CVS History and Examination

Question 1

Jugular Venous Waveform

Answer 1

• Check for’double’ waveforms (a&v)
• Check for big V waves (tricuspid regurgitation) and cannon waves suggesting AV dissociation.

Question 2

Loud first heart sound

Answer 2

Loud with MS, hyperdynamic circulation (e.g. anaemia and short PR).

Question 3

Second heart sound

Answer 3

Normally split and increased with inspiration, reversed with LBBB and other causes of delayed LV systole.

Question 4

Added heart sounds

Answer 4

Third (mid-diastolic) common in young, pregnant, pathological in MR, LVF

Fourth (pre-systolic); HTN, isch, LVH

Clicks: relatively common, MV prolapse

Question 5

Aortic murmurs

Answer 5

• Many flow murmurs are innocent, particularly in children and pregnancy.
• Aortic sclerosis common in elderly and causes systolic murmur.
• Aortic stenosis commonest cause for valve surgery. Systolic murmur radiating to carotids and best sign of significance is slow carotid upstroke.
• Aortic regurgitation blowing decrescendo diastolic murmur.

Question 6

Mitral murmurs

Answer 6

Mitral incompetent (reguritant) murmur systolic. Classical teaching = pansystolic.

Pheumatic MR like that as is MR due to severe LV dilatation but common causes now are prolapse and papillary muscle dysfunction which cause late systolic murmurs.

Mitral stenosis (now very rare in Tasmania) has a rumbling mid diastolic murmur.

Mitral valve prolapse: systolic click and/or late systolic murmur.

Question 7

Tricuspid valve

Answer 7

Regurgitation best diagnosed by big V waves and pulsatile liver.

Stenosis is virtually never seen.

Question 8

Hypertrophic obstructive cardiomyopathy (HCOM)

Answer 8

Systolic murmur varying with LV volume

Question 9

Ventricular septal defec (VSD)

Answer 9

Loud pansystolic murmur

Question 10

Atrial septal defect (ASD)

Answer 10

Fixed split second sound sometimes soft sysolic murmur.

Question 11

Patent ductus arteriosus (PDA)

Answer 11

Loud continuous ‘machinery’ murmur