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MD2 > Cardiovascular Examination > Flashcards

Cardiovascular Examination Flashcards

1
Q

Cardio Exam - Intro

A

Introduce self

Explain examination

Gain consent

Get Vitals

Wash Hands

Check Patient Details

Ask about any pain

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2
Q

Cardio Exam - General Inspection

A

General mental state, alertness, respiratory effort

Supplemental oxygen?

Sweaty? colour? cyanosed? rash (shingels?) tenderness over location? Pulse? BP, resp, temp? pain? posture?

ECG, lines (IV), catheter, fluid/drugs

incisions, scars, dressings

Weight (BMI), cachexia, marfans?

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3
Q

Cardio Exam - Hands & Arms

A

erythema, pallor of palmar creases (anaemia), clubbing, nicotine

janeway lesions, osler’s nodes, splinter haemorrhages

radial artery (use brachial if grafted) pulse - rate and rhythm

BP sitting & standing

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4
Q

Cardio Exam - Head & Neck

A

Eyes: conjuntival pallor, jaundiced sclerae (CCF and hepatic congestion), arcus senilis

Mouth: lips & tongue (cyanosis), arched palate (Marfan’s)

Neck: JVP (<3cm), carotid (character, bruit)[bell]

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5
Q

Cardio Exam - Chest

A

Inspection - scars, apex pulsation, pacemaker

Palpation - apex beat (5th intercostal space, MAL),

Auscultation - heart sounds and murmurs, pericardial rub, lung bases (crackles), respiratory signs, pleural rub, pitting oedema of sacrum

Abdomen - liver tenderness (distension of capsule), palpate abdominal aorta

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6
Q

Chest Exam - Lower Limbs

A

Peripheral oedema (medial malleolus, anterior tibia)

Palpation of dorsalis pedis and posterior tibial

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7
Q

Cardio Exam - Completion

A
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8
Q

Murmur - Aortic Stenosis

A

pansystolic , crescendo-decrescendo

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9
Q

Murmur - Aortic Regurgitation

A

Soft A2

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10
Q

Murmur - Mitral Regurgitation

A

pansystolic, rectangular

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11
Q

Murmur - Mitral Stenosis

A

Loud S1

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12
Q

Heart Sounds - S1

A

Mitral and Tricuspid closure (mitral before tricuspid)

Indicates beginningo of ventricular systole

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13
Q

Heart Sounds - S2

A

Aortic and Pulmonary valve closure (aortic first)

Splitting of S2 may be audible in 70% of patients

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14
Q

Heart Sounds - S3

A

Turbulence during early ventricle filling, may be normal

Low-pitched [bell], mid-diastolic

Gallop rhythm - ‘Kentucky’

Sign ofleft ventricular failure and dilation, Aortic regurgitation, Mitral regurgitation, ventricular septal defect, patent ductus arteriosus

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15
Q

Heart Sounds - S4

A

turbulence during atrial contraction - high pressure atrial wave reflected back from poorly compliant ventricle

late diastolic, low-pitch

‘Tennessee’ tripple gallop

Sign of stiff ventricle -> HTN, Aortic stenosis, IHD, Hypertrophic cardiomyopathy

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16
Q

Causes of Clubbing

A

Common

CARDIOVASCULAR
Cyanotic congenital heart disease
Infective endocarditis
Left atrial myxoma

RESPIRATORY
Lung carcinoma (usually not small cell carcinoma)
Chronic pulmonary suppuration:

  • Bronchiectasis
  • Lung abscess
  • Empyema
  • TB
  • Abcess

Idiopathic pulmonary fibrosis
NOT Chronic bronchitis or COPD

Uncommon

RESPIRATORY
Cystic fibrosis
Asbestosis
Pleural mesothelioma (benign fibrous type) or pleural fibroma

GASTROINTESTINAL
Cirrhosis (especially biliary cirrhosis)
Inflammatory bowel disease
Coeliac disease

THYROTOXICOSIS
Familial (usually before puberty) or idiopathic

Rare

Neurogenic diaphragmatic tumours
Pregnancy
Secondary parathyroidism

UNILATERAL CLUBBING
Bronchial arteriovenous aneurysm
Axillary artery aneurysm

17
Q

Schamroth’s Sign

A

Loss of diamond-shaped space - evidence of clubbing

18
Q

Splinter Haemorrhage

A

Evidence of physical trauma, endocarditis, vasculitis, rheumatoid arthritis, polyarteritis nodosa, haematological malignancy, antiphospholipid syndrome, sepsis.

19
Q

Osler’s nodes

A

Rare manifestation of infective endocarditis

Red, raised, tender, palpable nodules on pulps of fingers, thenar, or hypothenar eminences

20
Q

Janeway Lesions

A

Non-tender erythematous maculopapular lesions containing bacteria, occuring rarely in infective endocarditis.

21
Q

Arcus senelis

A

Half or complete grey circle around outer perimeter of pupil associated with increased cardivascular risk

22
Q

JVP waveform

A
23
Q

Slides on Pulse Abnormalities

A
24
Q

Carotid Waveforms

  • Anacrotic
  • Plateau
  • Bisferiens
  • Collapsing
  • Small Volume
  • Alternans
A
25
Q

Causes of elevated central venous pressure

A

Right ventricular failure
Tricuspid stenosis or regurgitation
Pericardial effusion or constrictive pericarditis
Superior vena caval obstruction
Fluid overload
Hyperdynamic circulation

26
Q

JVP - Causes of a dominant A wave

A

Tricuspid stenosis (also causing a slow y descent)

Pulmonary stenosis

Pulmonary hypertension

27
Q

JVP - Causes of cannon A waves

A

Complete heart block

Paroxysmal nodal tachycardia with retrograde atrial conduction

Ventricular tachycardia with retrograde atrial conduction or atrioventricular dissociation

28
Q

JVP - Causes of a dominant v wave

A

Tricuspid regurgitation

29
Q

JVP - Causes of X descent changes (absence, exaggeration)

A

Absent: atrial fibrillation
Exaggerated: acute cardiac tamponade, constrictive pericarditis

30
Q

JVP - Causes of Y descent changes (sharp, slow)

A

Sharp: severe tricuspid regurgitation, constrictive pericarditis

Slow: tricuspid stenosis, right atrial myxoma

MD2 (34 decks)

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