Cardiac Examination Flashcards

1
Q

How to begin a CVS examination

A
Wash hands
Bare forearms
Introduce yourself
Consent
Comfortable
45 degrees
Head support, chest exposed
Good light
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2
Q

General inspection

A
Stand back
Well or ill
Distress
Pale
Sweaty
Cyanosed
Tachypnoeic
Scars
Clues
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3
Q

Causes of irregularly irregular pulse

A

Ventricular etopics, AF, A flutter, wandering atrial pacemaker

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4
Q

Causes of regularly irregular pulse

A

Sinus arrythmia or second degree heart block

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5
Q

Cardiac causes of clubbing

A

Myoma, congential cyanotic heart disease, any chronic hypoxia and endocarditis

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6
Q

Hand examination

A
Look
Clubbing, splinter haemorrhages
Feel the temperature
Feel tendon xanthomata
Feel the radial pulses bilaterally
Pulse rate and rhythm
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7
Q

Causes of splinter haemorrhage

A

Endocarditis, vasculitis e.g SLE, trauma

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8
Q

Examine pulses

A

Brachial pulse for character
Lift arm and feel for waterhammer or collapsing
Palpate R carotid

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9
Q

How do you palpated R carotid pulse

A

Left thumb

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10
Q

Slow rising pulse causes

A

Aortic stenosis

Poorly functioning left ventricle

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11
Q

Collapsing pulse causes

A
Aortic regurgitation
Little blood (anaemia, thyroxicosis)
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12
Q

Corneal arcus

A

Can be normal in the elderly, arcus senilis

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13
Q

Why wont an anaemic person be cyanosed

A

Not adequate Hb to have 4g deoxygenated

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14
Q

What are you looking at the eyes for

A

Conjuctival pallor, corneal arcus, eyelids for xanthelasmata

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15
Q

What are you looking at the cheeks for

A

Malar flush (mitral stenosis)

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16
Q

What are you checking under the tongue and inside the lower lip for

A

Central cyanosis

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17
Q

How do you examine the JVP

A

Head slightly to left
Assess pulsation
Fixed?
Examine height above sternal angle

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18
Q

Cause of high JVP

A

Right heart failure

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19
Q

Cause of exaggerated JVP

A

Tricuspid regurg

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20
Q

Cause of fixed JVP

A

Tamponade

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21
Q

How does JVP differ from JVP

A

Double pulse, occlude, impalpable, varies with respiration and head tilt

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22
Q

How does hepatojugular reflux cause

A

Squeezing liver sinusoids and returning blood to the heaptic and the great veins

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23
Q

Apex beat displaced laterally

A

Cardiomegaly, lung or chest wall disease

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24
Q

Apex beat displaced medialy

A

Left pneumothorax or large left pleural effusion

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25
Q

How do you find apex beat

A

5th intercostal space and mid clavicular space

26
Q

How do you examine apex beat

A

Palpate chest for heave, thrill, tap and identify apex ebat

27
Q

How to find the 5th ICS more easily

A

Angle of lewy then count down three

28
Q

Parasternal heave is a sign of

A

Enlarged right ventricle

29
Q

Define heave

A

Outward movement of the palpating hand by the cardiac contraction

30
Q

Define thrill

A

Palpable murmurs

31
Q

When to use bell

A

Low pitched sounds, mitral and aortic stenosis

32
Q

When to use diaphragm

A

High pitched sounds, aortic and mitral regurgitation

33
Q

What is aortic sclerosis

A

Thickening of the valves but not stiffening

34
Q

Where do you auscultate

A
Diaphragm
Apex
Left sternal angle
Right sternal angle
Base
Bell, repeat
Carotids
35
Q

How do you accentuate AR

A

Patient sitting forward and breath held in expiration

36
Q

How do you accentuate MS

A

Patient in the left lateral position

37
Q

Whats valvasalva maneuver

A

Maximum handgrip, decrease venous return and supsequently decreased LV filling. Louder murmur

38
Q

1st heart sound

A

Mitral and tricuspid valve closure

39
Q

2nd heart sound

A

AV and PV

40
Q

Why do you raise the arm when taking pulse

A

Mitral regurg

41
Q

What is an alternative to measuring the JVP

A

Raise the hand above the level of the heart and look at vein in the back of the hand

42
Q

Cause of physiological splitting of heart sound

A

Inspiration, increased venous return to RA. RV more blood, RV longer to systole

43
Q

Cause of reversed splitting of heart sound

A

Expiration, Aortic Stenosis or LBBB. Aortic closes after pulmonary.

44
Q

Cause of fixed splitting

A

Atrial septal defect causes left to right shunt. Pulmonary closes after aortic, independent of breathing.

45
Q

Cause of paradoxical splitting

A

Due to RBBB or pulmonary stenosis. P2 then A2

46
Q

3rd heart sounds

A

Abnormal in adults over 40, LV overload

47
Q

4th heart sound

A

increased ventricular

48
Q

How to make heart sounds easier to hear with fat people

A

Ask them to sit forward

49
Q

How to tell if its the first heart sound

A

Feel for the carotid pulse

50
Q

What is a murmur

A

Turbulent blood flow through a valve or stenosed/regurgitant

51
Q

AS murmur

A

Ejection, systolic, crescendo decrescendo

52
Q

AR murmur

A

Early diastolic decrescendo

53
Q

PDA murmur

A

Continuous machinery murmur

54
Q

Causes of pitting bilateral lower limb oedema

A

Liver failure, heart failure, renal failure, hypoalbuminaemia, bilateral venous insufficiency

55
Q

Causes of non pitting bilateral lower oedema

A

Lymphoedema

56
Q

Causes of unilateral pitting oedema

A

DVT, pelvic mass, ruptured bakers cyst, post thrombotic syndrome, cellulitis

57
Q

Non chest parts of CVS examination

A
Percuss and auscultate lung bases
Sacral oedema
Feel liver, assess ascites
Examine peripheral pulses and check for radiofemoral delay
Ankle oedema
Blood pressure
58
Q

Signs of heart failure

A
JVP
Ankle oedema
Crackles in lungs
3rd/4th heart sound
Displaced apex
MR
59
Q

Where are you auscultating

A

Apex, base, aortic, pulmonic

60
Q

Tennis ball sign on CT

A

Aortic dissection