EMQ Flashcards
Slow rising pulse, narrow pulse pressure, heaving apex beat and fourth heart sound?
Aortic Stenosis
Collapsing pulse, wide pulse pressure, ‘pistol-shot’ sound heard over femoral arteries?
Aortic Regurgitation
Other signs include Corrigan’s sign (carotid pulsation), de Musset’s sign (head-nodding) and Quincke’s sign (capillary pulsation in nail bed)
Radiofemoral delay in a patient with hypertension?
Coarctation of aorta
Twice as common in men, involves narrowing of aorta. Look out for Turner’s syndrome 45XO. Also notched ribs on chest radiograph.
Pulsus paradoxus, JVP rises on inspiration, heart sounds muffled.
Cardiac tamponade
Beck’s triad - falling BP, rising JVP on inspiration and muffled heart sounds. Indicative of cardiac tamponade/constrictive pericarditis
Bounding pulse in a patient who is short of breath?
Acute CO2 retention
Bounding pulse also felt in patients with sepsis
Tapping apex beat, loud S1, mid-diastolic murmur loudest at the apex in expiration lying on the left side?
Mitral stenosis. Recognised complication of rheumatic heart disease. Causes pulmonary hypertension and pulmonary valve regurgitation can result in an early diastolic murmur (Graham Steell). May be associated with SOB, chest pain, palpatations and haemoptysis. AF is common and so is Malar flush.
Heaving undisplaced apex beat, absent A2 with ejection systolic murmur radiating to the carotids?
Aortic stenosis. Associated with narrow pulse pressure and absent 2nd heart sound. Symtpoms include angina, SOB and syncope. Surgical correction by valve replacement is warranted by patients symptoms or the pressure gradient against the valve.
Pansystolic murmur heard best at lower left sternal edge during inspiration in a patient with pulsatile hepatomegaly?
Tricuspid regurgitation. Infective endocarditis of the tricuspid valve is a well-recognised cause of tricuspid regurgitation in IV drug users. Giant systolic V waves may be seen in the JVP.
Displaced, volume-overloaded apex. Soft S1, pansystolic murmur at apex radiating to axilla?
Mitral regurgitation. Rheumatic heart disease is common cause. Mitral valve prolapse is a more common cause in UK. MR may also develop acutely with MI, secondary to papillary muscle rupture. LV volume is overloaded, increased left-sided filling pressures and resulting in acute pulmonary odemea and dyspnoea. Rarer causes include connective tissue diseases such as Marfan’s and Ehlers-Danlos syndrome
Left parasternal heave and harsh pansystolic murmur at lower left sternal edge that is also audible at apex?
Ventricular Septal Defect.
A 40 year old woman develops sudden-onset dyspnoea at rest following hip replacement surgery. On examination she is tachycardic and her ECG shows right axis deviation?
PE
