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Cardiovascular Examination Flashcards

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1
Q

What are the main presenting symptoms for a cardiovascular problem?

A
  • Chest pain
  • Palpitations
  • Dyspnoea
  • Dizziness/Blackouts
  • Claudication
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2
Q

In a cardiovascular PMH what areas should be asked about?

A
  • Angina
  • Previous heart attack
  • Stroke
  • Rheumatic Fever
  • Diabetes
  • Hypertension
  • Hypercholestrolaemia
  • Previous Tests/Proecdures - ECG, angiogram, angioplasty/stents, ECHO, scintigraphy, CABG
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3
Q

What are the five main types of palpitations?

A
  • Regular fast palpitations (SVT, VT)
  • Irregular fast palpitations (AF, atrial flutter)
  • Dropped/missed beats related to rest, recumbency or eating (ectopic beats)
  • Regular pounding (anxiety)
  • Slow palpitations (drug-induced)
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4
Q

What are the main risk factors for ischaemic heart disease?

A
  • Hypertension
  • smoking
  • diabetes mellitus
  • family history (1st degree relative)
  • hyperlipidaemia
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5
Q

What are the 8 steps in the cardiovascular examination?

A
  1. General Inspection
  2. Hands - temperature and inspection
  3. Radial and brachial pulses
  4. Blood pressure
  5. Neck - JVP and carotid pulse
  6. Face - colour and features
  7. The praecordium
  8. Complete examination - oedema, listen to lung bases, liver and peripheral pulses
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6
Q

What position should the patient be in for a cardiovascular examination?

A

expose the patient and position in supine at 45degrees

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7
Q

What information can be gathered from standing at the end of the patient’s bed?

A
  • General appearance
    • Well/Unwell
    • Distressed?
    • In pain?
  • Potential Findings
    • GTN spray (indicates angina)
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8
Q

What are the main findings from the patient’s nails?

A
  • finger clubbing
  • koilonchyia
  • Nail fold infarcts
  • splinter haemorrhages
  • nail bed pulsation
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9
Q

What is finger clubbing indicative of?

A
  • Infective endocarditis
  • cyanotic CHD
  • atrial myxoma
  • non-cardiac cause
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10
Q

What is suspected when a patient has koilonychia?

A

iron deficiency anaemia

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11
Q

What do nailbed infarcts indicate?

A
  • vasculitis
  • SLE
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12
Q

What are the potential causes of splinter haemorrhages?

A
  • Infective endocarditis
  • trauma
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13
Q

What is nail bed pulsation a sign of?

A

Quincke’s sign

Aortic regurgitation

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14
Q

What is the major pathological sign that can occur on the face that has cardiovascular signficance?

A

Malar flush

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15
Q

What is malar flush a sign of?

A

mitral stenosis

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16
Q

What are the main features that should be looked for in the eyes?

A
  • corneal arcus and xanthelasma
  • conjunctival pallor
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17
Q

What are corneal arcus and xanthalasma a sign of?

A

hypercholestrolaemia

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18
Q

What is conjunctival pallor a sign of?

A
  • anaemia
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19
Q

What are the two main signs found upon inspection of the mouth?

A
  • central cyanosis
  • poor dentition
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20
Q

Why can poor dentition be signifcant?

A

risk factor for infective endocarditis

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21
Q

What can central cyanosis indicate

A
  • lung disease
  • cardiac shunt
  • abnormal Hb
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22
Q

What are the main types of R-L shunt?

A
  • cyanotic congenital heart disease
  • eisenmenger’s syndrome (reversal of L-R shunt; long term complication of congenital heart defect)
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23
Q

What are the four main observations in the hands?

A
  • temperature and capillary refill
  • peripheral cyanosis
  • osler’s nodes and janeway lesions
  • tendon xanthomata
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24
Q

What is tendon xanthomata a sign of?

A

hypercholestrolaemia

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25
What are janeway lesions and osler's nodes a sign of?
infective endocarditis
26
What are the main causes of peripheral cyanosis?
* peripheral vascular disease * Raynauds * congestive cardiac failure * shock * a cause of central cyanosis
27
What is the difference between janeway lesions and oslers nodes?
* Osler's nodes = tender nodules in the finger pulps * Janeway lesions = red macules on the palms
28
What are the two main causes of R-L cardiac shunt?
cyantoic congenital heart disease Eisenmenger's syndrome
29
Where are the two main pulses taken in a cardiovascular examination?
* Wrist - radial pulse * Neck - carotid pulse
30
What should be established when examining the patient's radial oulse?
* rate - bradycardia or tachycaria * Rhythm - regular, irregular or irregularly irregular * Volume - normal, thready, bounding
31
What does a collapsing pulse indicate?
aortic regrugitation
32
What are the causes of radio-radio delay?
* cervical rib * aortic coaraction/dissection * embolism
33
What are the causes of radio-femoral delay?
* Aortic coarction/dissection * embolism
34
What does an exaggerated pulsation of the carotid pulse suggest and what is the name of this sign?
Aortic regurgitation Corrigan's Sign
35
What other pulse, other than the carotid, is observed in the neck
Jugular Venous Pressure (JVP)
36
What does an elevated JVP suggest?
* RHF * volume overload * PE * Constrictive pericarditis
37
What does an elevated JVP with decreased BP suggest?
* tension pneumothroax * cardiac tamponade * PE * Asthma
38
What does an elevated and fixed JVP suggest?
SVC obstruction
39
What do cannon A waves in the JVP suggest?
* complete heart block * VEBs * VT
40
What do giant V waves in the JVP suggest?
tricuspid regurgitation
41
What does sacral oedema indicate?
right sided heart failure
42
What does peripheral oedema suggest?
right sided heart failure
43
What other investigations should be offered following a cardiovascular examination?
* ECG * CXR * ECHO * Urinalysis
44
What other examinations should be offered after a cardiovascular examination?
* Abdominal exam * hepatomegaly and ascites (RHF) * Spenomegaly = IE * AAA * Peripheral pulses
45
What do crepitiations at the bases of the lungs suggest?
left sided heart failure
46
What areas of the should be inspected in a CVS exam?
* Scars * Visible heave * Legs - for vein harvesting
47
What scars can be visible on the chest?
* Pacemaker/ICD under clavicle * Midline sternotomy (CABG, valve replacement) * Left submammary (mitral valvotomy, pericardial window)
48
What are the two main visible heaves?
* Apical = left ventricular hypertrophy * Parastenal = right ventricular hypertrophy
49
What three areas require palpation in the CVS exam?
* Apex beat * Left parasternal heave * Thrills
50
What is a thrill?
palpable murmur (grade 4 or above)
51
What does a left parastenal heave indicate?
right ventricular hypertrophy
52
Where can the apex beat be felt?
5th intercostal space in the midclavicular line
53
What does a tapping apex beat indicate?
mitral stenosis
54
What does a heaving apex beat indicate?
LVH
55
What does a thrusting apex beat indicate?
mitral/aortic regurgitation left ventricular failure
56
What are the four areas that are ausculatated in the CVS exam?
* Apex (5th intercoastal space in midclavicular line) = mitral valve * LLSE (4th intercoastal space on left sternal edge) = tricuspid valve * 2nd Left intercostal space = pulmonary valve * 2nmd right intercostal space = aortic valve
57
What murmur radiates to the axilla?
mitral regurgitation
58
What murmur radiates to the carotids when breath is held on inspiration?
aortic stenosis
59
How can you amplify mitral stenosis?
Apex, patient is lying on LHS and breath is held on expiration using bell
60
How can you amplify aortic regurgitation?
LLSE, patient is leaning forward and breath is held in expiration (use diaphragm)
61
What are the main causes of an absent radial pulse?
* congenital * arterial embolism (AF) * atheroma * previous arterial line * previous coronary angiography * cervical rib * coarction of the aorta
62
What are the causes of AF?
* Ishcaemic heart disease * rheumatic heart disease * thyrotoxicosis * pneumonia * PE * Alcohol
63
What is Kussmaul's sign?
A rise in JVP on inspiration, which is opposite of normal (impaired RV filling)
64
What can cause Kussmaul's sign?
* tamponade * constrictive pericarditis * restrictive cardiomyopathy
65
Why is there a third heart sound?
* rapid ventricular filling * may be normal is \<30yo * Volume overload * CCF * Mitral regurgitation * Aortic regurgitation * Large anterior MI
66
What are the causes of a heaving apex beat?
* Aortic stenosis * hypertension * hypertrophic obstructive cardiomyopathy * coarction of the aorta
67
What are the causes of an irregularly irregular pulse?
* AF * VEBs (will disappear with exercise) * Complete heart block * variable ventricular escape
68
What is pulsus paradoxus?
an exaggeration of the normal situation in which BP falls during inspiration to such extent that during inspiration peripheral pulses cannot be felt
69
Causes of pulsus paradoxus
* tamponade * constrictive pericarditis * restrictive cardiomyopathy * severe asthma/COPD
70
Causes of a non-palpable apex beat
* Between fingers and apex * adipose tissue * air (pneumothorax, emphysema) * fluid (pericardial/plerual effusion) * Apex not in the normal position * Displaced * dextrocardia
71
Why is there a 4th heart sound?
* poorly compliant ventricle * always abnormal * cannot occur in AF * Pressure overload * aortic stenosis * hypertension * HOCM * post-MI fibrosis
72
What are the CXR features of LHF?
* **A**levolar Oedema * Kerly **B** lines * **C**ardiomegaly * Upper lobe venous **D**iversion * **P**leural Effusion
73
What are the main causes of cardiac failure?
* Pump failure * excessive peload * excessive afterload * high-output failure * isolated right heart failure
74
What are the main causes of pump failure?
* Drugs (negative inotrophes) * Arrhythmia * constrictive pericarditis * cardiomyopathy * IHD
75
What are the causes of excessive preload?
* regurgitant valvular disease (MR/AR) * Fluid overload * renal failure * IV fluids * Ventricular septal defect
76
What are the main causes of excessive afterload?
* aortic stenosis * hypertension
77
What are the causes of high-output failure?
* anaemia * pregnancy * metabolic * hyperthyroidism * Paget's disease
78
What are the causes of isolated right heart failure?
* primary pulmonary hypertension * cor pulmonale

Cardiology (6 decks)

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