CVS Examination Flashcards
How would the positioning and exposure of patients be for CVS ex?
- 45 d, supported by pillows
- expose chest, arms and ankles
How would you measure pt BP?
- seated
- wait 3mins - then standing
- best to perform at beginning of ex
What is the framework for CVS ex?
- General inspection
- Hands
- Pulse - Radial & Brachial
- Neck
- Face
- Inspect precordium
- Palpate precordium
- Auscultate precordium
- Auscultate neck
- Lung bases
- Abdomen
- Lower limb pulses
- Oedema
What are the key things to look for in general inspection?
- SOB
- cyanotic
- overweight/cachectic
- Turners, Down’s, Marfan
- Surgical scars
- Surrounding equipments
What are the type of surgical scars found on the thorax?
- Mid-sternotomy
- CABG
- Ant. thoracotomy
- lung biopsy, pericardial surgery
- Posterolateral thoracotomy
- non cardiothoracic related
- Clamshell (bilateral subpectoral)
- lung transplant
- Left subclavicular
- pacemaker
What are the common heart abnormalities in downs?
- Atrioventricular septal defect
- Ventricular septal defect
- Persistent ductus arteriousus
- Tetrallogy of fallot
What are the common heart abnormalities in Turners?
- Bicuspid aortic valve
- Coarctation of aorta
What are the common heart abnormalities in Marfans?
- abnormal valves
- Aortic/mitral regurgitation
What are the key things to examine the hands?
- Temperature - cold = CHF
- Sweat
- Nails
- blue discolouration
- splinter haemorrhage
- Finger clubbing - endocarditis, cyanotic congenital heart disease
- Xanthoma
- Osler nodes
- Janeway lesions
What are the key things when feeling for pulses?
- Rate: 15s x 4
- Rhythm
- irregularly irregular: AF
- regularly irregular: ectopic beat, mobitz type 1
- Character
What are the types of abnormal character felt on the pulse?
- Aortic stenosis
- slow-rising pulse
- Aortic regurgitation
- Collapsing pulse
What are the key things to examine on pt neck?
- Carotid pulse
- JVP - IJV (anterior to SMC)
- V-wave - tricuspid regurgitation
How would you calculate the JVP?
- centre of R atrium is 5cm below sternal angle
- normal JVP is 8cm of blood, which is 3cm above sternal angle
- JVP = vertical distance from sternal border to upper border of pulsation + 5cm
What is the hepatojugular reflex?
- exert pressure on liver with flat right hand
- JVP raise by 2cm
What are the wave features of JVP?
- a wave: atrial contraction
- c wave: ventricular contraction
- x descent: atrial relaxation
- v wave: atrial filling
- y decent: ventricular filling, tricuspid valve open
What are the abnormalities found on JVP?
- Raised JVP
- RVF, TS, SVCO, PE
- Large a waves
- pulmonary stenosis, TS
- absent a wave
- AF
- large v waves
- TR
- sharp x descent
- cardiac tamponade
- sharp y descent
- contrictive pericarditis
What key features too look for on the face?
- pale conjuctiva, corneal arcus, jaundice
- xanthelesma
- mitral facies - MS
- cyanosis - bluish discolouration of lips and tongue
- high arched palate - Marfans
- dental hygiene
What are the key things to do for precordium palpation?
- Apex beat @ 5th ICS, MCL
- Heave @ L sternal edge
- Thrill @ all the valves
What are the abnormal apex beats indicating?
- Laterally displaced: Enlarged heart
- Absent beat
- fat padding, emphysematous lung, dextrocardia
What does a heave indicate?
- Dilated/hypertrophied ventricular chamber
- LV heave: hands flat across heart (diagonal position)
- RV heave: hands flat at L sternal region (vertical position)
What does a thrill indicate?
- Systolic
- aortic stenosis
- VSD
- mitral regurgitation
- Diastolic
- MS
What are the key things to do when auscultating the precordium?
- Hear heart sounds
- place stethoscope on each valve
- hear S1, S2, (S3, S4)
- Listen for murmurs
- Listen for extra sounds
Where is best to hear S1 and describe the types of abnormalities exist
- @ Mitral valve
- Loud: MS, Tachycardia
- Soft: LBB, AS, AR
- Variable: AF, Complete HB
Where is best to hear S2 and describe the types of abnormalities exist
- @ aortic valve
- Loud: HTN, congenital AS, Pulmonary HTN
- Soft: AS, AR
What are the causes of 3rd heart sounds?
- Physiological
- normal in children and adults up to 30
- Pathological
- dilated cardiomyopathy
- AR
- MR
What are the causes of 4th heart sounds?
Inc. stiffness of ventricular myocardium
- hypertrophic cardiomyopathy
- HTN
What are the different types of Systolic murmurs?
Describe the and list what causes them?
- Pansystolic
- murmur that last throughout systole
- TR / MR
- Ejection systolic
- crescendo and decrscendo
- PS, AS
- Late systolic
- audible gap between S1 and start of murmur
- TR / MR through prolapsing valve
What are the different types of diastolic murmurs?
Describe them and list what causes them?
- Early
- backflow through incompetent A/P valves
- A/P R
- Mid-diastolic
- flow through narrow M/T valves
- M/T S
What is a continuous murmur and what causes it?
- heard throughout systole and diastole
- PDA, arteriovenous fistula
Why are R sided murmurs louder during inspiration and quieter during expiration?
- On inspiration, diaphragm flattens, intrathoracic pressure decrease
- Change in pressure transmitted across walls of heart
- R atrial pressure dec.
- Inc. venous return
Why is L-sided murmurs louder during expiration?
- On expiration, intrathoracic cavity increases
- Pulmonary blood vessels shrink, more blood pump from pulmonary veins into L Atrium
- Inc. in stroke volume
What are the types of extra sounds?
- Pericardial rub
- inflammed pericardial membranes
- Coxsakie A,B, Influenza
- inflammed pericardial membranes
- Metallic valves
- click sounds
What key things will you examine the abdomen for?
- Hepatomegaly
- Splenomegaly
- Ascites
- AAA
- Renal bruits
- Enlarged kidneys
What key things will you examine for oedema?
- Ankles and sacrum
- Pitting/non pitting oedema
- note the extend of oedema
What are the 6 diffferent types of mumurs?
- Ejection systolic
- Pansystolic
- Late systolic
- Early diastolic
- Mid-late diastolic
- Continuous machine like murmur
What causes Ejection systolic murmur?
*remember louder on expiration and lourder on inspiration
- Louder on expiration
- aortic stenosis
- hypertrophic obstructive cardiomyopathy
- Louder on inspiration
- pulmonary stenosis
- atrial septal defect
- Tetralogy of fallot
What causes pan-systolic murmur?
-
mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)
- tricuspid regurgitation becomes louder during inspiration, unlike mitral stenosis
- during inspiration, the venous blood flow into the right atrium and ventricle are increased → increases the stroke volume of the right ventricle during systole
- ventricular septal defect (‘harsh’ in character)
What causes late systolic murmur?
- mitral valve prolapse
- coarctation of aorta
What causes early diastolic murmur?
- aortic regurgitation (high-pitched and ‘blowing’ in character)
- Graham-Steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character)
What causes mid-late diastolic murmur?
- mitral stenosis (‘rumbling’ in character)
- Austin-Flint murmur (severe aortic regurgitation, again is ‘rumbling’ in character)
What causes continuous machine like murmur?
- PDA
