Cardiovascular Exam Flashcards
What is this? What causes this?
Janeway lesions
Painless, flat lesions
Haemorrhagic lesions on thenar eminence
Embolic phenomena in Infective Endocarditis
What is seen here? What causes this?
Oslers nodes
Painful, raised lesions
Immunological phenomena in Infective Endocarditis
What is seen here? List 4 features
Clubbing
Loss of Lovibond’s angle
Increased longitudinal curvature of the nail
Boggy nail bed
Drumsticking of finger nails
List 3 cardiovascular causes of clubbing
Atrial myxoma
Congenital cyanotic heart disease e.g. ToF
Infective Endocarditis
What is seen here? What causes this?
Tendon xanthomata
Hyperlipidaemia (typically familial hypercholesterolaemia)
3 causes of radio-radial delay
Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection
Aortic coarctation
3 causes of collapsing pulse
Normal physiological states: fever, pregnancy
Cardiac lesions: AR, PDA
High output states: anaemia, AV fistula, thyrotoxicosis
3 causes of Narrow pulse pressure
AS
Congestive heart failure
Cardiac tamponade.
2 causes of wide pulse pressure
Aortic dissection
AR
What is seen here? What causes this?
Splinter haemorrhages
Embolic phenomena of infective endocarditis
What is Quincke’s pulse? What causes it?
Visible capillary pulsations on compression to fingernail bed
Aortic regurgitation
What causes a slow rising pulse?
Aortic stenosis
What causes a bounding pulse?
CO2 retention
Give 2 features of a CO2 retention flap. What causes this?
Bilateral
Symmetrically timed
Hypercapnia: COPD/ T2 respiratory failure
What is pulsus paradoxus? Give 2 causes
varied pulse strength with each inspiration + expiration
Severe asthma
Cardiac tamponade
What is pulsus alternans? Name a cause
regular alterations in force of pulse (not varying with respiration)
Severe LVF
When may a jerky pulse be felt?
HOCM
What is seen here? List 3 causes
Malar flush
Mitral stenosis (CO2 retention causes vasodilation)
SLE
Polycythaemia rubra vera
What is seen here? What causes this?
Corneal arcus
If <50: hypercholesterolaemia
What is seen here? What causes this?
Xanthelasma
Hypercholesterolaemia
What is seen here? What causes this?
Kayser Fleischer Rings
Wilsons disease
What is this man suffering from? What clinical sign would be seen?
Superior vena cava obstruction
Raised JVP + absent pulsation
What is Kussmauls sign? When is this seen?
Paradoxical JVP rise on inspiration
Impaired ventricular filling
Cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy
What are cannon A waves in the JVP? What causes these?
Large A waves from simultaneous contraction of RA + RV
3rd degree heart block
List 4 causes of raised JVP
Fluid overload
Cardiac tamponade
RHF + Cor pulmonale
Constrictive pericarditis
What is this? What is it used for?
Hickman line
Administer drugs, take blood samples
Name the scar. What surgery may have been performed?
Midline sternotomy
CABG, aortic valve replacement, mitral valve replacement
Name the scar. What surgery may have been performed?
Anterolateral thoracotomy scar
Minimally invasive cardiac valve surgery
Name the scar. What surgery may have been performed?
Posterolateral thoracotomy scar
Mitral valve replacement, Blalock-Taussig shunt, coarctation repair
Name the scar. What surgery may have been performed?
Mid-axillary scar
ICD insertion
Name the scar. What surgery may have been performed?
Subclavicular
Pacemaker/ ICD insertion
Parasternal heave cause
RV hypertrophy
S4 cause
Atrial contraction against a stiff ventricle
S3 cause
turbulent ventricular filling
AR manoeuvre
lean forward + listen to the left 3rd ICS parasternal
MS manoeuvre
roll onto the left side + listen to 5th ICS MCL with the bell
Distinguish between aortic stenosis and aortic sclerosis
listen to the carotids with the bell
stenosis radiates a crescendo-decrescendo murmur whilst sclerosis will not
Aortic stenosis murmur
Ejection systolic, crescendo-decrescendo
Radiates to carotids
Soft/ absent S2
S4
Slow rising pulse
Narrow pulse pressure
4 causes of AS
Degenerative calcification (most common >65)
Bicuspid aortic valve (most common <65)
Rheumatic heart disease
HOCM
Mx of AS
Asymptomatic: observe
Symptomatic: valve replacement
Asymptomatic but valvular gradient > 40 mmHg + features e.g. LV systolic dysfunction: consider surgery
Aortic regurgitation murmur
Early diastolic
High pitch, blowing
Quinckes sign
De Musset’s sign
Collapsing pulse
Wide pulse pressure
5 causes of AR
Rheumatic heart disease
Infective endocarditis
CTDs: Marfans, EDS
Aortic dissection
Bicuspid aortic valve
Mx of AR
Medical Mx of any associated HF
Indications for surgery:
symptomatic patients with severe AR
asymptomatic patients with severe AR who have LV systolic dysfunction
What is De Musset’s sign?
Head bobbing
What is an Austin flint murmur?
Mid diastolic ‘rumbling’ murmur
Due to severe AR
Mitral stenosis murmur
Mid diastolic ‘rumbling’
Loud S1
Opening snap
Low volume pulse
AF
1 cause of MS
RHEUMATIC FEVER
Mx of MS
If mod-severe MS + AF require anticoagulation with Warfarin
Asymptomatic: regular echos
Symptomatic: Percutaneous mitral balloon valvotomy
or mitral valve surgery (commissurotomy, or valve replacement)
Mitral regurgitation murmur
Pansystolic
High pitched, blowing
Soft S1
If severe: widely split S2
3 causes of MR
Post-MI papillary muscle rupture
Infective endocarditis
Rheumatic fever
MR Mx
Acutely: nitrates, diuretics, positive inotropes + an intra-aortic balloon pump to increase cardiac output
If in HF: ACEi, b-blockers + spironolactone
Acute, severe regurgitation: surgery
Degenerative MR: Repair (over replacement)
If not possible: valve replacement
If a patient has a midline sternotomy scar but no leg vein harvest scars, what is the likely explanation?
Interior mammary artery graft
Where can vessels be harvested from for CABG?
Leg (saphenous vein)
Inside chest (internal mammary artery)
Arm (radial artery)
