Cardiovascular Exam Flashcards
What is peripheral cyanosis a sign of
Hypoxaemia
Raynaud’s
CCF
What is clubbing a sign of
Congenital cyanotic heart disease
Infective endocarditis
Atrialmyxoma
What are splinter haemorrhages a sign of
Infective endocarditis
Also: RA, vasculitis, trauma, sepsis
What are Osler’s nodes
Red, tender nodules on finger pulps or thenar eminence (immune complex deposition)
What are Osler’s nodes a sign of
Infective endocarditis (rare and late sign)
What are Janeway lesions
non-tender macular-papular lesions seen on palms or finger pulps (embolic phenomenon)
What are Janeway lesions a sign of
Infective endocarditis (rare)
Radio-radial delay causes
Aortic coarctation
Aortic dissection
Subclavian artery stenosis
Collapsing pulse causes
Aortic regurgitation
PDA
Also- pregnancy, fever, thyrotoxicosis
Pulsus paradoxus
Pulse wave volume decreases significantly during inspiration
Pulsus paradoxus causes
Cardiac tamponade (late) Also: severe acute asthma/COPD
Mucosal pallor of conjunctivae
Anaemia
Jaundice of sclera
Haemolytic anaemia
Corneal Arcus
Hypercholesterolaemia- significant only if >50
Xanthelasma
Hypercholesterolaemia
Mitral facies
Rosy cheeks suggestive of mitral stenosis
Central cyanosis
Hypoxaemia e.g. right to left cardiac shunt
Dental hygiene
Common source of organisms causing infective endocarditis
Carotid pulse
BEFORE palpating, auscultation first for presence of bruits to rule out stenosis disease which may potentially become dislodged during palpating
`carotid pulse- comment on
Volume and character
E.g. normal, slow rising, bounding, thready
How to differentiate JVP from carotid
Carotid is pulsatile, JVP is not
If it’s easily obstructable, it’s the JVP
JVP is double wave form, carotid is single (examine it)
If it reduces with inspiration it’s the JVP
Kussmaul’s sign
JVP will rise with inspiration in pericardial constriction, right ventricular infarction or cardiac tamponade
Ways to augment the JVP if you can’t find it
Press on liver to elicit hepatojugular reflex
Ask patient to lie more flat
Lift patient’s leg
Height of JVP
Vertical distance between the sternal angle and the top of the pulsation point of the JVP (should be less or equal to 3cm)
Causes of right sided heart failure
Increased pressure in the right side of heart
Right sided HF- e.g. due to left- sided heart failure or pulmonary hypertension (in turn due to COPD, interstitial lung disease etc.)
Tricuspid regurgitation
Constrictive pericarditis
Chest scars
sternotomy for CABG
Thoracotomy for valvular surgery
Thrills
Palpable vibration caused by turbulent blood flow through a heart valve i.e. palpable murmur
How to elicit thrills
Press fingertips on sternum at the level of 2nd intercostal space
Heaves
Right ventricular hypertrophy
How to elicit heaves
Press the heel of your hand over right sternal edge
Apex beat- position
Normally at 5th intercostal space mid-clavicle are line
Apex beat displacement
Cardiomegaly e.g. cardiomyopathy, CCF Mediastinal shift (e.g. pleural effusion, tension pneumothorax)
Forceful and sustained Apex Beat
Pressure-loaded e.g. left ventricular hypertrophy
Forceful and non-sustained apex beat
Volume-loaded e.g. hyper metabolic states, aortic/mitral regurgitation
Double impulse apex beat
Hypertrophic cardiomyopathy
Aortic valve
2nd intercostal space
Right sternal edge
Pulmonary valve
2nd intercostal space
Left sternal edge
Tricuspid valve
4th/5th intercostal space
Lower left sternal edge
Mitral valve
5th intercostal space
Midclavicular line
How do you accentuated manoeuvres
All in expiration
Ask patient to breathe in and out, and hold in expiration
Mitral stenosis
Mid diastolic rumble
Elicit mitral stenosis
Ask patient to roll onto their left side, and auscultation the mitral area using the bell
Mitral regurgitation
Pansystolic murmur
Elicit mitral regurgitation
In same position, auscultate in the mitral area again this time using the diaphragm
Auscultate into the axils to identify radiation of this murmur
Aortic stenosis
Ejection-systolic murmur (crescendo-decrescendo)
Aortic stenosis elicit
With patient back into normal seated position, auscultate the carotid arteries using the diaphragm
Aortic regurgitation
Early diastolic murmur
Aortic regurgitation elicit
Sit patient forwards and auscultate over aortic area with diaphragm
Bibasal crackles
E.g. pulmonary oedema due to LVF
Scars in legs
Saphenous vein grafts fir CABG
Extras in cardio exam
Full set of obs Peripheral vascular and respirator exams ECG Bloods CXR Echo
