Examination Flashcards
Position of bed
45°
General inspection of patients
Chest wall deformities - Pectus excavatum
sternotomy scar
Lateral thoratocomy scar
Visible pulsation
Prominent venous collaterals
Anemia
Cyanosis
Pyrexia
Pedal edema
Median sternotomy scar Indicates
Previous coronary artery bypass graft
Cardiac bypass
Lateral thoracotomy scar indicates
Previous mitral valvotomy
Hands exam
Clubbing
Cyanosis
Pallor
Splinter hemorrhages
Oslers nodes
Leukonychia
Pulse
Only cardiac cause of clubbing
Infective endocarditis
Signs of infective endocarditis
Vasculitic rash
Splinter hemorrhages
Oslers nodes
Janeway lesions
Roths spots
Evaluation of pulse includes
Rate
Rythm
Character
symmetry
Character of radial pulse
Volume
Waveform
When is pulse volume low
In heart failure
When is pulse volume high
In aortic regurgitation
When is pulse waveform slow rising
Aortic stenosis
In which case is there a pulse waveform rapidly rising which then collapse in early diastole
In aortic regurgitation due to high volume in LV (normal pulmonary venous return + blood back flow ) being ejected
When do you have collapsing pulse
In aortic regurgitation
When do you have alternating pulse high and low systolic
Severe left ventricular failure
In inspiration , blood venous return increases or decreases
Increaes
Pulses to feel in cardiac exam
Radial brachial
Carotid
Femoral
Popliteal
Pedal
Normal upper limit of JVP
4 cm
Kussmauls sign
Paradoxical increase in JVP during inspiration in constrictive pericarditis and tamponade due to inability to accommodate venous return
Type of waveform in JVP
Double waveform
Causes of elevated JVP
Congestive heart failure
Cor pulmonale
Pulmonary embolism
RV infarction
Tricuspid valve dx
Tamponade
Constrictive pericarditis
Hypertrophic/restrictive cardiomyopathy
SVCO
Iatrogenic fluid overload
What is apex beat
Lowest most lateral point at which impulse can be palpated
Characteristics of JVP
Double waveform
Varies with respiration
Varies with posture
Non palpable
Obliterated by pressure
Hepatojugular reflux
Normal location of apex beat
Fifth intercostal
Midclavicular line
When can you have ventricular dilatation
In mitral or aortic regurgitation
When do you have left ventricular hypertrophy
Hypertension
Aortic stenosis
Can LV hypertrophy lead to displacement of apex beat
No
In which case is there an apical double thrust
Palpable 3rd and 4th sounds
Where can you palpate LV aneurysm
Medial to cardiac apex
What do you feel in right ventricular enlargement
Systolic heave in left parasternal
What is a thrill
Turbulent flow leading to palpable vibrations
When do you feel thrills
Aortic stenosis
VSD
Patent ductus arteriosus
What is first heart sound
Mitral and tricuspid valves closure
What is Second heart sound
Aortic and pulmonary valve closure
What sound is characteristics to 3rd and 4th sound
Gallop sound to cardiac rythm
When is S3 normal
Children and young adults
High output states - anemia, pregnancy, thyrotoxicosis
What disease does S3 indicate
LV failure
Mitral regurgitation
Constrictive pericarditis
What causes S4
Hypertension
Aortic stenosis
Hypertrophic cardiomyopathy
When can you hear early systole clicking due to valve opening being loud
Aortic stenosis when pliant and on calcified
When can you hear later systole clicking due to valve opening being loud
Mitral valve prolapse
When can you hear early diastole clicking due to valve opening being loud
Mitral stenosis
Grading of loudness of murmurs
1 -6
1 is barely audible
6 is audible even without stethoscope application
Quality of murmur
Low
Medium
High pitched
