Cardiovascular Examination Flashcards
Which signs should you look for in Inspection in a Cardiovascular examination
- Cyanosis
- Malar Flush
- Syndromic Features
- Oedema
- ECG stickers
- Scars
- Pallor
What is a malar flush?
What does it indicate?
Indicator for Mitral Stenosis due to Co2 retentionn –> Vasodilation
Name genetic syndromes that might cause cardiovascular problems
- Turners syndrome
- Downs syndrome
- Marfans syndrome
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What are possible cardiac causes for clubbing?
- Infective endocarditis
- Congenital cyanotic heart disease
- Shunting
- Atrial myxoma (rare)
What is a Xanthoma?
Lipid depositions due to hypercholesteraemia
(e.g. tendon of handy, eyes)
What is a splinter Haemorrhage?
- Hämmorhage in nail
- Either due to
- Immune complex deposition
- or Microthrombosis
Which conditions can cause splinter Haemorrhages?
Sign of
- Infective endocarditis
- Vasculitis
- SLE
- RA
- Psoriasis
What is a Janeway lesion?
non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms (and soles). Janeway lesions are typically associated with infective endocarditis.
What are oslers nodes?
red-purple, slightly raised, tender lumps, often with a pale centre, typically found on the fingers or toes
- associated w. infective endocarditis
What is Quinquies sign?
pulsation of nail bed à association aortic incompetence
What are possible causes for radiao-radial delay?
- Subclavian artery stenosis (e.g. compression by a cervical rib)
- Aortic dissection
- Aortic coarctation
Which underlying condition might cause a slow-rising pulse?
Aortic stenosis
Which condition might cause a throbbing pulse?
C02 retention/ aortic regurgitation (Aortenklappe nicht dicht)
What are possible causes for a narrow pulse pressure
Narrow pulse pressure = <25mmHg
- aortic stenosis
- congestive heart failure
What are possible causes for a wide pulse pressure?
Aortic regurgitation
aortic dissection
What are possible reasons for a big difference in blood pressure between two arms?
- Atherosklerosis
- Aortic dissection
What are possible reasons for a collapsing pulse?
- 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)
What is the association between anaemia and MI
Anaemia is associated with an increased MI risk
How do you call lipid deposits around the eye?
Xanthelasma
- Corneal arcus around iris)
What are possible sign for infective endocarditis?
- poor dentition
- clubbing
- oslers nodes
- Janeway lesions
- splinter haemorrhage
What is Angular stomatitis?
What is it associated wiht?
Also called Angular Cheileitis
- infectionn around angles of mouth
- Seen in:
- immunocompromised
- Poor nutrition: coeliac disease, iron deficiency, riboflavin deficiency
- Systemic illness, particularly inflammatory bowel disease (ulcerative colitis and Crohn disease)
- Sensitive skin, especially atopic dermatitis
- Genetic predisposition, for example in Down syndrome
- Oral retinoid medication: isotretinoin for acne, acitretin for psoriasis.
Why should you ausculatate the carotids before palpation?
To rule out presence of bruits
- The presence of a bruit suggests underlying carotid stenosis, making palpation of the vessel potentially dangerous due to the risk of dislodging a carotid plaque and causing an ischaemic stroke.
What are possible reasons for a raised JVP?
- PQRST
- Pulmonary HTN, PE, Pericarditis, Pericardial effusion
- Quantity of fluid (overload)
- Right heart failure
- Superior vena cava obstruction
- Tamponade (fluid in pericardium)
How do you measure the JVP?
It is a double /triple wave w. each heart beat
- press into right upper quadrant
- identify highest point of pulsation
- Using a horizontal line from this point, measure vertically from the sternal angle. The sternal angle is about 5 cm above the right atrium
- Normal = <4cm
What are possible reasons for displacemnet of the Apex beat?
Ventricular hypertrophy
How do you palpate for heaves?
What do they indicate?
Place heel of hand parallel to the left sternal edge (fingers vertical) to palpate for heaves
- if present: heel of and lifted with each cycle
- indication for right ventricular hypertrophy.
How do you palpate for thrills?
What do they indicate?
Palpable murmor
- each heart valve
- lie fingers flat on chest
