General diagnosis - Cardiovascular exam Flashcards
Aneurysm of the arch of the aorta
vascular surgeon referral
- bovine cough and tracheal tug
- dilation of the arch of the aorta
- associated with: atherosclerosis, HTN, Marfan’s syndrome, tertiary syphilis
- chest xray: widening of the S. mediastinum
- CT confirms aneurysm
Aortic imcompetence
cardiologist referral
- titubation, diastolic murmur (2nd right intercostal space near sternum)
- valvular heart disease
- associated w/: rheumatic fever,marfan’s syndrome, syphilitic aortitis
- ECHOcardiography confirms Dx
Aortic stenosis
cardiologist referral
- angina, systolic murmur (2nd right intercostal space parasternally)
- valvular heart disease often caused rheumatic fever
- ECHOcardiography confirms Dx
Bacterial endocardidtis
hospital referral
- fatigue, fever, harsh murmur (tricuspid valve MC affected)
- valvular heart disease seen with intravenous drug users (staphylococcus aureus)
- blood cultures grow offending organism
Cardiac tamponade
hospital referral
Beck’s triad: distant heart sounds, high jugular venous pressure, hypotension
- compression of the heart by fluid/blood w/in pericardial sac (infection or traumatic)
- ECHOcardiography confirms Dx
Coarctation of the aorta
vascular surgeon referral
- HTN in upper limbs and delayed radiofemoral pulse
- congenital narrowing of the aorta beyond left subclavian aa.
- CT confirms Dx
Fallot’s tetralogy
pediatric cardiologist referral
- failure to thrive d/t poor feeding, cyanosis, clubbing of the fingers and loud pansystolic murmur herd (3rd left intercostal space parasternally)
- MC cyanotic congenital heart disease (pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect)
- chest xray: boot-shaped heart
Hyperthyroidism
Co-manage with enocrinologyist
- goiter, tachycardia, diarrhea, BL exophthalmos (in graves disease), unblinking stare, fine physiological tremor of outstretched hands — older pts present with atrial fibrillation-irregularly irregular pulse.
- overactive thyroid gland with excess production of thyroxin
- elevated T3 and T4 with a low TSH in primary hyerthyroidism
Mitral incompetence
cardiologist referral
- pansystolic murmur (5th left intercostal space, midclavicular line)
- valvular heart disease often caused by rheumatic fever
- ECHOcardiography confirms Dx
Mitral stenosis
cardiologist referral
- malar flush, diastolic murmur with an opening snap (5th left intercostal space, midclavicular line)
- valvular heart disease often caused by rheumatic fever
Mitral valve prolapse
cardiologist referral
- atypical chest pain, mid-systolic click (5th left intercostal space, midclavicular line)
- valvular heart disease (idiopathic), associated w/ marfan’s syndrome
- echography confirms Dx and severity of prolapse
Pulmonary embolism
911
sudden onset of dyspnea, pleuritic chest pain, hemoptysis
- breakaway clot from DVT causing obstruction of pulmonary aa. or branch
- positive d-dimer
- lung perfusion scan or spiral CT of chest is diagnostic
Subacute bacterial endocarditis
hospital referral
- fatigue, low grade fever, anemia, splinter hemorrhages, clubbing of the fingers and splenomegaly
- disease caused by infection of previously damaged heart valves by streptocccus viridans
- blood cultures grow causative organism associated with dental caries
Subclavian steal syndrome
cardiologist referral
- syncope, especially with upper body exercise and radio-radial delay (>10 mm diff b/w BP in both arms)
- congenital occlusion of subclavian aa w/ shunting of blood via vertebral aa
- MRA confirms Dx
S. vena cava obstruction
cardiothoracic surgeon referral
- edema of the face and distended neck and upper limb veins
- obstruction fo the SVC by large mass in the S. mediastinum
- seen in lymphoma
- chest xray: widening of the S. mediastinum
- CT scan will show the mass
Absence of Schamroths space or nail bed angle
clubbing of the fingers
Beau’s lines (transverse grooves in nails)
recent serious disease
carotid bruit (whooshing sound)
significantly narrowed artery
clubbing of fingers
bacterial endocarditis, Fallot’s tetralogy
cyanosis-central (blue lips, fingers, toes)
sever respiratory distress, Fallot’s tetralogy
cyanosis-peripheral (blue finger, toes)
cold temperature, raynaud’s disease
diagonal earlobe creases
increased risk of heart attack
dilated chest and arm veins
superior vena cava obstruction
diastolic murmur in 2nd RICS
aortic regurgitation
elevated jugular venous pressure
CHF, cardiac temponade
diastolic murmur 5th LICS
mitral stenosis
displaced apex beat outside of 5th LICS
left ventricular hypertrophy
distended jugular veins
congestive heart failure
erythema marginatum, cardiac murmur, joint pain
rheumatic fever
hepatojugular reflex (increased JVP with RUQ pressure)
congestive heart failure
koilonychia (spoon shaped nails)
severe iron deficiency anemia
left parasternal heave
right ventricular hyperophy
loss of hair on the dorsum of the foot and toes
peripheral vascular disease
malar flush (red flushed cheeks)
mitral stenosis, carcinoid tumors
midsystolic click in 5th LICS
mitral valve prolapse
pale nail beds, mucosa or tongue
anemia
pansystolic murmur in 5th LICS
mitral regurgitation
peripheral edema BL
CHF, chronic bronchitis, cirrhosis, renal failure
peripheral edema unilateral
DVT, cellulitis
precodial thrill (palpable murmur)
pathological murmur
pulses alternans (strong followed by weak)
left ventricular failure
pulses bigeminus (double beats)
hypertrophic obstructive cardiomyopathy
pules magnus (bounding pulse)
fever, anemia, hyperthyroidism
pulses paradoxus (pule decreases in inspiration)
> 10 mm Hg : asthma, cardiac tamponade
pulses parvus (low volume pulse0
shock, aortic stenosis
Radio-femoral delay
coarctation of the aorta
S3 heart sound
normal in healthy young adults, CHF
S4 heart sound
HTN, cardiomyopahty
split 1st heart sound varies with breathing
normal in health yound 30yo adults
split 1st heart sound-fixed (no variation)
ASD or right bundle branch block
Splinter hemorrhage
subacute bacterial endocarditis
systolic murmur in 2nd RICS
aortic stenosis
systolic murmur in the 5th LICS midclavicular line
mitral regurgitation (incompetence)
titubation (nodding of head with heart beat)
aortic regurgitation (incompetence)
tracheal tug (downward pull on trachea)
aneurysm of the arch of the aorta
xanthelasma (yellow eyelid deposits)
hyperlipidemia (50% pts)
water hammer pulse (bounding pulse)
fever, anemia, hyperthyroidism)
