CVS Flashcards
What can be noticed on inspection of the general appearance of patients with aortic stenosis?
They are pale and sweaty
Why do patients with aortic stenosis appear the way they do?
Low cardiac output
How does the pulse feel on a patient with aortic stenosis?
Rate - elevated
Rhythm - sinus rhythm
What blood pressure could you expect in a patient with aortic stenosis?
100 systolic 75 diastolic
What pulse characteristic could you expect in a patient with aortic stenosis?
Slow rising carotid impulse
Low volume
Where can pulse characteristics be felt?
Brachial artery
Will aortic stenosis have any JVP signs? Why?
No as it is a left sided lesion.
What will be felt on palpating of the apex beat in a patient with aortic stenosis?
Non displaced, pressure loaded beat.
Can any heaves/thrills be felt on palpating in a patient with aortic stenosis?
You may feel a thrill in the aortic or carotid regions.
What can be heard on auscultation of aortic stenosis?
Crescendo-decrescendo systolic murmur. S2 can be heard unless stenosis is severe.
What can be heard in severe aortic stenosis?
A seagull noise
What is a pale and sweaty appearance associated with in the CVS examination?
Aortic stenosis
What can sinus rhythm of pulse with tachycardia, but low BP indicate?
Aortic stenosis
What is a slow rising carotid impulse with low volume characteristic of?
Aortic stenosis
What does a raised JVP indicate?
A Right sided lesions eg tricuspid regurgitation
With what can the apex beat be felt non-displaced but pressure loaded?
Aortic stenosis
With what may a thrill in the aortic region be felt?
Aortic stenosis
With what may a thrill in the carotid region be felt?
Aortic stenosis
Which valve lesion can sound like a seagull?
Aortic stenosis
Which valve lesion has a pansystolic murmur which has a diamond shape ie crescendo/decrescendo?
Aortic stenosis
What can be noticed on inspection of the general appearance of patients with aortic regurgitation?
There are 11 key signs
What are the peripheral signs of aortic regurgitation due to?
Volume overload
What are the main/most common signs of aortic regurgitation?
Quincke sign (severe AR - nail bed pulsation) De Musset sign (head nod with pulse) Corrigans sign (neck pulse - collapsing nature)
What is the pulse rate, rhythm and BP with aortic regurgitation?
Sinus rhythm
Normal HR
BP Systolic high eg 200/70
What pulse characteristsic can be felt with aortic regurgitation?
Collapsing pulse aka water hammer pulse
High volume
Is the JVP raised with aortic regurgitation? Why?
No - it is a Left sided lesion
Where is the apex beat felt in aortic regurgitation?
Displaced
How does the apex beat feel in aortic regurgitation?
Volume loaded
What does aortic regurgitation sound like on auscultation?
Decrescendo after S2 (start of diastole)
How long is the sound in aortic regurgitation?
If mild or severe, short. Use other signs to determine severity.
If moderate, long.
What are the 11 clinical signs including De Musset, Quincke, and Corrigans sign for?
Aortic regurgitation
What can normal rate and rhythm but high BP be a sign of?
Aortic regurgitation
What can a high volume pulse with a collapsing character be a sign of?
Aortic regurgitation
What can a displaced, volume loaded apex beat be an indication of?
Aortic regurgitation
What does an early diastolic decrescendo murmur indicate?
Aortic regurgitation
What can be noticed on inspection of the general appearance of patients with mitral stenosis?
Malar flush
How does the pulse feel on a patient with mitral stenosis?
Irregularly irregular - AF
Why does a mitral stenosis pulse feel the way it does?
AF due to LV dilation
What pulse characteristic could you expect in a patient with mitral stenosis?
Normal as does not obstruct LV outflow
Is JVP raised with mitral stenosis?
It may be raised due to pulmonary hypertension and cor pulmonale etc
What will be felt on palpating of the apex beat in a patient with mitral stenosis? Why?
Non displaced
Tapping apex beat (due to increased force of mitral valve closing)
Can any heaves/thrills be felt on palpating in a patient with mitral stenosis?
RV heave possible if RV dilated (assoc with raised JVP)
What can be heard on auscultation of mitral stenosis?
Soft diastolic sound - abscence of silence (dot dash)
Why can this sound be heard on auscultation of mitral stenosis?
Turbulence of flow between La and LV during diastole
What is malar flush associated with?
Mitral stenosis
What can an irregularly irregulr HR be associated with?
Mitral stenosis
AF
What may JVP be raised with due to increased pulmonary BP?
Mitral stenosis
What is a tapping apex beat (non displaced) associated with?
Mitral stenosis
When may a RV heave be palpable (2)?
- Mitral stenosis if RV dilated due to pulmoary hypertension etc
- Tricuspid regurgitation if patient has lung disease
What does a soft, diastolic murmur (dot dash) indicate?
Mitral stenosis
What can be noticed on inspection of the general appearance of patients with mitral regurgitation?
Normal appearance - tiredness or SoB may be noted from the hx
How does the pulse feel on a patient with mitral regurgitation?
Normal (although AF may develop if severe)
What is the character of the pulse felt with mitral regurgitation?
Normal
Is JVP raised with mitral regurgitation? Why?
No - it is not a R sided lesion
How does the apex beat feel with mitral regurgitation? Why?
Displaced and volume loaded as there is an active large stroke volume
Can anything be palpated on the chest with mitral regurgitation?
Rarely - thrill in mitral region
How does mitral regurgitation sound on auscultation?
Pan systolic murmur with different shapes according to cause of mitral regurgitation
What can make mitral regurgitation sound different?
- Infective endocarditis - low murmur (dash dot dot)
2. Prolapse (more common) - Crescendo/wedge shaped.
What can a displaced apex beat that is volume loaded indicate?
Mitral regurgitation
What can a low pansystolic murmur indicate?
Mitral or tricuspid regurgitation caused by infective endocarditis.
What can a systolic murmur of increasing volume (wedge shaped) indicate?
Mitral regurgitation due to prolapsed valve
What can be noticed on inspection of the general appearance of patients with tricuspid regurgitation? Why?
Elephant ears - ears move due to V waves from internal jugular
How does the pulse feel on a patient with tricuspid regurgitation?
Normal as it is a R sided lesion
What pulse characteristic could you expect in a patient with tricuspid regurgitation?
Normal as it is a R sided lesion
Is the JVP raised with tricuspid regurgitation? Why?
Yes - S waves and V waves are present. Right sided lesion increasing preload on R side of heart
What may be palpable in a patient with tricuspid regurgitation?
RV heave if the patient has lung disease
How does tricuspid regurgitation sound on auscultation?
May have a murmur or may not depending on cause
What can make tricuspid regurgitation sound different?
- Functional regurgitation - no murmur may be heard
2. Traumatic TR or infective endocarditis - low pan systolic murmur (valve must be abnormal for murmur)
What lesion can cause elephant ears?
Tricuspid regurgitation
When can elevated JVP with S waves and V waves be seen?
Tricuspid regurgitation
If seen with lung disease, when may a RV heave be palpable?
Tricuspid regurgitation
What can be noticed on inspection of the general appearance of patients with a small VSD?
Nothing - normal appearance
How does the pulse feel on a patient with a small VSD?
Normal
What pulse characteristic could you expect in a patient with a small VSD?
Normal
Will a small VSD have any JVP signs?
No
What will be felt on palpating of the apex beat in a patient with a small VSD?
It will be normal
Can any heaves/thrills be felt on palpating in a patient with a small VSD?
Often a thrill is palpable at the left lower sternal edge
What can be heard on auscultation of a small VSD?
A very loud pansytolic murmur
Why can this be heard in a patient with a small VSD?
Blood flow between the L side and R side ventricles due to systole
