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.
