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Systems Examinations > CVS > Flashcards

CVS Flashcards

1
Q

What can be noticed on inspection of the general appearance of patients with aortic stenosis?

A

They are pale and sweaty

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2
Q

Why do patients with aortic stenosis appear the way they do?

A

Low cardiac output

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3
Q

How does the pulse feel on a patient with aortic stenosis?

A

Rate - elevated

Rhythm - sinus rhythm

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4
Q

What blood pressure could you expect in a patient with aortic stenosis?

A

100 systolic 75 diastolic

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5
Q

What pulse characteristic could you expect in a patient with aortic stenosis?

A

Slow rising carotid impulse

Low volume

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6
Q

Where can pulse characteristics be felt?

A

Brachial artery

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7
Q

Will aortic stenosis have any JVP signs? Why?

A

No as it is a left sided lesion.

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8
Q

What will be felt on palpating of the apex beat in a patient with aortic stenosis?

A

Non displaced, pressure loaded beat.

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9
Q

Can any heaves/thrills be felt on palpating in a patient with aortic stenosis?

A

You may feel a thrill in the aortic or carotid regions.

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10
Q

What can be heard on auscultation of aortic stenosis?

A

Crescendo-decrescendo systolic murmur. S2 can be heard unless stenosis is severe.

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11
Q

What can be heard in severe aortic stenosis?

A

A seagull noise

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12
Q

What is a pale and sweaty appearance associated with in the CVS examination?

A

Aortic stenosis

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13
Q

What can sinus rhythm of pulse with tachycardia, but low BP indicate?

A

Aortic stenosis

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14
Q

What is a slow rising carotid impulse with low volume characteristic of?

A

Aortic stenosis

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15
Q

What does a raised JVP indicate?

A

A Right sided lesions eg tricuspid regurgitation

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16
Q

With what can the apex beat be felt non-displaced but pressure loaded?

A

Aortic stenosis

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17
Q

With what may a thrill in the aortic region be felt?

A

Aortic stenosis

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18
Q

With what may a thrill in the carotid region be felt?

A

Aortic stenosis

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19
Q

Which valve lesion can sound like a seagull?

A

Aortic stenosis

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20
Q

Which valve lesion has a pansystolic murmur which has a diamond shape ie crescendo/decrescendo?

A

Aortic stenosis

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21
Q

What can be noticed on inspection of the general appearance of patients with aortic regurgitation?

A

There are 11 key signs

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22
Q

What are the peripheral signs of aortic regurgitation due to?

A

Volume overload

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23
Q

What are the main/most common signs of aortic regurgitation?

A 
Quincke sign (severe AR - nail bed pulsation)
De Musset sign (head nod with pulse)
Corrigans sign (neck pulse - collapsing nature)
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24
Q

What is the pulse rate, rhythm and BP with aortic regurgitation?

A

Sinus rhythm
Normal HR
BP Systolic high eg 200/70

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25
Q

What pulse characteristsic can be felt with aortic regurgitation?

A

Collapsing pulse aka water hammer pulse

High volume

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26
Q

Is the JVP raised with aortic regurgitation? Why?

A

No - it is a Left sided lesion

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27
Q

Where is the apex beat felt in aortic regurgitation?

A

Displaced

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28
Q

How does the apex beat feel in aortic regurgitation?

A

Volume loaded

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29
Q

What does aortic regurgitation sound like on auscultation?

A

Decrescendo after S2 (start of diastole)

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30
Q

How long is the sound in aortic regurgitation?

A

If mild or severe, short. Use other signs to determine severity.
If moderate, long.

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31
Q

What are the 11 clinical signs including De Musset, Quincke, and Corrigans sign for?

A

Aortic regurgitation

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32
Q

What can normal rate and rhythm but high BP be a sign of?

A

Aortic regurgitation

33
Q

What can a high volume pulse with a collapsing character be a sign of?

A

Aortic regurgitation

34
Q

What can a displaced, volume loaded apex beat be an indication of?

A

Aortic regurgitation

35
Q

What does an early diastolic decrescendo murmur indicate?

A

Aortic regurgitation

36
Q

What can be noticed on inspection of the general appearance of patients with mitral stenosis?

A

Malar flush

37
Q

How does the pulse feel on a patient with mitral stenosis?

A

Irregularly irregular - AF

38
Q

Why does a mitral stenosis pulse feel the way it does?

A

AF due to LV dilation

39
Q

What pulse characteristic could you expect in a patient with mitral stenosis?

A

Normal as does not obstruct LV outflow

40
Q

Is JVP raised with mitral stenosis?

A

It may be raised due to pulmonary hypertension and cor pulmonale etc

41
Q

What will be felt on palpating of the apex beat in a patient with mitral stenosis? Why?

A

Non displaced

Tapping apex beat (due to increased force of mitral valve closing)

42
Q

Can any heaves/thrills be felt on palpating in a patient with mitral stenosis?

A

RV heave possible if RV dilated (assoc with raised JVP)

43
Q

What can be heard on auscultation of mitral stenosis?

A

Soft diastolic sound - abscence of silence (dot dash)

44
Q

Why can this sound be heard on auscultation of mitral stenosis?

A

Turbulence of flow between La and LV during diastole

45
Q

What is malar flush associated with?

A

Mitral stenosis

46
Q

What can an irregularly irregulr HR be associated with?

A

Mitral stenosis

AF

47
Q

What may JVP be raised with due to increased pulmonary BP?

A

Mitral stenosis

48
Q

What is a tapping apex beat (non displaced) associated with?

A

Mitral stenosis

49
Q

When may a RV heave be palpable (2)?

A
  1. Mitral stenosis if RV dilated due to pulmoary hypertension etc
  2. Tricuspid regurgitation if patient has lung disease
50
Q

What does a soft, diastolic murmur (dot dash) indicate?

A

Mitral stenosis

51
Q

What can be noticed on inspection of the general appearance of patients with mitral regurgitation?

A

Normal appearance - tiredness or SoB may be noted from the hx

52
Q

How does the pulse feel on a patient with mitral regurgitation?

A

Normal (although AF may develop if severe)

53
Q

What is the character of the pulse felt with mitral regurgitation?

A

Normal

54
Q

Is JVP raised with mitral regurgitation? Why?

A

No - it is not a R sided lesion

55
Q

How does the apex beat feel with mitral regurgitation? Why?

A

Displaced and volume loaded as there is an active large stroke volume

56
Q

Can anything be palpated on the chest with mitral regurgitation?

A

Rarely - thrill in mitral region

57
Q

How does mitral regurgitation sound on auscultation?

A

Pan systolic murmur with different shapes according to cause of mitral regurgitation

58
Q

What can make mitral regurgitation sound different?

A
  1. Infective endocarditis - low murmur (dash dot dot)

2. Prolapse (more common) - Crescendo/wedge shaped.

59
Q

What can a displaced apex beat that is volume loaded indicate?

A

Mitral regurgitation

60
Q

What can a low pansystolic murmur indicate?

A

Mitral or tricuspid regurgitation caused by infective endocarditis.

61
Q

What can a systolic murmur of increasing volume (wedge shaped) indicate?

A

Mitral regurgitation due to prolapsed valve

62
Q

What can be noticed on inspection of the general appearance of patients with tricuspid regurgitation? Why?

A

Elephant ears - ears move due to V waves from internal jugular

63
Q

How does the pulse feel on a patient with tricuspid regurgitation?

A

Normal as it is a R sided lesion

64
Q

What pulse characteristic could you expect in a patient with tricuspid regurgitation?

A

Normal as it is a R sided lesion

65
Q

Is the JVP raised with tricuspid regurgitation? Why?

A

Yes - S waves and V waves are present. Right sided lesion increasing preload on R side of heart

66
Q

What may be palpable in a patient with tricuspid regurgitation?

A

RV heave if the patient has lung disease

67
Q

How does tricuspid regurgitation sound on auscultation?

A

May have a murmur or may not depending on cause

68
Q

What can make tricuspid regurgitation sound different?

A
  1. Functional regurgitation - no murmur may be heard

2. Traumatic TR or infective endocarditis - low pan systolic murmur (valve must be abnormal for murmur)

69
Q

What lesion can cause elephant ears?

A

Tricuspid regurgitation

70
Q

When can elevated JVP with S waves and V waves be seen?

A

Tricuspid regurgitation

71
Q

If seen with lung disease, when may a RV heave be palpable?

A

Tricuspid regurgitation

72
Q

What can be noticed on inspection of the general appearance of patients with a small VSD?

A

Nothing - normal appearance

73
Q

How does the pulse feel on a patient with a small VSD?

A

Normal

74
Q

What pulse characteristic could you expect in a patient with a small VSD?

A

Normal

75
Q

Will a small VSD have any JVP signs?

A

No

76
Q

What will be felt on palpating of the apex beat in a patient with a small VSD?

A

It will be normal

77
Q

Can any heaves/thrills be felt on palpating in a patient with a small VSD?

A

Often a thrill is palpable at the left lower sternal edge

78
Q

What can be heard on auscultation of a small VSD?

A

A very loud pansytolic murmur

79
Q

Why can this be heard in a patient with a small VSD?

A

Blood flow between the L side and R side ventricles due to systole

Systems Examinations (3 decks)

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