CVS examination Flashcards
CVS causes of clubbing are (3)
Infective endocarditis Cyanotic congenital heart disease Atrial Myxoma (benign tumour)
What are the 4 causes of Radio-radio (femoral) delay
Aortic coarctation
Aortic dissection
Aortic embolism
Cervical rib (just R-R)
When assessing character of pulse, a … is indicative of aortic stenosis
slow rising
When assessing character of pulse, a bisferious pulse feels like what
A double peak per cardiac cycle (translates as ‘striking twice’)
What does a Bisferious pulse character indicate
Mixed AR and AS
A … pulse pressure indicates AR
wide
A … pulse pressure indicates AS
Narrow
… can present with … and looks like flushing of cheeks with labial sparing
Mitral Stenosis … Malar flush
What does corrigans sign look like
Ear movement or head nodding as a result of powerful carotid pulsation
Corrigans sign is caused by …
Aortic regurgitation
How can you exacerbate JVP
Hepatojugualr reflex (ask if in pain)
Persistent elevation of JVP after pressing in RUQ indicates ….
RHF
Volume overload
…. and …. surgery will be visible as midline sternotomy scars
CABG
Valve replacement
A left submammary scar would indicate
Mitral valve replacement
Pericardial window
When is a pericardial window done
Pericardial effusion, fluid drains into pleural cavity where it is not dangerous.
What 3 types of character can you assess for when feeling the apex beat?
Thrusting
Heaving
Tapping
A thrusting apex beat indicates (3)
AR
MR
LVF
A heaving apex beat = LVH, which indicates what (4)
HOCM (hypertrophic cardiomyopathy)
Aortic stenosis
Hypertension
Aortic coarctation
A Tapping apex beat indicates what one thing
MS
What minimum grade of murmur can be found as a thrill
grade 4 and above
What would a left parasternal heave indicate
RVH
Lung crepitations would indicate … sided heart failure
Left
When auscultating where MUST your left hand be?
palpating carotid pulse
… radiates to axilla
MR
All RIGHT sided murmurs can be made louder by
inspiration (lower intrathoracic pressure increases venous return)
Mitral and Aortic murmurs can be made louder by asking the patient to …
hold their breath on expiration (increased pressure)
To increase the volume of the MS diastolic murmur you would ask the patient to move … and hold their breath on …. whilst listening with the … of stethoscope
Roll onto LHS
expiration
bell
How would you amplify AS (2)
sit forward
Hold breath on expiration
How would you better differentiate between a CABG and valve replacement scar.
Is there an accompanying leg scar
Central cyanosis will present with … feeling hands (unless severe) and blue lips/tongue.
warm
What 3 things might causes central cyanosis
Hypoxic lung disease
R-L cardiac shunt
Methaemoglobinaemia
What are the 2 causes of R-L cardiac shunt
Cyanotic congenital heart disease
Eisenmengers syndrome
∆∆ for atrial fibrillation (3)
AF
VEBs (ventricular ectopic beats - disappear on exercise)
Complete heart block + ventricular escape
The 6 important causes of atrial fibrillation are remembered by the mneumonic PPARTI . What are the first 3
PE
Pneumonia
Alcohol
The 6 important causes of atrial fibrillation are remembered by the mneumonic PPART. What are the last 3
Rheumatic heart disease
Thyrotoxicosis
Ischaemic heart disease
An abnormally large decrease in pulse wave amplitude and BP during inspiration despite the heart being heard on auscultation is called a …
Pulsus paradoxus
In pulsus paradoxus key thing to remember is that it is due to a decreased ability of the heart to contract when pressure increases e.g. during inspiration. Knowing this, what are the 4 main causes (4)
Severe obstructive lung disease
Tamponade
Restrictive cardiomyopathy
Constrictitive pericarditis
same as Kussmauls except for SOLD
Describe Kussmauls signs
Increased JVP on inspiration
What is physiologically causes Kussmauls sign
impaired RV filling
What are the causes of Kussmauls sign
Tamponade
Constrictive pericarditis
Restricitve cardiomyopathy
same as pulsus paradoxus
there are 5 logical causes of an impalpable apex beat
Fat Fluid (pericardal/pulm. effusion) Air (pneumothorax) Displaced (LHF) Dextrocardia
An elevated JVP can be caused by (4)
Constrictive pericarditis
PE
RHF
Volume overload
Continued elevated JVP can only be caused by one thing
SVC obstruction
A decreased BP with an increased JVP can be caused by 3 things
Massive PE
Tamponade
T pneumothorax
