Cardiovascular exam *See WCS 06*

Question 1

Collapsing pulse

Physiological causes?

Answer 1

Exercise, fever, pregnancy

Question 2

Collapsing pulse

Pathological causes? (non-cardiac)

Answer 2

High cardiac output:

Thyrotoxicosis, Anemia, Paget disease, Liver cirrhosis, Systolic hypertension, Cor pulmonale

Question 3

Collapsing pulse

Cardiac causes?

Answer 3

AORTIC DISSECTION,
PATENT DUCTUS ARTERIOSUS,
mitral regurgitation,
heart block

Question 4

Brachial pulse.

• Slow rising ?
• Bounding ?

Answer 4

• Slow rising > aortic stenosis

- Bounding > aortic regurgitation

Question 5

3 causes of elevated JVP height?

Answer 5

• Right sided heart failure
• Tricuspid regurgitation
• Constrictive pericarditis

Question 6

Purpose of Hepato-jugular reflux test?

Answer 6

• Compress right side IVC to increase flow to heart > more venous return > Ventricles cannot handle increased volume > Elevate JVP
• Demonstrate constrictive/ restrictive pathology
  e. g. Constrictive pericarditis, RV failure, LV failure, restrictive cardiomyopathy

Question 7

Cardiac apex: causes of

• Inferior and lateral displacement
• Double apex beat

Answer 7

• Inferior and lateral displacement = LV hypertrophy

- Double apex beat = hypertrophic cardiomyopathy

Question 8

Cause of Pansystolic murmur accentuated by expiration?

accentuated by inspiration?

Answer 8

accentuated by expiration > Ventricular septal defect

accentuated by inspiration > Tricuspid regurgitation

Question 9

Give one cause each for

• Loud S2
• Wide splitting of S2
• Fixed splitting of S2
• Paradoxical splitting of S2

Answer 9

• Very loud S2 > Pulmonary hypertension
• Wide splitting of S2 > Pulmonary stenosis
• Fixed wide splitting > ASD
• Paradoxical splitting > Aortic stenosis (LV close later than RV)

Question 10

2 causes of continuous murmur?

How to differentiate?

Answer 10

patent ductus arteriosus or continued AS/AR

PDA radiates to the back towards the scapula, AS/AR doesn’t

Question 11

2 causes of Ejection systolic murmur?

Cause of Soft S2 + crescendo and decrescendo systolic murmur

Answer 11

Ejection systolic murmur during expiration > aortic stenosis and Hypertrophic cardiomyopathy

Soft S2 + crescendo and decrescendo systolic murmur= aortic stenosis

Question 12

Cardiac cause of enlarged and pulsatile liver?

Answer 12

tricuspid regurgitation

Question 13

Seagull murmur is heard in aortic area.

Cause?

Answer 13

Aortic regurgitation

Question 14

Radiation of aortic stenosis?

Answer 14

Left and right carotid area