W2L9 CV Exam Flashcards
What is the usual cause of a regularly irregular pulse?
Premature beats
What are the 6 ways to check hat you are looking at the JVP and not an arterial pulse?
- Double impulse (if in sinus rhythm)
- Falls with inspiration, rises with expiration
- Not palpable
- Can be occluded by gentle finger pressure and fills above finger
- Varies with sitting up or lying down
- Increases with hepato-jugular reflux
6 features:
2 to see: (1 & 2)
2 to feel: (3 & 4)
2 to do: (5 & 6)
What is a high (>3cm at 45 degrees) JV pressure indicative of?
high RA pressure–> RHF, fluid overload, pulm hypertension.
What is a single wave JVP indicative of?
AF
What is a JVP that rises with inspiration indicative of?
constrictive pericarditis (Kussmaul’s sign)
Large A wave in JVP=
stiff RA
Large V wave in JVP=
tricuspid regurgitation
What is the character of the carotid pulse in aortic stenosis?
plateau pulse: Small volume, late rise
What is the character of the carotid pulse in aortic regurgitation?
High volume, rapid fall (collapsing)
What is a tapping apex beat indicative of?
mitral stenosis
What is a heaving apex beat indicative of?
LV hypertrophy
What is a dyskinetic apex beat indicative of?
Ventricular dysfunction, such as aneurism following MI
What and when is S3?
after S2
– Turbulence during early filling of the ventricle
– May be normal
– Dilated left ventricle
• Dilated Cardiomyopathy
• Volume overload: Mitral or Aortic Regurgitation
What and when is S4?
before S1
– Turbulence during atrial contraction – In stiff ventricle • Hypertension • Aortic Stenosis • Hypertrophic Cardiomyopathy
Describe the murmur of AS:
– Murmur is crescendo- decrescendo:
“ejection systolic”
- radiates to carotids
Ejection systolic murmur loudest in the aortic area, radiating to the carotids, loudest on expiration and a slow rising carotid pulse.
Describe the murmur of MR:
Pansystolic or middle- late systolic murmur loudest at the apex radiating to the axilla, louder with the Valsalva manoeuvre.
What are the signs of RHF?
Elevated juglar venous pressure
Peripheral oedema
Hepatomegaly
RV heave
What are the signs of LHF?
Stony dullness and creps at lung bases LV hypertrophy (apex beat shifted laterally)
What are the signs of pulmonary ht?
– Palpable RV heave
– Loud P2
– S4 present
– increased a wave of JVP
What are the signs of COPD (in a CV exam)?
Ptosed liver
What are the signs of TR?
Pulsatile liver
Large v wave of JVP
What are the signs of AR?
Collapsing/ bounding pulse
Wide pulse pressure
What are the signs of AF?
Single wave JVP
Irreg irreg pulse
