CARDIOVASCULAR PHYSICAL EXAMINATION Flashcards
What does a slow rate of rise of the carotid arterial pulse indicate?
A carotid arterial pulse that is reduced (parvus) and delayed (tardus) suggests the presence of aortic valvular stenosis.
This may be accompanied by a palpable thrill if ventricular function is good.
What does a brisk carotid arterial upstroke indicate when associated with normal pulse pressure?
It usually indicates:
* Simultaneous emptying of the left ventricle into a high-pressure bed (the aorta) and a lower pressure bed (e.g., right ventricle or left atrium)
* Hypertrophic cardiomyopathy (HCM)
In HCM, the pulse is brisk and bifid due to delayed obstruction.
What does a brisk carotid upstroke indicate when associated with widened pulse pressure?
It usually indicates aortic regurgitation (AR).
The pulse in AR has a rapid upstroke and collapse.
What are common causes of rapid upstroke and widened pulse pressure?
Common causes include:
* Anemia
* Fever
* Exercise
* Thyrotoxicosis
* Pregnancy
* Cirrhosis
* Beriberi
* Paget disease
* Arteriovenous fistulas
* Patent ductus arteriosus
* Aortic regurgitation
* Anxiety
These conditions are typically associated with rapid ventricular contraction and low peripheral vascular resistance.
What is pulsus paradoxus?
An exaggerated fall in systolic blood pressure during quiet inspiration.
It is best detected in a peripheral vessel and can occur in cardiac tamponade and other conditions.
What is pulsus alternans?
The alternation of strong and weak arterial pulses despite regular rate and rhythm.
It indicates severe left ventricular dysfunction and is often associated with an S3 gallop.
What is the Duroziez double murmur?
A to-and-fro double murmur over a large central artery, usually the femoral, elicited by firm compression with a stethoscope’s diaphragm.
It indicates a systolic murmur (normal) and a diastolic murmur (pathologic, typical of aortic regurgitation).
What is carotid shudder?
A palpable thrill felt at the peak of the carotid pulse in patients with aortic stenosis or regurgitation.
It represents the transmission of the murmur to the artery.
What is the Corrigan pulse?
The bounding and quickly collapsing pulse of aortic regurgitation, also known as water hammer pulse.
It is best felt by elevating the patient’s arm while palpating the radial artery.
How do you auscultate for carotid bruits?
Place the stethoscope’s bell on the patient’s neck in a quiet room and auscultate from just behind the upper end of the thyroid cartilage to below the angle of the jaw.
What is the correlation between symptomatic carotid bruit and high-grade stenosis?
A strong correlation exists; bruits with transient ischemic attacks or minor strokes should be evaluated for high-grade carotid stenosis (70%–99%).
Imaging is mandatory as the absence of a bruit does not exclude disease.
What is central venous pressure (CVP)?
The pressure within the right atrium–superior vena cava system, reflecting right ventricular end-diastolic pressure.
Which veins should be evaluated for assessing venous pulse and central venous pressure?
Central veins, especially the internal jugular vein, are ideal for evaluation.
The right internal jugular vein is preferred due to its direct line with the right atrium.
Can the external jugular veins be used to evaluate central venous pressure?
Theoretically no, but practically yes, as they can yield comparable estimates despite being farther from the right atrium.
What is a cannon a wave?
The hallmark of atrioventricular dissociation, occurring when the atrium contracts against a closed tricuspid valve.
