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Medicine > Cardiology - Cardiovascular Examination > Flashcards

Cardiology - Cardiovascular Examination Flashcards

1
Q

What angle should the bed be in a cardiovascular exam?

A

45 degrees

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2
Q

When you carry out a general inspection of the patient what should you be looking for?

A

Cyanosis
Shortness of breath
Pallor
Malar flush
Oedema

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3
Q

What does cyanosis suggest?

A

Poor circulation
- Peripheral vasoconstriction secondary to hypovolaemia

Inadequate oxygenation of blood
- Right-to-left cardiac shunting

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4
Q

What does SOB suggest?

A

Congestive heart failure
Pericarditis
Pneumonia
PE

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5
Q

What does pallor suggest?

A

Underlying anaemia
- Haemorrhage
- Chronic disease

Poor perfusion
- Congestive heart failure

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6
Q

What does malar flush suggest?

A

Mitral stenosis

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7
Q

What does oedema suggest?

A

Congestive heart failure

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8
Q

What does pallor of the hands suggest?

A

Congestive heart failure

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9
Q

What does cyanosis of the hands suggest?

A

Hypoxaemia

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10
Q

What does xanthomata on the hands suggest?

A

- Hyperlipidaemia (typically familial)
- Coronary artery disease
- Hypertension

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11
Q

What does Arachnodactyly (spider fingers) suggest?

A

Marfan’s syndrome

Associated with:
- Mitral valve prolapse
- Aortic valve prolapse
- Aortic dissection

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12
Q

What is clubbing of the fingers suggestive of?

A
  • Congenital cyanotic heart disease
  • Infective endocarditis
  • Atrial myxoma

Loss of Schamroth’s window

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13
Q

What do splinter haemorrhages suggest?

A
  • Trauma
  • Infective endocarditis
  • Sepsis
  • Vasculitis
  • Psoriatic nail disease
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14
Q

What do Janeway lesions suggest?

A

Infective endocarditis

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15
Q

What do Osler’s nodes suggest?

A

Infective endocarditis

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16
Q

What do cool hands vs cool and sweat hands suggest?

A

Cool hands
Congestive cardiac failure
Acute coronary syndrome

Cool and sweaty
Acute coronary syndrome

17
Q

What does a capillary refill time of over two seconds mean?

A

Poor peripheral perfusion

Hypovolaemia
Congestive heart failure

18
Q

What does radio-radial delay suggest?

A

Subclavian artery stenosis (compression by cervical rib)
Aortic dissection
Aortic coarctation

19
Q

What causes a collapsing pulse?

A
  • Pregnancy
  • Fever
  • Aortic regurgitation
  • Patent ductus arteriosus
  • Anaemia
  • Arteriovenous fistula
  • Thyrotoxicosis
20
Q

What do these types of pulse mean when palpating brachial pulse?

Slow-rising
Bounding
Thready

A

Slow-rising
- Aortic stenosis

Bounding
- Aortic regurgitation
- CO2 retention

Thready
- Intravascular hypovolaemia e.g. sepsis

21
Q

What causes narrow pulse pressure?

A

Aortic stenosis
Congestive heart failure
Cardiac tamponade

22
Q

What causes wide pulse pressure?

A

Aortic regurgitation
Aortic dissection

23
Q

What does a difference in blood pressure between arms suggest?

A

Aortic dissection

24
Q

Why do you need to listen to the carotids first before palpating?

A

Rule out a bruit, as this suggests carotid stenosis making palpation dangerous

Risk of dislodging a carotid plaque

Be aware of aortic stenosis radiating

25
Q

What causes raised JVP?

A

Right-sided heart failure Commonly due to left-sided

Tricuspid regurgitation
Infective endocarditis and rheumatic heart disease

Constrictive pericarditis

26
Q

What is a positive hepatojugular reflux?

A

Pressure to liver, JVP rise should last for 1-2 cardiac cycles before falling

Sustained rise in JVP is positive

27
Q

What do these signs suggest?
- Conjunctival pallor
- Corneal arcus
- Xanthelasma
- Kayser-Fleischer rings

A

Conjunctival pallor
- Anaemia

Corneal arcus
- In under 50s hypercholesterolaemia

Xanthelasma
- Hypercholesterolaemia

Kayser-Fleischer rings
- Wilson’s disease, can cause cardiomyopathy

28
Q

What do these signs suggest?
- Central cyanosis
- Angular stomatitis
- High-arched palate
- Dental hygiene

A

Central cyanosis
- Hypoxaemia

Angular stomatitis
- Iron deficiency

High-arched palate
- Marfan’s (risk for mitral/aortic valve prolapse and aortic dissection)

Dental hygiene
- Infective endocarditis risk factor

29
Q

What do these different chest scars suggest?
- Median sternotomy
- Anterolateral thoracotomy
- Infraclavicular
- Left mid-axillary

A

Median sternotomy
- CABG

Anterolateral thoracotomy
- Cardiac valve surgery

Infraclavicular scar
- Pacemaker insertion

Left mid-axillary scar
- Subcutaneous implantable cardioverter-defibrillator

30
Q

What causes thrills and how do you assess them?

A

Turbulent blood flow (palpable murmur)

Assess at each of the heart valves and parasternal heave for right ventricular hypertrophy

31
Q

What accentuation manoeuvres are used for aortic stenosis?

A

Auscultate carotids while patients holds their breath

32
Q

What accentuation manoeuvres are used for aortic regurgitation?

A

Sit patient forwards, listen to aortic area during expiration for early diastolic murmur

33
Q

What accentuation manoeuvres are used for mitral regurgitation?

A

Roll patient to left side, listen to mitral area during expiration for pansystolic murmur due to mitral regurgitation

Auscultate into axilla to identify radiation

34
Q

What accentuation manoeuvres are used for mitral stenosis?

A

While patient on left side, use bell during expiration for a mid-diastolic murmur

35
Q

When auscultating the posterior chest wall, what do coarse crackles suggest?

A

Pulmonary oedema

36
Q

What does absent air entry and stony dullness on percussion suggest?

A

Pleural effusion, associated with left ventricular failure

37
Q

Why do you need to carefully inspect the patients legs?

A

Evidence of saphenous vein harvesting

38
Q

What do you need to “do” to complete your assessment?

A
  • Measure BP
  • Peripheral vascular examination
  • 12-lead ECG
  • Urine dip
  • Blood glucose
  • Fundoscopy

Medicine (91 decks)

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