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Cardiology > Cardiovascular Examination > Flashcards

Cardiovascular Examination Flashcards

1
Q

What are the main presenting symptoms for a cardiovascular problem?

A
  • Chest pain
  • Palpitations
  • Dyspnoea
  • Dizziness/Blackouts
  • Claudication
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2
Q

In a cardiovascular PMH what areas should be asked about?

A
  • Angina
  • Previous heart attack
  • Stroke
  • Rheumatic Fever
  • Diabetes
  • Hypertension
  • Hypercholestrolaemia
  • Previous Tests/Proecdures - ECG, angiogram, angioplasty/stents, ECHO, scintigraphy, CABG
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3
Q

What are the five main types of palpitations?

A
  • Regular fast palpitations (SVT, VT)
  • Irregular fast palpitations (AF, atrial flutter)
  • Dropped/missed beats related to rest, recumbency or eating (ectopic beats)
  • Regular pounding (anxiety)
  • Slow palpitations (drug-induced)
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4
Q

What are the main risk factors for ischaemic heart disease?

A
  • Hypertension
  • smoking
  • diabetes mellitus
  • family history (1st degree relative)
  • hyperlipidaemia
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5
Q

What are the 8 steps in the cardiovascular examination?

A
  1. General Inspection
  2. Hands - temperature and inspection
  3. Radial and brachial pulses
  4. Blood pressure
  5. Neck - JVP and carotid pulse
  6. Face - colour and features
  7. The praecordium
  8. Complete examination - oedema, listen to lung bases, liver and peripheral pulses
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6
Q

What position should the patient be in for a cardiovascular examination?

A

expose the patient and position in supine at 45degrees

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7
Q

What information can be gathered from standing at the end of the patient’s bed?

A
  • General appearance
    • Well/Unwell
    • Distressed?
    • In pain?
  • Potential Findings
    • GTN spray (indicates angina)
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8
Q

What are the main findings from the patient’s nails?

A
  • finger clubbing
  • koilonchyia
  • Nail fold infarcts
  • splinter haemorrhages
  • nail bed pulsation
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9
Q

What is finger clubbing indicative of?

A
  • Infective endocarditis
  • cyanotic CHD
  • atrial myxoma
  • non-cardiac cause
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10
Q

What is suspected when a patient has koilonychia?

A

iron deficiency anaemia

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11
Q

What do nailbed infarcts indicate?

A
  • vasculitis
  • SLE
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12
Q

What are the potential causes of splinter haemorrhages?

A
  • Infective endocarditis
  • trauma
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13
Q

What is nail bed pulsation a sign of?

A

Quincke’s sign

Aortic regurgitation

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14
Q

What is the major pathological sign that can occur on the face that has cardiovascular signficance?

A

Malar flush

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15
Q

What is malar flush a sign of?

A

mitral stenosis

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16
Q

What are the main features that should be looked for in the eyes?

A
  • corneal arcus and xanthelasma
  • conjunctival pallor
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17
Q

What are corneal arcus and xanthalasma a sign of?

A

hypercholestrolaemia

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18
Q

What is conjunctival pallor a sign of?

A
  • anaemia
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19
Q

What are the two main signs found upon inspection of the mouth?

A
  • central cyanosis
  • poor dentition
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20
Q

Why can poor dentition be signifcant?

A

risk factor for infective endocarditis

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21
Q

What can central cyanosis indicate

A
  • lung disease
  • cardiac shunt
  • abnormal Hb
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22
Q

What are the main types of R-L shunt?

A
  • cyanotic congenital heart disease
  • eisenmenger’s syndrome (reversal of L-R shunt; long term complication of congenital heart defect)
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23
Q

What are the four main observations in the hands?

A
  • temperature and capillary refill
  • peripheral cyanosis
  • osler’s nodes and janeway lesions
  • tendon xanthomata
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24
Q

What is tendon xanthomata a sign of?

A

hypercholestrolaemia

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25
Q

What are janeway lesions and osler’s nodes a sign of?

A

infective endocarditis

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26
Q

What are the main causes of peripheral cyanosis?

A
  • peripheral vascular disease
  • Raynauds
  • congestive cardiac failure
  • shock
  • a cause of central cyanosis
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27
Q

What is the difference between janeway lesions and oslers nodes?

A
  • Osler’s nodes = tender nodules in the finger pulps
  • Janeway lesions = red macules on the palms
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28
Q

What are the two main causes of R-L cardiac shunt?

A

cyantoic congenital heart disease

Eisenmenger’s syndrome

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29
Q

Where are the two main pulses taken in a cardiovascular examination?

A
  • Wrist - radial pulse
  • Neck - carotid pulse
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30
Q

What should be established when examining the patient’s radial oulse?

A
  • rate - bradycardia or tachycaria
  • Rhythm - regular, irregular or irregularly irregular
  • Volume - normal, thready, bounding
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31
Q

What does a collapsing pulse indicate?

A

aortic regrugitation

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32
Q

What are the causes of radio-radio delay?

A
  • cervical rib
  • aortic coaraction/dissection
  • embolism
33
Q

What are the causes of radio-femoral delay?

A
  • Aortic coarction/dissection
  • embolism
34
Q

What does an exaggerated pulsation of the carotid pulse suggest and what is the name of this sign?

A

Aortic regurgitation

Corrigan’s Sign

35
Q

What other pulse, other than the carotid, is observed in the neck

A

Jugular Venous Pressure (JVP)

36
Q

What does an elevated JVP suggest?

A
  • RHF
  • volume overload
  • PE
  • Constrictive pericarditis
37
Q

What does an elevated JVP with decreased BP suggest?

A
  • tension pneumothroax
  • cardiac tamponade
  • PE
  • Asthma
38
Q

What does an elevated and fixed JVP suggest?

A

SVC obstruction

39
Q

What do cannon A waves in the JVP suggest?

A
  • complete heart block
  • VEBs
  • VT
40
Q

What do giant V waves in the JVP suggest?

A

tricuspid regurgitation

41
Q

What does sacral oedema indicate?

A

right sided heart failure

42
Q

What does peripheral oedema suggest?

A

right sided heart failure

43
Q

What other investigations should be offered following a cardiovascular examination?

A
  • ECG
  • CXR
  • ECHO
  • Urinalysis
44
Q

What other examinations should be offered after a cardiovascular examination?

A
  • Abdominal exam
    • hepatomegaly and ascites (RHF)
    • Spenomegaly = IE
    • AAA
  • Peripheral pulses
45
Q

What do crepitiations at the bases of the lungs suggest?

A

left sided heart failure

46
Q

What areas of the should be inspected in a CVS exam?

A
  • Scars
  • Visible heave
  • Legs - for vein harvesting
47
Q

What scars can be visible on the chest?

A
  • Pacemaker/ICD under clavicle
  • Midline sternotomy (CABG, valve replacement)
  • Left submammary (mitral valvotomy, pericardial window)
48
Q

What are the two main visible heaves?

A
  • Apical = left ventricular hypertrophy
  • Parastenal = right ventricular hypertrophy
49
Q

What three areas require palpation in the CVS exam?

A
  • Apex beat
  • Left parasternal heave
  • Thrills
50
Q

What is a thrill?

A

palpable murmur (grade 4 or above)

51
Q

What does a left parastenal heave indicate?

A

right ventricular hypertrophy

52
Q

Where can the apex beat be felt?

A

5th intercostal space in the midclavicular line

53
Q

What does a tapping apex beat indicate?

A

mitral stenosis

54
Q

What does a heaving apex beat indicate?

A

LVH

55
Q

What does a thrusting apex beat indicate?

A

mitral/aortic regurgitation

left ventricular failure

56
Q

What are the four areas that are ausculatated in the CVS exam?

A
  • Apex (5th intercoastal space in midclavicular line) = mitral valve
  • LLSE (4th intercoastal space on left sternal edge) = tricuspid valve
  • 2nd Left intercostal space = pulmonary valve
  • 2nmd right intercostal space = aortic valve
57
Q

What murmur radiates to the axilla?

A

mitral regurgitation

58
Q

What murmur radiates to the carotids when breath is held on inspiration?

A

aortic stenosis

59
Q

How can you amplify mitral stenosis?

A

Apex, patient is lying on LHS and breath is held on expiration using bell

60
Q

How can you amplify aortic regurgitation?

A

LLSE, patient is leaning forward and breath is held in expiration (use diaphragm)

61
Q

What are the main causes of an absent radial pulse?

A
  • congenital
  • arterial embolism (AF)
  • atheroma
  • previous arterial line
  • previous coronary angiography
  • cervical rib
  • coarction of the aorta
62
Q

What are the causes of AF?

A
  • Ishcaemic heart disease
  • rheumatic heart disease
  • thyrotoxicosis
  • pneumonia
  • PE
  • Alcohol
63
Q

What is Kussmaul’s sign?

A

A rise in JVP on inspiration, which is opposite of normal (impaired RV filling)

64
Q

What can cause Kussmaul’s sign?

A
  • tamponade
  • constrictive pericarditis
  • restrictive cardiomyopathy
65
Q

Why is there a third heart sound?

A
  • rapid ventricular filling
  • may be normal is <30yo
  • Volume overload
    • CCF
    • Mitral regurgitation
    • Aortic regurgitation
    • Large anterior MI
66
Q

What are the causes of a heaving apex beat?

A
  • Aortic stenosis
  • hypertension
  • hypertrophic obstructive cardiomyopathy
  • coarction of the aorta
67
Q

What are the causes of an irregularly irregular pulse?

A
  • AF
  • VEBs (will disappear with exercise)
  • Complete heart block
  • variable ventricular escape
68
Q

What is pulsus paradoxus?

A

an exaggeration of the normal situation in which BP falls during inspiration to such extent that during inspiration peripheral pulses cannot be felt

69
Q

Causes of pulsus paradoxus

A
  • tamponade
  • constrictive pericarditis
  • restrictive cardiomyopathy
  • severe asthma/COPD
70
Q

Causes of a non-palpable apex beat

A
  • Between fingers and apex
    • adipose tissue
    • air (pneumothorax, emphysema)
    • fluid (pericardial/plerual effusion)
  • Apex not in the normal position
    • Displaced
    • dextrocardia
71
Q

Why is there a 4th heart sound?

A
  • poorly compliant ventricle
  • always abnormal
  • cannot occur in AF
  • Pressure overload
    • aortic stenosis
    • hypertension
    • HOCM
    • post-MI fibrosis
72
Q

What are the CXR features of LHF?

A
  • Alevolar Oedema
  • Kerly B lines
  • Cardiomegaly
  • Upper lobe venous Diversion
  • Pleural Effusion
73
Q

What are the main causes of cardiac failure?

A
  • Pump failure
  • excessive peload
  • excessive afterload
  • high-output failure
  • isolated right heart failure
74
Q

What are the main causes of pump failure?

A
  • Drugs (negative inotrophes)
  • Arrhythmia
  • constrictive pericarditis
  • cardiomyopathy
  • IHD
75
Q

What are the causes of excessive preload?

A
  • regurgitant valvular disease (MR/AR)
  • Fluid overload
    • renal failure
    • IV fluids
  • Ventricular septal defect
76
Q

What are the main causes of excessive afterload?

A
  • aortic stenosis
  • hypertension
77
Q

What are the causes of high-output failure?

A
  • anaemia
  • pregnancy
  • metabolic
    • hyperthyroidism
    • Paget’s disease
78
Q

What are the causes of isolated right heart failure?

A
  • primary pulmonary hypertension
  • cor pulmonale

Cardiology (6 decks)

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