examination of the cardiovascular system Flashcards
what is a malar flush a sign of? (a reddish/blueish tinge over cheekbones)
mitral valve disease which often follows rheumatic fever
what is a butterfly rash caused by?
SLE (systemic lupus erythematosus)
what would you look for in the eyes?
anaemia under the eyelids, corneal arcus (ring around the cornea caused by high blood lipids), Xanthelasmata (LDL deposits in the eyelids)
what would you look for in the fingernails?
koilonychia (spoon shaped nails caused by iron deficient anaemia); clubbing (caused by heart and lung conditions that reduce the oxygen in the blood), painter haemorrhages (caused by infective endocarditis); osler’s nodes (bacterial endocarditis)
Which condition is cause by the following signs and symptoms?:
fever (low grade and intermittent); heart murmurs; splinter hemorrages, osler nodes, laneway lesions, roth spots
infective endocarditis
which one (osler nodes or laneway lesions) are tender?
osler nodes
which one (osler nodes or laneway lesions) are indicative of acute rather than subacute infective endocarditis?
laneway lesions
what does the histology of laneway lesions usually confirm?
septic micro emboli
what is the cause of laneway lesions?
septic microemboli
what is the cause of osler nodes?
vasculitis
what is a ‘roth spot’?
a red spot caused by haemorrhage found in the retina with a white centre (fibrin-platelet plug)
what is a zanthelasma a sign of?
a cutaneous marker of underlying atherosclerosis and increased level of serum cholesterol and LDL cholesterol
what does a REGULARLY irregular heartbeat indicate?
an ectopic heart beat (occasionally irregular)
what does an IREGULARLY irregular heartbeat indicate?
atrial fibrillation
what is a ‘water hammer pulse’ the sign of?
aortic regurgitation
what does a an elevated jugular venous pressure indicate?
an elevated right atrial pressure
where is the apex beat felt?
at the 5th intercostal space in the mid clavicular line
where on the chest would ‘heaves’ be felt?
on the left sternal edge (sign of right ventricular enlargement)
where on the chest would ‘thrills’ be felt?
on the apex and sternal notch
what are the 4 places on the chest which are listened to for abnormalities?
aortic valve (2nd right intercostal space), pulmonary valve (2nd left intercostal space), tricuspid valve (lower left sternal border) and mitral (apex)
what murmur may be heard at the apex of the chest?
early diastolic murmurs of mitral stenosis
what may be heard at the lower left border of the sternum?
early diastolic murmurs of aortic and tricuspid regurgitation
what sounds may be heard at the left 2nd intercostal space?
mitral stenosis, pulmonary valve murmurs
what sounds may be heard at the right 2nd intercostal space?
systolic ejection sounds (e.g. aortic stenosis, hypertrophic obstructive cardiomyopathy)
what type of murmur may be heard at the left axilla?
mitral regurgitation
what murmur may be heard just below the left clavicle?
continuous ‘machinery’ murmur of a persistent patent ductus arteriosus
what is a grade 3 murmur?
easily heard but no thrill
what is a grade 1 murmur?
heard by an expert in optimum conditions
what is a grade 2 murmur?
heard by a non-expert in optimum conditions
what is a grade 6 murmur?
extremely loud heard without stethescope
what is a grade 4 murmur?
a loud murmur with a thrill
what is a grade 5 murmur?
very loud, often heard over a wide area with a thrill
how would you accentuate a diastolic murmur of mitral stenosis?
bell at apex in expiration in left lateral position
how would you accentuate a systolic murmur of mitral regurgitation?
at left axilla (with diaphragm of stethoscope)
how would you accentuate a diastolic murmur of aortic regurgitation?
at lower left sternal edge with patient sat forwards
how would you accentuate a murmur of aortic stenosis?
over carotids with diaphragm in held inspiration
