Examination of the cardiovascular system

Question 1

What are the cardiovascular causes of clubbing?

Answer 1

• Congenital cyanotic heart disease, in particular Fallot’s tetralogy
• Infective endocarditis

Question 2

What are the CV causes of splinter haemorrhages?

Answer 2

• Trauma

* Infective endocarditis

Question 3

What causes central cyanosis?

Answer 3

• Shunting of deoxygenated venous blood into the systemic circulation
• right-to-left heart shunt

Question 4

What causes peripheral cyanosis?

Answer 4

• Peripheral vasoconstriction and stasis of blood in extremities lead to increased peripheral oxygen extraction
• Conditions causing it are: congestive heart failure / circulatory shock / exposure to cold / Raynaud’s

Question 5

What is the first pulse to be examined?

Answer 5

• right radial pulse

Question 6

What is the cause of a delayed femoral pulsation?

Answer 6

• Proximal stenosis, particularly aortic coarctation

Question 7

What should be the pulse rate of an adult potion lying in bed?

Answer 7

• 60-80 beats/min

Question 8

What is a normal physiological change in rhythm during inspiration and expiration? What is it called?

Answer 8

• Slight quickening in early inspiration
• Slight slowing in expiration
• Sinus arrhythmia

Question 9

What two signs can be found when assessing the rhythm of the pulse?

Answer 9

• Premature beats

* Atrial fibrillation - irregularly irregular pulse

Question 10

What signs can be found when assessing the character of the pulse?

Answer 10

• Carotid pulsations
• Collapsing pulse
• Small-volume pulse
• Plateau pulse
• Alternating pulse
• Bigeminal pulse
• Pulsus bisferiens
• Dicrotic pulse
• Paradoxical pulse

Question 11

What causes an elevated JVP?

Answer 11

• Heart failure
• Constrictive pericarditis
• Cardiac tamponade
• Renal disease with salt and water retention
• Over-transfusion or excessive infusion of fluids
• Congestive cardiac failure
• SVC obstruction

Question 12

What will causes a displacement of the apex beat?

Answer 12

• Left ventricular dilation

Question 13

What conditions may stop the apex beat being palpated?

Answer 13

• Emphysema
• Obesity
• Pericardial or pleural effusions

Question 14

What types of abnormal apex beat may be palpated and what conditions cause them?

Answer 14

• A tapping apex - mitral stenosis
• A vigorous apex - aortic regurgitation (diseases with volume overload
• A heaving apex - aortic stenosis / systemic hypertension / hypertrophic cardiomyopathy
• A double pulsation - hypertrophic cardiomyopathy
• A sustained left parasternal heave - right ventricular hypertrophy or left atrial enlargement
• A palpable thrill - aortic stenosis

Question 15

How can you make left-sided and right-sided valve murmurs more prominent?

Answer 15

• Left-sided are more prominent on expiration

* Right-sided are more prominent on inspiration

Question 16

How can a mitral murmur be made to be more prominent on auscultation?

Answer 16

• Patient reclining to the left

Question 17

What is the first heart sound?

Answer 17

•Mitral and tricuspid valve closure

Question 18

What causes a loud S1?

Answer 18

• Being thin
• Hyperdynamic circulation
• Tachycardias
• Mild-moderate mitral stenosis

Question 19

What causes a soft S1?

Answer 19

• Obesity
• Emphysema
• Pericardial effusion
• Severe calcific mitral stenosis
• Mitral or tricuspid regurgitation
• Heart failure
• Shock
• Bradycardias
• First-degree block

Question 20

What is the second heart sound?

Answer 20

• Aortic and pulmonary valve closure

Question 21

What are the pathological third and fourth heart sounds? How do they effect the rhythm?

Answer 21

• Third: rapid ventricular filling (present in heart failure)
• Fourth: occurs in late diastole and is associated with atrial contraction
• Produce a gallop rhythm

Question 22

What are heart murmurs and when do they occur?

Answer 22

• Turbulent blood flow

* In hyper dynamic states or with abnormal valves