Cardiovascular Examination Flashcards
1
Q
What should you try notice in the patient upon general inspection during a cardiovascular examination? (3)
A
Dyspnoea, pallor or cyanosis
2
Q
What sign shows clubbing?
A
Schamroth’s sign
3
Q
What is Schamroth’s sign used to diagnose?
A
Clubbing
4
Q
What should you inspect the finger nails for during a cardiovascular examination?(2)
A
Splinter haemorrhages and clubbing
5
Q
What are splinter haemorrhages a sign of? (2)
A
Infective endocarditis or trauma
6
Q
What should you examine the dorsum of the hands for? (6)
A
Xanthomata Osler nodes Janeway lesions Temperature and colour of skin Capillary refill time
7
Q
Difference between Janeway lesions and Osler nodes? (4)
A
Osler: on fingers, painful, raised nodules
Janeway: on palms, flat, red macules
8
Q
What are xanthomata associated with?
A
Hypercholesterolaemia and elevated LDL levels
9
Q
What is a normal capillary refill time?
A
Less than 3 seconds
10
Q
What can cause poor perfusion and a high capillary refill time?(4)
A
Hypovolaemia, hypothermia, peripheral vascular disease or just cool peripheries
(with associated vasoconstriction).
11
Q
What are Janeway lesions associated with?
A
Infective endocarditis
12
Q
What are Osler’s nodes associated with?
A
Infective endocarditis
13
Q
When is a pulse described as bounding?
A
If it has an increased up-stroke and down-stroke
14
Q
What is a bounding pulse a sign of?
A
CO2 retention
15
Q
What type of pulse is associated with CO2 retention?
A
Bounding
16
Q
When is a pulse described as slow-rising?
A
If it has a delayed up-stroke
17
Q
What is a slow-rising pulse a sign of?
A
Aortic stenosis
18
Q
What is a jerky pulse a sign of?
A
Hypertrophic cardiomyopathy
19
Q
What type of pulse is associated with hypertrophic cardiomyopathy?
A
Jerky
20
Q
What type of pulse is associated with aortic stenosis?
A
Slow-rising
21
Q
What is radio-radial delay?
A
Inequality in timing between the two radial pulses
22
Q
What is radio-radial delay a sign of?
A
Aortic coarctation
23
Q
What is strength inequality of pulses a sign of?
A
Aortic dissection
24
Q
What characteristic of pulses is associated with aortic dissection?
A
Radio-radial strength inequality
25
What characteristic of pulses is associated with aortic coarctation?
Radio-Radial and radio-femoral delay
26
What type of pulse is associated with aortic regurgitation?
Water hammer/collapsing pulse
27
What does a small pulse pressure indicate?
Aortic stenosis
28
What does a large pulse pressure indicate?
Aortic regurgitation
29
What pulse pressure indicates aortic stenosis?
Narrow
30
What pulse pressure indicates aortic regurgitation?
Wide
31
What should a full cardiovascular examination involve regarding blood pressure?
Checking lying and standing blood pressure to check for a postural hypotension
32
What is a postural drop in blood pressure quantified as?
A fall on standing of greater than 15mmHg in systolic BP or 10mmHg diastolic
33
What is conjunctival pallor a sign of?
Anaemia
34
What should you examine the face for in a cardiovascular examination? (6)
```
Xanthelasma
Senile arcus
Conjunctival pallor
Central cyanosis under tongue and in the skin
Petechiae in mucosa of mouth
Dental hygiene
```
35
What signs of hyperlipidaemia are in the face? (2)
Xanthelasma and senile arcus
36
What are xanthelasma a sign of?
Hyperlipidaemia
37
What is senile arcus a sign of?
Hyperlipidaemia
38
What causes a blue colour to the skin and below the tongue?
Hypoxia
39
Where do you check for hypoxia?
Below the tongue and in the skin
40
What signs of infective endocarditis are in the face? (2)
Petechiae in the mucosa of the mouth and poor dental hygiene
41
What can be used to provide a measure of the central venous pressure?
Jugular veinous pulse/pressure
42
How can we illicit the JVP to be more obvious?
Hepatojugular reflux
43
What height of JVP is a sign of right ventricular failure?
4cm or greater throughout the hepatojugular reflux
44
What is Kussmaul's sign?
A paradoxical increase in the JVP with inspiration
45
What conditions can cause Kussmaul's sign?(2)
Constrictive pericarditis or cardiac tamponade
46
What can the JVP used to help diagnose? (3)
Right ventricular failure
Constrictive pericarditis
Cardiac tamponade
47
After looking at the JVP what should you look at?
Carotid pulse
48
What cardiovascular causes of clubbing are there? (3)
Infective endocarditis
Cyanotic congenital heart disease
Atrial myxoma
49
What does a median sternotomy scar indicate?(2)
Previous valve surgery or a coronary artery by-pass graft.
50
What should you inspect the precordium for? (4)
Scars (median sternotomy, lateral thoracotomy)
Cardiac pacemaker
Defibrillator
Visible cardiac impulses
51
Which direction of displacement of the apex beat suggests cardiomegaly?
Infero-laterally
52
What are the three characters of the apex beat?
Normal/pressure-overloaded/volume-overloaded
53
What may cause a pressure overloaded apex beat? (?)
Aortic stenosis or hypertension
54
What may cause a volume overloaded apex beat? (?)
Mitral regurgitation, dilated cardiomyopathy or ventricular damage due to ischaemic heart disease
55
What does an infero-lateral displacement of the apex beat indicate?
Cardiomegaly
56
Which types of pulse is palpable at the apex?(2)
Tapping
| Double impulse
57
Which type of apex beat can indicate aortic stenosis?
Pressure overloaded
58
Which type of apex beat can indicate hypertension?
Pressure overloaded
59
Which type of apex beat can indicate mitral regurgitation?
Volume overloaded
60
Which type of apex beat can indicate dilated cardiomyopathy?
Volume overloaded
61
Which type of apex beat can indicate ventricular damage due to ischaemic heart disease?
Volume overloaded
62
Which type of apex beat feels heaving, sustained and forceful?
Pressure overloaded
63
Which type of apex beat feels diffuse and displaced laterally and/or inferiorly?
Volume overloaded
64
How does a pressure overloaded apex beat feel?
Heaving, sustained and forceful
65
How does a volume overloaded apex beat feel?
Diffuse and displaced laterally and/or inferiorly
66
What type of apex beat is associated with mitral stenosis?
Tapping apex beat
67
What type of apex beat is associated with hypertrophic cardiomyopathy?
Double impulse
68
What disease is a double impulse apex beat associated with?
Hypertrophic cardiomyopathy
69
What disease is a tapping apex beat associated with?
Mitral stenosis
70
How can you detect right ventricular hypertrophy?
Place the heel of your hand over the lower left sternal edge and feel for a right ventricular heave as a push against your hand
71
What does placing the heel of your hand over the lower left sternal edge and feeling for a right ventricular heave suggest?
Right ventricular hypertrophy
72
How do you feel for cardiac thrills?
By systematically placing the flat of your hand over the apex (mitral valve area), lower left sternal edge (tricuspid valve area), right 2nd intercostal space (aortic valve area) and left 2nd intercostal space (pulmonary valve area).
73
What order should you auscultate the heart valves in?
Mitral tricuspid aortic pulmonary
74
What does auscultating over the carotid arteries help identify? (2)
Aortic stenosis and stenotic carotid bruit
75
What does auscultating over the left axilla help identify?
Mitral regurgitation
76
Where should you auscultate for aortic stenosis?
Over the carotid arteries
77
Where should you auscultate for mitral regurgitation?
Left axilla
78
How do differentiate between the murmur of aortic stenosis and stenotic carotid bruit?
by identifying the site of the sound’s maximal intensity; stenotic carotid bruits are heard loudest above the thyroid cartilage, aortic stenosis over the precordium.
79
Which heart sound is caused by closure of the AV valves?
S1
80
Which heart sound is caused by closure of the semi-lunar valves?
S2
81
What causes the S1 heart sound?
Closure of the AV valve
82
What causes the S2 heart sound?
Closure of the semi-lunar valve
83
When does physiological splitting of S2 increase?
Upon end of inspiration
84
What are the pathological splittings of S2 known as? (3)
Wide splitting
Fixed splitting
Reverse splitting
85
What is wide S2 splitting?
Exaggerated physiological splitting
86
What is fixed S2 splitting?
Unaffected by inspiration
87
What is reverse S2 splitting?
Widens in expiration
88
What type of S2 splitting widens in expiration?
Reverse splitting
89
What type of S2 splitting is unaffected by respiration?
Fixed splitting
90
What type of S2 splitting is exaggerated physiological splitting?
Wide splitting
91
What does the cadence of S1, 2 and 3 resemble?
Ken-tuck-y
92
When does S3 occur?
Occurs in early diastole, just after S2
93
Where is S3 best heard?
Over the apex
94
What pitch is S3?
Low-pitched
95
What does the presence of S3 indicate? (3)
Left ventricular failure,
| mitral regurgitation or high output cardiac states
96
When is S3 physiological?
In the young
97
What does the cadence of S1, 2 and 4 resemble?
Ten-nes-see
98
When does S4 occur?
In late-diastole, immediately before S1
99
What does the presence of S4 indicate?
Poorly compliant ventricle
100
What is S4 associated with? (3)
Aortic stenosis, hypertension and left ventricular failure
101
What is a high-pitched ringing sound heard in early systole shortly after S1 known as?
Ejection click
102
What does an ejection click sound like and when does it occur?
A high-pitched ringing sound heard in early systole shortly after S1
103
What is an ejection click associated with?
Aortic or pulmonary stenosis
104
What causes the ejection click?
Sudden opening of the deformed valve
105
What is a mid-systolic click associated with?
Mitral valve prolapse
106
What is a mid-systolic click often followed by?
A late systolic murmur
107
What is an opening snap in early diastole associated with?
Mitral stenosis
108
What causes the opening snap in early diastole in mitral stenosis?
The rapid opening of a stenosed but pliable mitral valve under high left atrial pressure
109
What does the sound of pericardial friction rub sound like?
Walking on snow
110
What is the sound resembling walking on snow throughout the cardiac cycle caused by?
Pericardial friction rub by pericarditis
111
What causes pericardial friction rub?
Pericarditis
112
What does pericarditis cause that can be auscultated?
Pericardial friction rub
113
What should you assess when detecting a murmur?
Timing, site of greatest intensity, character, loudness, and radiation
114
How do you assess the investing of a murmur?
Levine's grading system
115
Which is the most important feature of a murmur?
Timing
116
Expiration accentuates left or right murmurs?
Left
117
Inspiration accentuates left or right murmurs?
Right
118
What are you auscultating for when you auscultate the apex whilst the patient holds their breath on expiration on their side?
Mid diastolic murmur of mitral stenosis
119
What are you auscultating for when you auscultate the lower left sternal edge whilst the patient holds their breath on expiration whilst sitting forward?
The accentuated early diastolic murmur of aortic regurgitation
120
Right sided murmurs are accentuated by inspiration or expiration?
Inspiration
121
Left sided murmurs are accentuated by inspiration or expiration?
Expiration
122
A pansystolic murmur that increases in intensity in expiration is most likely due to...?
Mitral regurgitation
123
A pansystolic murmur that increases in intensity in inspiration is most likely due to...?
Tricuspid regurgitation
124
What are fine inspiratory crackles auscultated from the lung bases indicative of?
Heart failure
125
What is pulsus paradoxus?
Defined as an inspiratory decline in systolic BP that exceeds 10mmHg, but a more appropriate threshold may be 12mmHg
126
What should you always check for in patients with suspected pericardial disease?
Pulsus paradoxus
127
Which patients should you always check for pulsus paradoxus?
Patients with suspected pericardial disease
128
What is pulsus paradoxus a sign of?
Cardiac tamponade
129
What sign strongly indicates cardiac tamponade?
Pulsus paradoxus
130
What is a water hammer pulse associated with?
Atrial regurgitation
