CVS Exam Signs Flashcards
Give 2 cardiovascular causes of clubbing
- Cyanotic congenital heart conditions
- Endocarditis
What are Janeway lesions and Osler’s nodes?
Microvascular infarctions caused by septic emnboli
Where would you see Janeway lesions? Are they painful?
- On palms
- Painless
Where would you see Osler’s nodes?
Are they painful?
- On pad of fingers
- Painful
Give 3 hand signs of infective endocarditis
- Osler’s nodes
- Janeway lesions
- Splinter haemorrhages
What would be a cause of a regularly irregular pulse?
Heart block
What would be the rate and rhythm in AF?
- Tachycardic
- Irregularly irregular
What is the character of the pulse in:
- Aortic stenosis
- Aortic regurg
- Stenosis - slow rising
- Regurg - collapsing
What is JVP a measure of?
Which vein are you looking at?
Right atrial pressure
Internal jugular vein
What affects JVP apart from RA pressure (2 factors)?
- Fluid status
- Contractility
How is JVP measured?
Height above sternal angle, plus 5cm, as RA is 5cm below sternal angle
What is normal JVP?
Less than 3cm (8cm in total)
Give 4 causes of a raised JVP
- RV failure
- Cardiac tamponade
- SVC obstruction
- Fluid overload
How would distinguish whether you were seeing the JVP or the carotid pulse?
- Carotid - palpable
- JVP - non-palpable, obliterated by compression
What is hepatojugular reflux?
Phenomenon whereby firm pressure to RUQ causes transient rise in JVP
If persists - RV dysfunction
What is malar flush a sign of?
Why does it occur?
Mitral stenosis
CO2 retention results in vasodilatation
What is a thrill?
A palpable murmur
What is a heave?
What does it signify?
Sustained forceful pulsation
RV hypertrophy
What is a murmur?
Extra/abnormal sound during the heartbeat cycle, caused by turbulent blood flow
What are the two major causes of murmur?
- Valvular stenosis
- Valvular incompetence resulting in regurgitation
Describe the normal heart sounds in terms of character and what they signify
S1 - crescendo-decrescendo - A-V valves closing - beginning of systole
S2 - shorter duration, higher frequency - outflow valves closing - end of ventricular systole
When timing a murmur with the carotids, what does the carotid pulse equate with?
- Pulse = ventricular systole - S1
Where would you best hear a murmur of mitral stenosis?
- In apex, with bell, when patient rolled to left - held expiration
Which murmur is best heard over the carotids?
Aortic stenosis
Which murmur are you listening for if you lean the patient forward in held expiration, and listen over the 5th ICS, left sternal edge?
Aortic regurgitation
How would you listen best for mitral regurgitation?
Over axilla
You hear a murmur over the apex when the patient is rolled to the left.
What is the likely diagnosis?
When would you hear the murmur?
Mitral stenosis
Mid-diastolic
You identify a pansystolic murmur. What is the likely diagnosis?
Where would you best hear it?
Mitral regurgitation
Over axilla
Which condition causes an ejection systolic murmur?
Aortic stenosis
When and where would you best hear a murmur of aortic regurgitation?
- Early diastolic
- Leaning forward, 5th ICS, left sternal edge, held expiration
What would cause a continuous murmur?
Patent ductus arteriosus
If you identified basal lung crepitations but no peripheral oedema, which side is the heart failure?
Left
Would you be more likely to get peripheral or pulmonary oedema in RHF?
Peripheral
Where would you palpate for the dorsalis pedis pulse?
What about posterior tibial?
- Dorsalis pedis - between flexor hallucis longus and flexor digitorum longus tendons
- Posterior tibial - posterior to medial malleolus
