CVS PE Flashcards
Indicates presence of central R to L shunting
Clubbing
Unopposable, “fingerized” thumb
Holt-Oram Syndrome
Arachnodactyly and positive wrist and thumb
Marfan Syndrome
Posterior calf pain on active DORSIFLEXION of the foot against resistance
Homan’s Sign
Caused by R to L shunting at the level of the heart or lungs and seen in tongue or lips
Central cyanosis
Related to ↓ extremity blood flow due to small vessel constriction and can be seen in patients with severe heart failure, shock and peripheral vascular disease
Peripheral cyanosis (Acrocyanosis)
Also seen in patients with advanced mitral stenosis or scleroderma
Malar telangiectasia
High-arched palate
Marfan syndrome
Bifid uvula
Loeys-Diets syndrome
Orange tonsils
Tangier disease
Hypertelorism, low set ears, micrognathia
Congenital Heart Disease
Blue sclerae
Osteogenesis Imperfecta
SYSTOLIC pulsations over the LIVER signify
severe tricuspid regurgitation
whhyyyy
The single most important bedside measurement from which to estimate the volume status
Jugular Venous Pressure
Venous waveform that signifies atrial CONTRACTION
a wave
Seen in px with reduced right ventricular compliance
prominent a wave
Seen in px with AV dissociation and RA contraction against a closed tricuspid valve
cannon a wave
Venous waveform that signifies atrial RELAXATION
x descent
Venous waveform that occurs when closed tricuspid valve is pushed into the RA during early right ventricular systole
c wave
Venous waveform that signifies atrial FILLING (atrial diastole)
v wave
Venous waveform that signifies venous EMPTYING
y descent
Rise or lack of fall of the JVP with inspiration
Kussmaul’s sign
Very low (even 0 mmHg) diastolic pressure is seen in px with
chronic severe aortic regurgitation
large arteriovenous fistula
large a wave
tricuspid stenosis
pulmonary stenosis
pulmonary hypertension
cannon wave
complete heart block
VVI pacing
ventricular tachycardia
steep “x”, “y” descent
constrictive pericarditis
cardiac tamponade
large “v” wave, “cv” wave
tricuspid regurgitation
White coat HPN
Defined by:
at least 3 separate clinic based measurement >140/90 mmHg
AND
at least 2 non-clinic based measurements <140/90 mmHg in the absence of any evidence of target organ damage
Masked HPN
Suspected when normal or even low blood pressures are recorded in patients with advanced atherosclerotic disease especially when evidence of target organ damage is present or bruits are available
Orthostatic hypertension
This is defined by a FALL in systolic pressure >20mmHg and diastolic pressure >10 mmHg in response to assumption of the upright posture from a supine position within 3 min
Performed routinely before instrumentation of the radial artery
Allen’s Test
Pulsus magnus
Pulse that is STRONG and BOUNDING
Pulsus parvus
Pulse that is THREADY
Pulvus Parvus et Tardus
Pulse that is WEAK and DELAYED
seen in SEVERE AORTIC STENOSIS
Corrigan’s or water-hammer pulse
Carotid upstroke that has sharp rise and rapid fall off
CHRONIC SEVERE AORTIC REGURGITATION
Hypertrophic Obstructive Cardiomyopathy (HCOM)
With BIFID pulse and inscription of percussion and tidal wave
Coincides with the closure of mitral and tricuspid valves and best heard at the apex–
1st Heart Sound (S1)
Coincides with the closure of aortic and pulmonic valves and best heart at the base
2nd Heart Sound (S2)
Aortic area
2nd ICS at the right sternal border
Pulmonic area
2nd ICS at the left sternal border
Tricuspid area
Between 3rd to 5th ICS at the left sternal border
Mitral area
Near the apex of the heart at the 5th ICS at the left midclavicular line
Murmur that coincides with carotid upstroke
Systolic murmur
Begins after S1 and ends before S2
Midsystolic murmur
Starts with S1 and stops at S2
Pansystolic (Holosystolic) murmur
Usually starts in mid or late systole and persists up to S2
Late systolic murmur
Wide splitting
RBBB
severe MR
Unusual narrow split or singular S2
pulmonary arterial HPN
Fixed splitting
secundum ASD
Reversed or paradoxical splitting
LBBB right ventricular pacing severe AS HOCM acute Mi
Tricuspid Regurgitation
Early systolic murmur that increases in intensity with inspiration (Carvallo sign) –
Tricuspid regurgitation
Systolic murmur at the 4th ICS left parasternal border which increased on inspiration
Midsystolic ejection murmur
Aortic stenosis (AS) or pulmonic stenosis (PS)
Systolic click with mid-to-late systolic murmur
mitral valve prolapse
Holosystolic murmur
ventricular septal defect, chronic MR or TR
This murmur always signify structural heart disease
Diastolic murmur
Soft, early diastolic murmur
acute severe aortic regurgitation
Decrescendo, blowing diastolic murmur
chronic severe aortic regurgitation
Mid-late diastolic murmur/rumble with OPENING SNAP
Mitral stenosis
Begins in systole and extends into all part of diastole
Continuous murmur
Austin Flint murmur
Low-pitched mid-to-late apical diastolic murmur of chronic severe AR
Graham Steel Murmur
High-pitched, decrescendo diastolic blowing murmur along the left sternal border heard in PULMONIC REGURGITATION secondary to dilatation of the RV outflow tract
100 % specific for diagnosis of acute pericarditis
Pericardial Friction Rub
High-pitched diastolic sound in constrictive pericarditis produced by the abrupt halt in early ventricular filling
Pericardial Knock
Lower-pitched diastolic sound in atrial myxoma caused by prolapse of the mass through mitral orifice
Tumor Plop