Cardiovascular Examination Flashcards
risk factors for peripheral arterial disease
body habitus, age, smoking, etc
inspection of the upper arms may reveal?
skin colour changes (pink, pale, matted) ischaemic changes (gangrene) tar stains in fingers tendon xanthomata
what does palpation involves of the upper limbs
check temperature, capillary refill, pulses
what is required in upper limb pulse checks?
radial pulse (including radio-radial delay and radio-femoral delay) brachial pulse blood pressure (>10 mmHg difference is significant)
inspection of face may reveal
eyes: corneal arcus, xantholasma
mouth: central cyanosis
check carotid pulse character and bruits
abdomen inspection is required - true or false?
true. check body habitus, scars, aortic pulse and femoral pulse
is it imporant to check for aortic pulse even in a focused exam of the legs?
yes. (will reveal if issues may be caused by a AAA)
what skin colour changes may be present on a lower limb inspection?
pink, pale, matted
true or flase, check for ischaemic changes between toes and at heels?
true
give examples of trophic changes
shiny skin, hair loss, thin skin, ulcers
why might scars be present on the lower leg?
previous surgeries - CABG venous grafting, femoral-popliteal bypass
palpation of lower limbs requires checking temperature, capillary refill and pulses?
yes
name the lower limb pulses and their anatomical location
dorsalis pedis - lateral to the extensor hallucis longus tendon
posterior tibial - halfway between the posterior border of the medial malleolus and the achilles tendon
popliteal - within the popliteal fossa
tenderness of calves may indicate critical ischaemia - true or false
true
describe Buerger’s triangle
with the pateint lying supine, lift their leg until heel becomes pale and hold for 30s (if it does not become pale the test is normal; if it becomes pale, this is Buerger’s angle)
pallor followed by reactive hyperaemia on dependancy is a positive test and implies significant peripheral aterial disease - true or false?
true
what is the ABPI of intermittent claudication?
ABPI <0.9
what is the ABPI of acute ischaemic limb? any other characteristics?
ABPI <0.6
6P’s - pale, pulseless, parasthesia, paralysis, pain, perishingly cold
what is the equation for critical ischaemia?
= tissue loss + rest pain + ABPI <0.3
clubbing of the fingernails could be suggestive of what diseases?
cyanotic congenital heart disease
infective endocarditis
splinter haemorrhages could indicate what infection?
infective endocarditis
define Quincke’s sign
visible pulsation of capillary bed
aortic regurgitation
extensor tendon xanthomata is due to hypolipidaemia - true or false?
false - indicative of hyperlipidaemia
Osler’s nodes and Janeway lesions could indicate infective endocarditis. what are they?
O - painfull red lesions on palms and soles
J - nodular haemorrhaic lesions on palms and soles
anticoagulation issue could present as ___ on the skin
bruising
tachycardia is defined as a pulse rate <60 bpm, and bradycardia is defined as a pulse rate <100 bpm. true or false?
false
tachycardia is defined as a pulse rate >100 bpm, bradycardia is defined as a rate <60 bpm.
irregularly irregular pulse could be suggestive of what?
atrial fibrillation and ventricular ectopics
regularly irregular pulse could be suggestive of what?
2nd degree heart block
the radio-radial delay and radio-femoral delay may indicate aortic dissecion/coarctation of the aorta/aortic arch aneurysm. true or false
true
what conditions could a collapsing pulse indicate?
aortic regurgitation
patent ductus arteriosus
arteriovenous malformation
large pulse pressure is a sign of aortic stenosis. true or false
false.
large pulse pressure would indicate aortic regurgitation. aortic stenosis has a narrow pulse pressure.
name 4 facial signs which may be found on examination
pallor
malar flush
ruddy plethoric complexion
swollen cyanotic face
name 4 signs you would look for in the eyes
conjunctiva pallor
haemorrhages
corneal arcus
xantholasma
a high arched palate may be indicative of which condition?
Marfans
what could cause a raised JVP (hint: PQRST)
pulmonary hypertension/PE/PS/pericarditis/pericardial effusion quality of fluid eg overload right heart failure SVC obstruction tamponade/TR
carotid pulse pressure and volume of aortic stenosis
slow rising low volume
carotid pulse pressure and volume of aortic regurgitation
bounding/collapsing
same as patent ductus arteriosus
define Corrigan’s sign
visible carotid pulsation (aortic regurgitation)
define de Musset’s sign
heart bobbing in time with pulse (aortic regurgitation)
define pectus excavatum
congenital deformity producing a ‘caved-in/hollowed’ chest appearance
pigeon chest is an alternate name for pectus excavatum - true or false?
false. pectus carinatum may also be called pigeon chest
an impalpable apex beat may be due to
obesity, muscular or hyperinflated chest
a displaced apex beat may result from what conditions?
LV dilation eg from mitral/aortic regurgitation
what causes a heaving apex?
high pressure pulsation in LVH eg aortic stenosis or systemic hypertension
what causes a thrusting apex?
large area pulsation in volume overload eg MR or AR
mitral stenosis produces a tapping apex - true or false
true
what causes a parasternal heave?
RV hypertrophy in pulmonary hypertension
what is a thrill?
a palpable murmur
most common cause of a thrill
aortic stenosis
why must the lung bases be auscultated?
check from pulmonary oedema in heart failure - heard as fine crackles
peripheral oedema would indicate ___ and ___
hypoalbuminaemia and RVF
true or false - auscultation of the heart valves is done with the diaphragm of the stethoscope
true. unless stated otherwise
