The cardiac examination Flashcards
nuggets of knowledge for the exam
Features of down syndrome?
Low set ears, epicanthic folds, brushfield spots, flat nasal bridge
Features of Ank Spond
Question mark posture, restricted neck movements
Features of Marfans
tall, arachnodactyly, arm span ?heigh. chest wall deformity
Features of turners syndrome
Webbed neck, short stature, wide carrying angle , infertility, absence of secondary sexual characteristics, wide small nipples
Features of Noonans syndrome
Similar to turners but can be male and are fertile
Features of Holt Oram syndrome
Triphalangeal thumb, radial hypoplasia
What is a malar flush
Rash present in pulmonary HTN secondary to M.S.
Which HS does the metallic valve make
It makes a sound when it closes i.e. AVR would be heard at S2
What scars can be present in a cardio exam and what are their indications?
Midline sternotomy - CABG/ Valve replacement/ Transplant
Lateral thoracotomy - MVR, valvotomy, coarctation of aorta fixation, Blalock Tousig shunt insertion
Subclavicular (PPM/ICD)
ACF scar - angiogram
Leg scar - vein harvesting
Peripheral signs of IE?
Oslers nodes - painful raised lesions on pulp of fingers
Janeway lesions - Macular lesions, painless on palms/ soles of feet
Clubbing
Clubbing in cardiology exam causes
Congenital heart disease (exp cyanotic)
Eisenmenger
IE
Atrial myxoma
What can cause an unequal pulse on examination
Blalock Toussig shunt (connection between branch on Subclavian Art and Pulmonary Art to shunt blood to lungs in cyanotic heart disease). can cause unequal underdeveloped limb. done in ToF
Cervical rib
Subclavian stenosis
AV fistula
Coarctation of aorta
What signs do you look for in the eyes?
Corneal arcus
Xanthelasma
Anaemia
Jaundice (haemolysis across stenoses valve)
Lens of eye (ectopia lentis - marfans/ homocystinuria)
Signs on mouth
Dentition
Central Cyanosis
Uvula bobbing
Head bobbing
Signs of pseudoxanthoma elasticum
Plucked chicken skin appearance (neck, chest, shoulders, arm folds)
Retinal angiod streaks
MV prolapse
GI haemorrhage
increased risk of IHD
Talk through the JVP waveform
A wave - atrial contraction
C wave - ventricular contraction
X decent - (Part 1) relaxation of atria (part 2) TV closed and heart moves down as ventricular contraction at maximum
V wave - Ventricular passive filling. TV closed.
Y decent - TV opens and passive filling of RV
Gynaecomastia in CVS
Digoxin/ spironolactone
JVP in AF?
single wave due to absent A wave
Causes of giant A waves
Due to atrial contraction against some resistance. occurs every beat
- Pulmonary HTN
- Tricuspid stenosis
- Right Ventricular failure
Causes of canon A waves
Contraction of atria against closed TV
- Complete HB
- VT
- ventricular ectopics
Causes of large CV wave
Tricuspid regurgitation
JVP features of tamponade
Absent Y decent. Prominent X decent.
JVP features of constrictive pericarditis
Prominant deep X and Y decent
When is kussmauls sign present and why?
Constrictive pericarditis > Tamponade
Inspiration increases JVP (normally it will fall). In constriction inspiration increases venous return to heart. Due to inability for heart to expand against stiff pericardium RV cannot accommodate increase in return of blood. Therefore JVP increases.
Explain pulsus paradoxicus
Can occur with tamponade
Fall in BP normal on inspiration due to reduced filling of left heart (typically <10mmHg) and increased filling of rt heart reduced LV size. In tamponade this effect is more pronounced. Bowing of septum into LV impairing stroke volume.
What does MS do to apex?
Tapping apex
What does a thrusting apex imply?
Volume overload
What does a heaving apex imply
Pressure overload
As diastolic murmurs are challenging to hear, what might you expect with a patient with AR?
ESM (aortic flow murmur)
Present S2
Collapsing pulse
Displaced apex
As diastolic murmurs are challenging to hear, what might you expect with a patient with MS?
AF
Malar flush
tapping apex
loud S1
Why does S3 occur and when may it be present?
Passive diastolic filling of LV.
normal if <30. Can occur in LVH/ constrictive pericarditis and MR
Why does S4 occur and when may it be present?
Atrial contraction against stiff ventricle
HOCM, LVH, Amyloidosis, Ventricular ischaemia. absent in AF
List disorders than influence the volume of S1
Quiet: Mitral regurg
Loud: MLUBS
Mitral stenosis, Left-> Right shunts, hyperdynamic state, ectopic beats (atrial), Short PR
List disorders than influence the volume of S2
Loud: pulmonary HTN, ASD
Quiet: AS
Disorder that effect the splitting of S2:
Wide: DUBS
Deep inspiration, pUlmonary stenosis, right Bundle branch block, Severe MR
Reverse: DUBS
DUctus arteriosus, LBBB, Severe AS
Fixed: ASD
