Auscultation Flashcards
Determine heart issues from auscultation (24 cards)
Cardiac surgery gives you clues during examination. If you see a midline sternotomy plus legs scar, what ops are likely?
- Simple CABG most likely
2. Possible valve replacement with CABG
Cardiac surgery gives you clues during examination. If there is a midline sternotomy with no scar what are the most likely ops?
- Valve replacement most likely
2. Possible CABG without vein graft (LIMA or radial artery graft only)
When the JVP is elevated what does this indicate?
- RHF
- Volume overload
- PE
- Constrictive pricarditis
When the JVP is elevated with low blood pressure, what does this indicate?
- Tension pneumathorax
- Cardiac tamponade
- Massive PE
- Severe asthma
What happens when the JVP is fixed and elevated?
- Superior vena cava obstruction
Obstruction of the SVC by tumour tissue or blood clot
What occurs when cannon A waves are present in the JVP?
- Complete heart block
- Ventricular ectopic beats
- Ventricular tachycardia
When there are giant V waves associated with JVP, what does this indicate?
- Tricuspid regurgitation
Look for ear wiggling and feel for pulsatile hepatomegaly
How do you differentiate between types of cyanosis?
- Pure peripheral cyanosis causes blue hands
2. Central cyanosis causes blue lips and tongue and when severe can also cause blue hands
When central cyanosis is present (blue lips and tongue) what conditions could be present?
- Hypoxic lung disease
- Right to left cardiac shunt: Cyanotic congenital heart disease, Eisenmenger’s syndrome
- Methaemoglobinaemia
When peripheral cyanosis is present (blue hands), what conditions maybe present?
- Peripheral vascular disease
- Reynaud’s syndrome
- Heart failure
- Shock
- Central cyanosis
What conditions are present when there is an irregularly irregular pulse?
- Atrial fib
- Ventricular ectopic beats (VEBs)
- Complete heart block
- Variable Ventricular escape
To differentiate between AF and VEBs, exercise patient and VEBs will disappear
What are the cause of absent radial pulse?
- Congenital
- Arterial embolism (due to AF)
- Atheroma (usually subclavian)
- Previous arterial line
- Previous coronary angiography
- Cervical rib
- Coarctation of the aorta
What are the features of the JVP vs carotid
- Double pulsation
- Non palpable
- Obliterated when pressure applied to the neck
- Height changes with respiration
- Height changes with angle of patient
- Rises with hepatojugular reflux
What are important causes of AF?
- Ischaemic heart disease
- Rheumatic heart disease
- Thyrotoxicosis
- Pneumonia
- PE
- Alcohol
What is pulsus paradoxus
An exaggeration of the normal situation on which BP falls during inspiration, to such an extent that peripheral pulse may not be felt, despite LV contracting (and heart sounds can still be heard)
What causes pulsus paradox us?
- Tamponade
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Severe asthma/COPD
What is Kussaul’s sign
A rise in JVP on inspiration which is opposite of normal (due to impaired RV filling)
What causes Kussmaul’s sign?
- Tamponade
- Constrictive pericarditis
- Restrictive cardiomyopathy
What are the causes of a non-palpable apex beat?
- Adipose tissue
- Air (pneumathorax or emphysema)
- Fluid (pleural or pericardial effusion)
- Apex not in the normal position:
- Displaced (usually laterally in LHF)
- Dextrocardia
What causes a heaving apex?
- Aortic stenosis
- Hypertension
- Hypertrophic Obstructive Cardiomyopathy
- Coarctation of the the aorta
Chest X ray features of LHF (ABCDE)
- A lveolar oedema
- Kerley B lines
- C ardiomegaly
- Upper lobe venous D iversion
- Pleural E ffusion
What are the causes of pericarditis?
- Viral ( coxsackie)
- Bacterial/ fungal infection
- Post MI
- Dressler’s syndrome
- SLE/RA/scleroderma
- Uraemia
- Malignancy
What is the 3rd heart sound?
- Due to. rapid ventricular filling
- May be normal if <30 years old
- Think volume overload
- Causes: CCF, MR, AR, Anterior MI
Atrial septal murmer is associated with?
Ejection systolic murmur
