Cardiovascular assessment

Question 1

How do you assess JVP?

Answer 1

Lie the patient down flat, slowly raise the patient’s upper body at about 30-45° to the highest point at which the jugular is still distended. Draw a horizontal line to above the sternum and measure the distance between this line and the sternum surface plus 5cm.

Question 2

When examining a patient’s hands during a cardiovascular exam what are you looking for?

Answer 2

Cyanosis
Splinter haemorrhages
Xanthomata
Osler’s nodes
Janeway lesions
Tar staining
Clubbing
Capillary refill

Question 3

What is radio radial delay and what can cause it?

Answer 3

Asynchronous radial pulses on the left vs the right side

Associated with:
Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection
Aortic coarctation

Question 4

What can a collapsing pulse signify?

Answer 4

Normal physiological states (e.g. fever, pregnancy)
Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)
High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)

Question 5

What is bruit?

Answer 5

Whooshing noises heard on auscultation of the arteries. Caused by narrowing or obstruction

Question 6

What is the hepatojugular reflux?

Answer 6

A rise in the JVP placing pressure on the liver

Question 7

What is a significant hepatojugular reflux?

Answer 7

> 4cm JVP rise

Question 8

What can corneal arcus signify?

Answer 8

Hyperlipidaemia
High cholesterol
Atherosclerosis

Question 9

What is an S-ICD?

Answer 9

Subcutaneous Implantable Cardioverter Defibrillator

Question 10

What is parasternal heave and what is it caused by?

Answer 10

A parasternal heave is when each systole has enough force for the heel of a hand placed on the chest wall to be lifted. Signifies right ventricular enlargement or severe left atrial enlargement

Question 11

What are thrills?

Answer 11

Vibrations felt on palpating a chest

Question 12

What condition is Beck’s triad for?

Answer 12

Cardiac Tamponade

Question 13

What are the three components of Beck’s Triad?

Answer 13

High jugular vein pressure
Hypotension
Distant heart sounds

Question 14

What is malar flush and what is it associated with?

Answer 14

Plum-red discolouration of the cheeks associated with mitral stenosis.

Question 15

What is arachnodactyly and what is it associated with?

Answer 15

‘Spider fingers’: fingers and toes are abnormally long and slender, in comparison to the palm of the hand and arch of the foot.
Arachnodactyly is a feature of Marfan’s syndrome, which is associated with mitral/aortic valve prolapse and aortic dissection.

Question 16

What are splinter haemorrhages and what are they associated with?

Answer 16

A longitudinal, red-brown haemorrhage under a nail that looks like a wood splinter.

Causes include:
Local trauma
Infective endocarditis
Sepsis
Vasculitis
Psoriatic nail disease.

Question 17

What are Janeway’s lesions and what are they associated with?

Answer 17

Non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms (and soles).
Associated with infective endocarditis.

Question 18

What are Osler’s nodes and what are they associated with?

Answer 18

Tender red-purple, slightly raised lumps, often with a pale centre, typically found on the fingers or toes.

Associated with infective endocarditis.

Question 19

What is considered a narrow pulse pressure and what can it signify?

Answer 19

Less than 25 mmHg of difference between the systolic and diastolic blood pressure.

Causes include:
Aortic stenosis
Congestive heart failure
Cardiac tamponade.

Question 20

What is considered a wide pulse pressure and what can it signify?

Answer 20

More than 100 mmHg of difference between systolic and diastolic blood pressure.

Causes include:
Aortic regurgitation
Aortic dissection.