Cardiovascular Examination Flashcards Preview

Semester 2 > Cardiovascular Examination > Flashcards

Flashcards in Cardiovascular Examination Deck (31):
1

When would you hear basal crackles in the heart?

In heart failure

2

When do the atrioventricular valves close?

The start of systole

3

When do the semilunar valves close?

At the start of diastole

4

What is the cause of murmurs?

Due to turbulent flow caused by anatomical changes or flow changes. Due to valve disorders - stenosis or regurgitation

5

When would you hear a systolic murmur?

In stenosis of aortic and pulmonary valves or regurgitation of atrioventricular valves causes a murmur in diastole

6

Types of percussion tone

Dull Resonant - normal Hyper-resonant Timpani (hollow)

7

How do you describe heart sounds?

When - systole, diastole What - character of sound Where - what valve Transmission - what other area was the sound transmitted to

8

How can you identify C7?

Vertebra prominens

9

The sternal notch overlies which structure?

Trachea

10

What does the manubrio-sternal angle help you to identify?

T4/5, bifurcation of trachea, 2nd costal cartilage, upper order of atria, aortic arch

11

When would you hear a diastolic murmur?

Stenosis of atrioventricular valves or in regurgitation of pulmonary valves

 

12

Causes of bruit

Turbulent blood flow within the heart or blood vessels, produced by damaged vessels. 

Causes: narrowed arteries, septal defects, av-regurgitation 

13

Name 4 principal symptoms of cardiovascular disease

Chest pain
Shortness of breath (dyspnoea)
Oedema (ankles)
Palpitations

Also:
Syncope (fainting)
Claudication (limping, cramping pain)

14

Clincal presentation of angina
 

Central chest pain - crushing, heavy sensation, tightness, choking

Precipitated by: physical exertion, stress, heavy meal

Caused by myocardial ischemia - narrowing 

Relieved by nitrates (GTN) and vasodilators or rest

15

Clinical presentation of MI

Central sharp chest pain, radiating to arm/shoulder/neck/jaw

Can be accompanied by sweaing or vomiting

Not releived by rest or nitrate

16

Presentation of breathing difficulties

Dyspnoea - shortness of breath (gasping for air)
PND - sudden shortness of breath while sleeping
Orthopnoea - shortness of breath when lying down

Commonly associated with left heart failure

 

17

Physiological cause of PND

In the recumbent position, there is a redistribution of fluid from the extremities to the lungs. 

The left ventricle is unable to match the output of the right ventricle and a backlog of blood in the left ventricle moves up through the atria and into the lung causing congestion. This inhibits gaseous exchange and there is reduced oxygen levels in the blood. 

18

Phyiological cause of oedema in CVD

Swelling caused by excessive accumulation of fluid in interstitial tissues. Typically affects ankles, feet and lower legs. When a patient lies down fluid re-distributes - sacral oedema seen. 

A sign of right heart failure. Backlog from the right side of the heart flows back into the vena cava towards the extremeties which causes increased venuous hydrostatic pressure. This causes venuoous dilation and therefore oedema. 
 

Oedema in CVD is pitting

19

Palpations

Awareness of one's own heartbeat (pounding or fluttering)

Usually associated with arrythmia

20

Name 9 symptoms associated with CVD

Dizzyness and Syncope
Fainting
Fatigue
Fever
Nausea and Vomiting
Shortness of breath
Palpitations
Sweating
Oedema
Intermittent claudication (leg)

 

 

21

Systemic signs of CVD 
(head - toe)

General: Beathless at rest, cyanosis, cahexic/obese

Hands: Clubbing, Splinter heamorrages, tar staining, capillary refill

Eyes: Xanthelasma, anaemia, corneal arcus

Face: malar flush, central cyanosis

Neck: JVP, carotid pulse

Pulse: radial - rate, rhytm, collapsing, brachial waveform

Chest: apex beat, thrills, heaves, heart sounds, murmurs, bruit

22

What is hepato-jugular reflux?

Used to assess right ventricular failure. 

In the supine position, the JVP of patients can be seen between the clavicular and sternal heads of the sternocleiodomastoid muscle. Height of JVP measured above sternal angle.

When firm pressure placed on RUQ of abdomen (15sec) in patients with cardiac pathology a transitent rise in JVP is seen. In normal patients there would be a decrease becuase venuous return to the heart is reduced. 

Sign of: tricuspid regurgitation, constrictive pericarditis

23

Palpable abnormalities

Heaves: caused by ventricular hypertrophy (apex-left, parasternal-right)

Displaced apex: caused by dilated left ventricle
Tapping apex (both heart sounds palpable): mitral stenosis

Thrills: palpable heart murmur

24

Abdominal signs of CVD

Hepatomegaly

Ascites

Splenomegaly

Abdonimal aortic aneurym

Renal bruit

25

3 common CV causes of chest pain

Angina pectoris

MI

Cadiomyopathy

 

26

Name 3 cardinal symptoms of heart disease

Dyspnoea

Chest pain

Syncope or dizzyness

Palpitations

 

27

Common presenting complaints of heart disease

Dyspnoea

Chest pain

Palpitations

Syncope

Swollen legs

Transient neurological symptoms

28

Cardiac causes of dyspnoea

Ischaemia: causing transient poor muscle function e.g. coronary artery disease, angina

Left ventricular impairment: leads to poor muscle function. There is reduced cardiac output and increased end-diastolic pressure in the left ventricle. e.g. MI, hypertensive heart disease, dilated cariomyopathy

Valvular heart disease: causes reduced cardiac output due to obstruction to blood flow or regurgitation, increasing LV end-diastolic pressure or LA pressure.

29

What are the four heart sounds?

S1: AV valve closure (end of diastole/beginning of systole)


S2: Aortic and pulmonary valve closure (late systole)


S3: Passive LV filling (early diastole)


S4: Atrial kick (active LV filling in late diastole)
 

30

Causes of systolic murmurs

Aortic stenosis

Mitral regurgitation

VSDs

ASDs

Pulmonary stenosis

31

How can you work out if a murmus is systolic or diastolic?

When feeling the pulse, systolic murmurs will be heard at the same as feeling the upstroke
 

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