Cardiovascular Examination Flashcards
When would you hear basal crackles in the heart?
In heart failure
When do the atrioventricular valves close?
The start of systole
When do the semilunar valves close?
At the start of diastole
What is the cause of murmurs?
Due to turbulent flow caused by anatomical changes or flow changes. Due to valve disorders - stenosis or regurgitation
When would you hear a systolic murmur?
In stenosis of aortic and pulmonary valves or regurgitation of atrioventricular valves causes a murmur in diastole
Types of percussion tone
Dull Resonant - normal Hyper-resonant Timpani (hollow)
How do you describe heart sounds?
When - systole, diastole What - character of sound Where - what valve Transmission - what other area was the sound transmitted to
How can you identify C7?
Vertebra prominens
The sternal notch overlies which structure?
Trachea
What does the manubrio-sternal angle help you to identify?
T4/5, bifurcation of trachea, 2nd costal cartilage, upper order of atria, aortic arch
When would you hear a diastolic murmur?
Stenosis of atrioventricular valves or in regurgitation of pulmonary valves
Causes of bruit
Turbulent blood flow within the heart or blood vessels, produced by damaged vessels.
Causes: narrowed arteries, septal defects, av-regurgitation
Name 4 principal symptoms of cardiovascular disease
Chest pain
Shortness of breath (dyspnoea)
Oedema (ankles)
Palpitations
Also:
Syncope (fainting)
Claudication (limping, cramping pain)
Clincal presentation of angina
Central chest pain - crushing, heavy sensation, tightness, choking
Precipitated by: physical exertion, stress, heavy meal
Caused by myocardial ischemia - narrowing
Relieved by nitrates (GTN) and vasodilators or rest
Clinical presentation of MI
Central sharp chest pain, radiating to arm/shoulder/neck/jaw
Can be accompanied by sweaing or vomiting
Not releived by rest or nitrate
Presentation of breathing difficulties
Dyspnoea - shortness of breath (gasping for air)
PND - sudden shortness of breath while sleeping
Orthopnoea - shortness of breath when lying down
Commonly associated with left heart failure
Physiological cause of PND
In the recumbent position, there is a redistribution of fluid from the extremities to the lungs.
The left ventricle is unable to match the output of the right ventricle and a backlog of blood in the left ventricle moves up through the atria and into the lung causing congestion. This inhibits gaseous exchange and there is reduced oxygen levels in the blood.
Phyiological cause of oedema in CVD
Swelling caused by excessive accumulation of fluid in interstitial tissues. Typically affects ankles, feet and lower legs. When a patient lies down fluid re-distributes - sacral oedema seen.
A sign of right heart failure. Backlog from the right side of the heart flows back into the vena cava towards the extremeties which causes increased venuous hydrostatic pressure. This causes venuoous dilation and therefore oedema.
Oedema in CVD is pitting
Palpations
Awareness of one’s own heartbeat (pounding or fluttering)
Usually associated with arrythmia
Name 9 symptoms associated with CVD
Dizzyness and Syncope
Fainting
Fatigue
Fever
Nausea and Vomiting
Shortness of breath
Palpitations
Sweating
Oedema
Intermittent claudication (leg)
Systemic signs of CVD
(head - toe)
General: Beathless at rest, cyanosis, cahexic/obese
Hands: Clubbing, Splinter heamorrages, tar staining, capillary refill
Eyes: Xanthelasma, anaemia, corneal arcus
Face: malar flush, central cyanosis
Neck: JVP, carotid pulse
Pulse: radial - rate, rhytm, collapsing, brachial waveform
Chest: apex beat, thrills, heaves, heart sounds, murmurs, bruit
What is hepato-jugular reflux?
Used to assess right ventricular failure.
In the supine position, the JVP of patients can be seen between the clavicular and sternal heads of the sternocleiodomastoid muscle. Height of JVP measured above sternal angle.
When firm pressure placed on RUQ of abdomen (15sec) in patients with cardiac pathology a transitent rise in JVP is seen. In normal patients there would be a decrease becuase venuous return to the heart is reduced.
Sign of: tricuspid regurgitation, constrictive pericarditis
Palpable abnormalities
Heaves: caused by ventricular hypertrophy (apex-left, parasternal-right)
Displaced apex: caused by dilated left ventricle Tapping apex (both heart sounds palpable): mitral stenosis
Thrills: palpable heart murmur
Abdominal signs of CVD
Hepatomegaly
Ascites
Splenomegaly
Abdonimal aortic aneurym
Renal bruit
3 common CV causes of chest pain
Angina pectoris
MI
Cadiomyopathy
Name 3 cardinal symptoms of heart disease
Dyspnoea
Chest pain
Syncope or dizzyness
Palpitations
Common presenting complaints of heart disease
Dyspnoea
Chest pain
Palpitations
Syncope
Swollen legs
Transient neurological symptoms
Cardiac causes of dyspnoea
Ischaemia: causing transient poor muscle function e.g. coronary artery disease, angina
Left ventricular impairment: leads to poor muscle function. There is reduced cardiac output and increased end-diastolic pressure in the left ventricle. e.g. MI, hypertensive heart disease, dilated cariomyopathy
Valvular heart disease: causes reduced cardiac output due to obstruction to blood flow or regurgitation, increasing LV end-diastolic pressure or LA pressure.
What are the four heart sounds?
S1: AV valve closure (end of diastole/beginning of systole)
S2: Aortic and pulmonary valve closure (late systole)
S3: Passive LV filling (early diastole)
S4: Atrial kick (active LV filling in late diastole)
Causes of systolic murmurs
Aortic stenosis
Mitral regurgitation
VSDs
ASDs
Pulmonary stenosis
How can you work out if a murmus is systolic or diastolic?
When feeling the pulse, systolic murmurs will be heard at the same as feeling the upstroke
