What - CVS Flashcards
What is the significance of patient’s head/neck at 45 degrees?
When the patient is lying at 45 degrees, the sternal angle is roughly in line with the base of the neck and this provides a convenient
zero point from which to measure the vertical height of the venous blood in the jugular vein
WHAT might you observe on general observation in the CVS patient? (not an exhaustive list!)
Breathlessness, pallor or cyanosis, malar flush, use of O2, Marfan’s syndrome
WHAT are normal values for these vital signs in adults?
Temp 35.5‐37 C, Pulse 60‐100 bpm, Resp Rate 6‐16/min, BP 100‐140/60‐80 , O2 sats 95‐99%
WHAT are three signs of CVS disease found in the nails, hands, eyes and mouth?
Nails – clubbing, splinter haemorrhages, poor capillary refill
Hands – peripheral cyanosis, pale palmar creases, xanthomata
Eyes – conjunctival pallor (anaemia), scleral icterus (jaundice), arcus senilis
Face – malar flush (Mitral stenosis, pulmonary stenosis), xanthelasmata, cyanosis
Mouth – cyanosis, poor dentition, high arched palate (Marfan’s)
WHAT may prominent carotid pulsations indicate?
Aortic regurgitation (Corrigan’s sign)
WHAT does the jugular venous pressure actually measure?
Right atrial pressure – may be raised with any dysfunction of Right side of heart
WHAT might you observe on the precordium of a CVS patient?
Scars, skeletal chest deformities, prominent apex beat, abnormal pulsations, pacemaker/defibrillator box under skin
WHAT does a heave indicate? A thrill indicate?
Heave = RV enlargement, severe LA enlargement; Thrills = palpable murmurs
WHAT does the bell of the stethoscope listen for? The diaphragm?
The bell is designed to hear low‐pitched sounds such as the diastolic murmur of mitral stenosis or a 3rd heart sound
The diaphragm is designed to hear higher=pitched sounds such as mitral regurgitation or a 4th heart sound
WHAT is the character/timing of a mitral regurgitation murmur?
Mitral regurgitation has a pansystolic murmur
WHAT are the landmarks of these valves for auscultation?
Tricuspid valve = 4th or 5th intercostal space
Pulmonary valve = 2nd intercostal space on Left
Aortic valve = 2nd intercostal space on Right
WHAT is the pathophysiology of these dynamic manoeuvres?
Murmurs that arise on R side of heart become louder during inspiration as this increases venous return and hence
blood flow to R side of heart. Murmurs on L side of heart become louder on expiration.
WHAT does a 3rd heart sound indicate? A 4th heart sound?
3rd HS = “Kentucky” rhythm – indicates turbulence due to increased atrial or ventricular end‐diastolic pressure (may be
physiological)
4th HS = “Tennessee” rhythm – high pressure atrial wave reflected back from a poorly compliant ventricle (always pathological)
WHAT are the of congestive cardiac failure at the bases of the lungs?
Percuss lung bases for pleural effusion and auscultate for crepitations
WHAT might pitting oedema indicate in a CVS patient?
Pitting oedema in sacrum or lower legs indicates right heart failure (excess fluid settles by gravity – eg prolonged bed sacrum)
