Home
Clinical Examination
Notes
CVS Exam
CVS Findings
Resp Exam
Resp Findings
Abdo Exam
Abdo Findings
Cranial Nerves
Cranial Nerve Findings
Neuro limbs
Neuro limb findings
Hip
Knee
Shoulder
GALS
Neck and Thyroid
Hands
Breast
Arterial system legs
Varicose veins
Lump
Groin lumps/Hernias
Ear
Eye
Paediatrics
This site is in active development. Please express your opinions on what we should offer.

Cardiovascular Examination: Findings

You would be expected to recognise and know the common causes for the majority of the below for finals. We can help you with the latter, but the former is up to you!

General

Raised JVP

Important causes:

Atrial Fibrillation

Important causes:

Anticoagulation is performed if: patient has a prosthetic heat valve, rheumatic mitral stenosis, prior CVA/TIA, patient is over 75 years old, hypertension, coronary artery disease, poor left ventricular function.

Clubbing

This list is actually sometimes useful, although must be learnt more because examiners like to ask questions concerning it:
Cardiovascular
Cyanotic congenital heart disease, infective endocarditis, atrial myxoma
Respiratory
Carcinoma, mesothelioma, fibrosis, pus (bronchiectasis, empyema, abscess)
Abdominal
Cirrhosis, inflammatory bowel disase, coeliac
Enocrinological
Thyroid acropachy

Murmurs

The first heart sound is the tricuspid and mitral valves closing. The second heart sound is the pulmonary and aortic valves closing. In finals you would really only be shown a patient with mitral stenosis or aortic regurgitation but it is important to know the basic features of other murmurs for written papers.
Systolic
Ejection : Intensity rises then falls, greatest mid-systolic. Aortic stenosis, atrial septal defect, pulmonary stenosis.
Pansystolic : Constant intensity. Mitral regurgition, tricuspid regurgitation, ventricular septal defect. 
Late : hypertrophic obstructive cardiomyopathy.
Diastolic
Mid : Mitral/tricuspid stenosis.
Early : Aortic regurg (rarely pulmonary regurgitation): Blowing (high-pitched) & begin with 2nd sound.
Continuous
Patent ductus arteriosus: due to connection between aorta/pulmonary artery meaning pressure in aorta always higher than in pulmonary artery (PDA).
Coarctation of the aorta.
Pericardial friction rub
Scratching/crunching due to movement of inflamed pericardium. Most obvious in systole but may be heard in diastole.

Extra heart sounds

Combined with tachycardia, 3rd and 4th heart sounds are termed a "gallop rhythm".
3rd sound
Heard immediately after 2nd. Due to early passive filling of ventricle. In > 40y consider heart failure or volume overload.
4th sound
Heard immediately before 1st. Caused by atrial contraction. In younger patients abnormal & due to ventricular stiffness assoc with hypertension, AS, acute MI.

Apex beat

Impalpable : muscle/fat, pleural effusion, pneumothorax, emphysema, pericardial effusion

Thrusting : volume overload (eg AR/MR, shunts)

Tapping (palpable 1st beat): mitral (rarely tric) stenosis, pressure loaded: Aortic stenosis, hypertension

Pulse

Irregularly irregular
Atrial fibrillation
Sinus tachycardia
Pain, anxiety
Small volume and slow rising
Aortic stenosis
Large volume and collapsing
Aortic regurgitation
Pulsus paradoxus
Exaggeration of the fall in systolic blood pressure and pulse pressure during inspiration. Causes: obstructive airways disease, constrictive pericarditis, tamponade, left ventricular disease (cardiomyopathy). It is not a feature of left ventricular failure.
Pulsus alternans
Alternate loud/soft HS in LV failure
Radio-femoral delay
Coarctation
Pulsus bisferiens
2 distinct impulses with each pulse beat in severe combined aortic valve stenosis and regurgitation, hypertrophic obstructive cardiomyopathy

Diseases

Heart failure

Right : Ankle oedema, ascites, tiredness, hepatomegaly, raised JVP, peripheral redness

Left : Shortness of breath, frothy red sputum, orthopnoea, PND

Endocarditis

  1. Roth spots (“target lesions” in eyes)
  2. Janeway lesions ( painless on hypothenar/thenar)
  3. Osler's nodes (blistering painful nodules on hands)
  4. splinter haemorrhages, splenomegaly
  5. microscopic haematuria.

SVC obstruction

Puffy face, capillary distension in region of SVC (i.e. above nipples) causing discoloration. ↑JVP, non-pulsatile. 50% have small cell lung cancer.

Corneal arcus

Grey opaque line surrounding the margin of the cornea, separated from it by an area of clear cornea. Due to raised lipids.

Mitral facies

Butterfly distribution on face associated with lesions to the mitral valve especially with rheumatic fever.
Copyright PassMED, 2008. Disclaimer