Cardiovascular Examination Flashcards
what should be looked for in general inspection in CV exam?
patient: well/unwell, comfortable, alert, breathless, pallor, cyanosis
around bed: oxygen, medication, IV infusions
what should be checked for on the hands?
perfusion: temperature, CRT, peripheral cyanosis
nails: clubbing, splinter haemorrhages, Quincke’s sign
dorsum: extensor tendon xanthomata
palms: osler nodes, janeway lesions
what should be checked on the arms
inspect for bruising
radial pulse (rate, rhythm, radio-radial delay)
collapsing pulse
what should be check on head and neck?
face
eyes
mouth
neck
what may be seen in the face?
malar flush
what may be seen in the eyes?
conjunctival pallor/haemorrhages
corneal arcus
xanthelasma
what may be seen in the mouth?
central cyanosis under tongue
petechial haemorrhages
poor dental hygiene
high arches palate
what may be seen in the neck?
JVP
hepatojugular reflex test
carotid pulse
what disease is associated with Mitral regurgitation, aortic regurgitation and mitral prolapse?
marfan’s syndrome
what disease is associated with aortic stenosis?
turner’s syndrome
what disease is associated with congential heart disease?
Down’s syndrome
what does a CRT >2s indicated
hypoperfusion
what disease may cause clubbing
cyanotic congential heart disese
infective endocarditis
what disease may cause splinter haemorrhages?
infective endocarditis
what is Quincke’s sign?
visible pulsations in the nails
what disease may cause Quincke’s sign?
aortic regurgitation
what is extensor tendon xanthomata
irregular nodules overlying tendons
what may cause extensor tendon xanothomata?
hyperlipidemia
what are Osler’s nodes
painful purple papules on pulps
what may cause Osler’s nodes?
infective endocarditis
what are Janeway lesions?
erythematous macules on palms
what may cause Janeway lesions?
infective endocarditis
what does bruising on arms suggest?
anticoagulation
what does a radio-radial delay in pulse suggest?
aortic dissection/ aneurysm
or proximal coarctation
how do you measure a collapsing pulse?
while feeling the radial pulse
quickly lift their arm up
check for shoulder pain first
a strong tapping is felt when arm elevated
what are the causes of a collapsing pulse?
classically aortic regurgitation
patient ductus arteriosus
high output states (anaemia, thyrotoxicosis)
physiological states (pregnancy, fever)
what does a wide pulse pressure in BP suggest?
aortic regurgitation
what does a narrow pulse pressure in BP suggest?
aortic stenosis
what disease may cause malar flush?
mitral stenosis
what may cause conjunctival pallor?
anaemia
what may cause conjuntival haemorrhages?
infective endocarditis
what may cause xanthelasma?
hyperlipidaemia
what is xanthelasma?
periorbital yellow plaques
what is central cyanosis under tongue a sign of?
hypoxia
what cause petecial haemorrhages?
infective enodcarditis
what is poor dental hygiene a risk for?
infective endocarditis
what disease does a high arched palate suggest?
marfan’s syndrome
how do you meausre JVP?
turn head slightly and look for double pulsation of internal jugular vein
up to 3cm above sternal angle is normal
what are some causes of a raised JVP?
PQRST pulmonary hypertension/ Pulmonary emolism/ pulmonary stenosis/pericardial effusion quantity of fluid i.e overload right ventricular failure SVC obstruction tamponade/ tricuspid regurgitation
how do you carry out the hepatojugular reflex test?
apply pressure over RUQ while observing JVP
transient rise= normal
what does a sustained rise in JVP with hepatojugular reflex test suggest?
right ventricular failure
what does a slow rising low volume carotid pulse suggest?
aortic stenosis
what does a bounding/ collapsing carotid pulse suggest?
aortic regurgitation or patent ductus arteriosus
what is Corrigan’s sign?
visible carotid pulsation
what is Corrigan’s sign a sign of?
aortic regurgitation
what is Musset’s sign?
head bobbing in time with pulse
what is Musset’s sign a sign of?
aortic regurgitation
what may cause an impalpable apex beat?
DOPE dextrocardia obese pericaridal effusion emphysema
what may cause a displaced apex beat?
LV dilation
cardiomegaly
mediastinal shift
what may cause parasternal heave and thrills?
pulmonary hypertension
how do you auscultate the aortic valve?
2nd ICS
right sternal edge
