• Left ventricular dilatation without failure: mitral regurgitation, ventricular septal defect, patent ductus arteriosus
• Right ventricular third heart sound in right ventricular failure, tricuspid regurgitation

Question 10

S4

Answer 10

• Aortic stenosis
• HOCM
• Hypertension
• Normal: in the elderly
• Pathological: Acute myocardial infarction
• Aortic stenosis (the presence of a fourth heart sound in individuals <40 years indicates significant obstruction)
• Hypertension (it is a constant finding in hypertension)
• Hypertrophic cardiomyopathy
• Pulmonary stenosis

Question 11

Systemic hypertension

Answer 11

• Loud S2
• Fourth heart sound

Question 12

Collapsing pulse

Answer 12

• Patent ductus arteriosus
• Aortic regurgitation
• Hyperkinetic conditions (anaemia, thyrotoxic, fever, exercise/pregnancy)
• Paget’s disease,
• complete heart block

Question 13

Pansystolic murmur

Answer 13

• Mitral regurgitation
• Tricuspid regurgitation
• Ventricular septal defect (generally radiates to the right of the sternum)

Question 14

Ejection systolic murmur

Answer 14

• Aortic stenosis
• Pulmonary stenosis
• Hypertrophic obstructive cardiomyopathy
• Atrial septal defect
• Tetralogy of Fallot

Question 15

Late systolic murmur

Answer 15

• Mitral valve prolapse
• Coarctation of aorta

Question 16

Early diastolic murmur

Answer 16

• Aortic regurgitation (high-pitched and ‘blowing’ in character)
• Graham-Steel murmur (pulmonary regurgitation, high-pitched and ‘blowing’ in character)

Question 17

Mid-late diastolic murmur

Answer 17

• Mitral stenosis (‘rumbling’ in character)
• Austin-Flint murmur (severe aortic regurgitation, again is ‘rumbling’ in character)

Question 18

Continuous machine-like murmur

Answer 18

• Patent ductus arteriosus

MCQs

Question 19

Pulsus paradoxus

Answer 19

• Severe asthma
• Cardiac tamponade

Link

Question 20

Slow-rising/plateau pulse

Answer 20

• Aortic stenosis

Question 21

Pulsus alternans

Answer 21

• Severe LVF

Question 22

Bisferiens pulse

Answer 22

• Mixed aortic valve disease
• HOCM may occasionally be associated with a bisferiens pulse

Question 23

Jerky pulse

Answer 23

• Hypertrophic obstructive cardiomyopathy

Question 24

Causes of irregularly irregular pulse

Answer 24

• AF
• Multiple ventricular ectopics
• Atrial flutter with varying block
• Complete heart block (there is associated bradycardia).
• Multifocal atrial tachycardia