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Cardiology > CVS Examination > Flashcards

CVS Examination Flashcards

1
Q

How would the positioning and exposure of patients be for CVS ex?

A
  • 45 d, supported by pillows
  • expose chest, arms and ankles
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2
Q

How would you measure pt BP?

A
  • seated
  • wait 3mins - then standing
  • best to perform at beginning of ex
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3
Q

What is the framework for CVS ex?

A
  1. General inspection
  2. Hands
  3. Pulse - Radial & Brachial
  4. Neck
  5. Face
  6. Inspect precordium
  7. Palpate precordium
  8. Auscultate precordium
  9. Auscultate neck
  10. Lung bases
  11. Abdomen
  12. Lower limb pulses
  13. Oedema
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4
Q

What are the key things to look for in general inspection?

A
  • SOB
  • cyanotic
  • overweight/cachectic
  • Turners, Down’s, Marfan
  • Surgical scars
  • Surrounding equipments
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5
Q
A
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6
Q

What are the type of surgical scars found on the thorax?

A
  • Mid-sternotomy
    • CABG
  • Ant. thoracotomy
    • lung biopsy, pericardial surgery
  • Posterolateral thoracotomy
    • non cardiothoracic related
  • Clamshell (bilateral subpectoral)
    • lung transplant
  • Left subclavicular
    • pacemaker
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7
Q

What are the common heart abnormalities in downs?

A
  • Atrioventricular septal defect
  • Ventricular septal defect
  • Persistent ductus arteriousus
  • Tetrallogy of fallot
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8
Q

What are the common heart abnormalities in Turners?

A
  • Bicuspid aortic valve
  • Coarctation of aorta
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9
Q

What are the common heart abnormalities in Marfans?

A
  • abnormal valves
    • Aortic/mitral regurgitation
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10
Q

What are the key things to examine the hands?

A
  • Temperature - cold = CHF
  • Sweat
  • Nails
    • blue discolouration
    • splinter haemorrhage
  • Finger clubbing - endocarditis, cyanotic congenital heart disease
  • Xanthoma
  • Osler nodes
  • Janeway lesions
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11
Q

What are the key things when feeling for pulses?

A
  • Rate: 15s x 4
  • Rhythm
    • irregularly irregular: AF
    • regularly irregular: ectopic beat, mobitz type 1
  • Character
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12
Q

What are the types of abnormal character felt on the pulse?

A
  • Aortic stenosis
    • slow-rising pulse
  • Aortic regurgitation
    • Collapsing pulse
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13
Q

What are the key things to examine on pt neck?

A
  • Carotid pulse
  • JVP - IJV (anterior to SMC)
  • V-wave - tricuspid regurgitation
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14
Q

How would you calculate the JVP?

A
  • 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
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15
Q

What is the hepatojugular reflex?

A
  • exert pressure on liver with flat right hand
  • JVP raise by 2cm
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16
Q

What are the wave features of JVP?

A
  • a wave: atrial contraction
  • c wave: ventricular contraction
  • x descent: atrial relaxation
  • v wave: atrial filling
  • y decent: ventricular filling, tricuspid valve open
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17
Q

What are the abnormalities found on JVP?

A
  • 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
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18
Q

What key features too look for on the face?

A
  • pale conjuctiva, corneal arcus, jaundice
  • xanthelesma
  • mitral facies - MS
  • cyanosis - bluish discolouration of lips and tongue
  • high arched palate - Marfans
  • dental hygiene
19
Q

What are the key things to do for precordium palpation?

A
  • Apex beat @ 5th ICS, MCL
  • Heave @ L sternal edge
  • Thrill @ all the valves
20
Q

What are the abnormal apex beats indicating?

A
  • Laterally displaced: Enlarged heart
  • Absent beat
    • fat padding, emphysematous lung, dextrocardia
21
Q
A
22
Q

What does a heave indicate?

A
  • Dilated/hypertrophied ventricular chamber
  • LV heave: hands flat across heart (diagonal position)
  • RV heave: hands flat at L sternal region (vertical position)
23
Q

What does a thrill indicate?

A
  • Systolic
    • aortic stenosis
    • VSD
    • mitral regurgitation
  • Diastolic
    • MS
24
Q

What are the key things to do when auscultating the precordium?

A
  • Hear heart sounds
    • place stethoscope on each valve
    • hear S1, S2, (S3, S4)
  • Listen for murmurs
  • Listen for extra sounds
25
Q

Where is best to hear S1 and describe the types of abnormalities exist

A
  • @ Mitral valve
  • Loud: MS, Tachycardia
  • Soft: LBB, AS, AR
  • Variable: AF, Complete HB
26
Q

Where is best to hear S2 and describe the types of abnormalities exist

A
  • @ aortic valve
  • Loud: HTN, congenital AS, Pulmonary HTN
  • Soft: AS, AR
27
Q

What are the causes of 3rd heart sounds?

A
  • Physiological
    • normal in children and adults up to 30
  • Pathological
    • dilated cardiomyopathy
    • AR
    • MR
28
Q

What are the causes of 4th heart sounds?

A

Inc. stiffness of ventricular myocardium

  • hypertrophic cardiomyopathy
  • HTN
29
Q

What are the different types of Systolic murmurs?

Describe the and list what causes them?

A
  • 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
30
Q

What are the different types of diastolic murmurs?

Describe them and list what causes them?

A
  • Early
    • backflow through incompetent A/P valves
    • A/P R
  • Mid-diastolic
    • flow through narrow M/T valves
    • M/T S
31
Q

What is a continuous murmur and what causes it?

A
  • heard throughout systole and diastole
  • PDA, arteriovenous fistula
32
Q

Why are R sided murmurs louder during inspiration and quieter during expiration?

A
  1. On inspiration, diaphragm flattens, intrathoracic pressure decrease
  2. Change in pressure transmitted across walls of heart
  3. R atrial pressure dec.
  4. Inc. venous return
33
Q

Why is L-sided murmurs louder during expiration?

A
  1. On expiration, intrathoracic cavity increases
  2. Pulmonary blood vessels shrink, more blood pump from pulmonary veins into L Atrium
  3. Inc. in stroke volume
34
Q

What are the types of extra sounds?

A
  • Pericardial rub
    • inflammed pericardial membranes
      • Coxsakie A,B, Influenza
  • Metallic valves
    • click sounds
35
Q

What key things will you examine the abdomen for?

A
  • Hepatomegaly
  • Splenomegaly
  • Ascites
  • AAA
  • Renal bruits
  • Enlarged kidneys
36
Q

What key things will you examine for oedema?

A
  • Ankles and sacrum
  • Pitting/non pitting oedema
  • note the extend of oedema
37
Q

What are the 6 diffferent types of mumurs?

A
  • Ejection systolic
  • Pansystolic
  • Late systolic
  • Early diastolic
  • Mid-late diastolic
  • Continuous machine like murmur
38
Q

What causes Ejection systolic murmur?

*remember louder on expiration and lourder on inspiration

A
  • Louder on expiration
    • aortic stenosis
    • hypertrophic obstructive cardiomyopathy
  • Louder on inspiration
    • pulmonary stenosis
    • atrial septal defect
  • Tetralogy of fallot
39
Q

What causes pan-systolic murmur?

A
  • 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)
40
Q

What causes late systolic murmur?

A
  • mitral valve prolapse
  • coarctation of aorta
41
Q

What causes early diastolic murmur?

A
  • aortic regurgitation (high-pitched and ‘blowing’ in character)
  • Graham-Steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character)
42
Q

What causes mid-late diastolic murmur?

A
  • mitral stenosis (‘rumbling’ in character)
  • Austin-Flint murmur (severe aortic regurgitation, again is ‘rumbling’ in character)
43
Q

What causes continuous machine like murmur?

A
  • PDA

Cardiology (15 decks)

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