CVS

Question 1

CVS end of bed

Answer 1

Oxygen
Medication/GTN
Pain/breathing
? Unwell/anx
Conditions ie marfans t21
Scarring

Question 2

CVS hands

Answer 2

Temp
P cyanosis
Nicotine

Nails
Clubbing
Splinter hs in IE (few n manual work)
CAP REFILL n <2s

Lumps
Oslers nodes - painful raised erythematous finger pads
Janeway lesions - thenar/hypot e - painless blanching red macules
Extensor tendon xanthoma ie FH

PULSE - RADIAL rate, rhythm
Radio radial or RF ? DELAY
COLLAPSING PULSE ?ar

BRACHIAL
BP

Question 3

CVS neck

Answer 3

Carotid
Vol
Character

JVP n =<4cm vert height above sternal angle at 45deg

Question 4

CVS face

Answer 4

Eyes
Arcus
Xanthelasma- MI risk

Anaemia

Mouth
Central cyanosis

Discs
Hypertension

Question 5

Pulses

Answer 5

Radial
Rate
Rhythm

RR or RF delay ie dissection/Coarctation
Collapsing - AR

Brachial
BLOOD PRESSURE

Carotid
Vol
Character

JVP n =<4cm vert height above sternal angle at 45deg

Question 6

Precordium

Answer 6

Pectus excavatum
or carinatum ie severe childhood lung disease
= DISPLACES HEART

Scars - sternotomy
Submamary ie mitral or tricuspid
Infraclav PPM ICD AND PALPATE

PALPATE
apex beat n 5th ic mid clav
Heaves
Thrills

Question 7

Heart auscultation

Answer 7

All areas diaphragm

UR = aortic ie AS HCM ejection systolic

UL = pulmonary and 2nd HS

LL = Tricuspid AR/TR diastolic so amplify!
VSD and direction!

Apex = Mitral MS
HS 1… 3 4

Question 8

Heart auscultation- other areas and amplification

Answer 8

L axilla = MR radiation
?LL PDA
UR/carotids = AS

Bell - apex and LL

AMPLIFICATION
MS - bell apex, left lat
AR - ll sternal diaphragm

CAROTID BRUITS

Amp

Question 9

Clubbing cardio resp

Answer 9

Cyanotic congenital HD
IE
AV shunt

Ca lung
INFECTION Chronic suppurative lung disease ie TB, bronchiectasis, abscess, empyrean, CF
CANCER Mesothelioma
FIBROSIS Pulmonary fibrosis

Question 10

Pansystolic murmurs

Answer 10

Mitral regurge - PANSYSTOLIC Apex radiating to axilla
? Arrhythmia, displaced apex beat

Mitral prolapse- MS click then LATE

Tricuspid regurge - PANSYSTOLIC
LLSE v JVP, PULSATILE LIVER

VSD small LLSE to RSE thrill

IVS rupture post MI = harsh murmur or rub

Question 11

Ejection systolic murmurs

Answer 11

Aortic Stenosis = sawing / EJECTION SYSTOLIC
Aortic area (urse) to CAROTIDS
THRILL
?LVH, narrow pulse pressure

Pulmonary stenosis

HCM ie subvalvular obstruction

ASD

Hyperdynamic circulation = fever, anaemia, prev

Question 12

Diastolic murmurs

Answer 12

Aortic regurge 
? EARLY DIASTOLIC 
LSE + AMPLIFICATION 
Duration inv severity!
COLLAPSING Pulse

PR = uncommon

Mitral stenosis
Low pitched RUMBLE ?opening snap
APEX+ AMPLIFICATION or exercise
MALAR FLUSH ?atrial arhthymia

TS = rare

Question 13

Other murmurs!

Answer 13

PDA
CONTINUOUS! ULSE ie pulmonary
Machine like

Multiple ie RF = MS plus MR

Question 14

Heart sounds

Answer 14

Valves snapping shut!

S1 = BEGINNING OF VENTRICULAR SYSTOLE
mitral and tricuspid

S2 = END OF VENTRICULAR SYSTOLE
Aortic and pulmonary

Physiological splitting
LV first End inspiration = pressure
INCREASED in PS Phypertension VSD
REVERSED AS HCM

S3 = BELL @ apex early diastole
N = kids/young
Pregnancy 
Fever
LVF CCF
MR

S4 = forced contraction, stiff ventricle 
LVH = BP AS HCM