CV Examination Flashcards
General structure of CV exam
General inspection
Obs/vitals
Hands: clubbing, anaemia, signs of SBE
Conjunctivae, tongue
JVP
Carotid pulse and auscultation
Apex beat, heaves, thrills,
Cardiac auscultation: positions, manoeuvres
Chest
Abdomen: hepatosplenomegaly
Oedema (sacral or peripheral)
Peripheral vascular examination
How common are peripheral signs of SBE? What are they?
IE is rare and peripheral signs are rare even in cases of IE; absence of peripheral signs does not rule out IE
Suspect IE if there is fever + murmur
Peripheral signs include spinter haemorrhages, Osler’s nodes, Janeway lesions, Roth’s spots, nail-fold infarcts
What is the best way to determine severity of valve lesions?
Echo (not physical signs)
Is apex beat a reliable measure of heart size?
No
What aspects are important to examine for on general inspection?
Colour, breathing, pain, posture
Attachments: ECG monitoring, lines (IV, central venous, arterial), urinary catheter, fluid/drug infusions, incisions, scars, dressings
When can the radial artery not be palpated?
Used for coronary grafting (in this case, use ular artery at wrist or brachial artery)
What does an irregularly irregular pulse suggest?
AF
What does a regularly irregular pulse suggest?
Premature beats (usually)
What does jugular venous pressure provide an indication of?
Measurement of R atrial pressure (R-sided filling pressure, which usually correlates with L-sided filling pressure)
“Moderately accurate” (more important whether elevated or not elevated, rather than actual level)
6 ways the jugular venous pressure can be distinguished from the carotid pulse
2 to see:
1) Double impulse (if in sinus rhythm)
2) Falls with inspiration, rises with expiration
2 to feel:
3) Not palpable
4) Can be occluded by gentle finger pressure
2 to do:
5) Varies with sitting up or lying down
6) Increases with hepato-jugular reflux
What does a raised JVP indicate?
High RA pressure (e.g. in cardiac failure, fluid overload)
What does a single wave JVP suggest?
AF
What is a JVP which rises with inspiration called and what does it suggest?
Kussmaul’s sign in constrictive pericarditis
What does a large “a wave” in the JVP suggest?
Stiff RV
What does a large “v wave” in the JVP suggest?
TR
What is the carotid pulse a good indicator of?
Most accurate representation of aortic pulse (in time with aortic pulse - the radial is delayed)
What does a small volume, late rise carotid pulse indicate?
AS (specific but not sensitive)
What does a high volume, rapid fall (collapsing) carotid pulse indicate?
AR
What do carotid bruits indicate?
Carotid narrowing; but not sensitive or specific, and poor predictor of TIA and stroke
What should be looked for on inspection of the chest wall?
Scars
Visible pulsation
In what % of adults is the apex beat palpable?
50%
What are the possible different characters of apex beat and what does each suggest?
Heaving (sustained): ventricular hypertrophy
Tapping: loud 1st heart sound (e.g. MS)
Dyskinetic: ventricular dysfunction (e.g. aneurysm)
What does listening with the bell help with?
HS (low pitched)
What does listening with the diaphragm help with?
Murmurs (high pitched)
