Cardiovascular Examination: Findings
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!
Right heart failure
SVC obstruction: non-pulsatile
Complete heart block: cannon A waves (occur when atria and ventricles constrict simultaneously)
Conditions resulting in raised atrial pressure: hypertension, heart failure
Atrial hypertrophy: mitral stenosis, mitral regurgitation
Inflammation/infiltration: cardiomyopathy, alcohol
Ischaemia: ischaemic heart disease
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.
This list is actually sometimes useful, although must be learnt more because examiners like to ask questions concerning it:
Cyanotic congenital heart disease, infective endocarditis, atrial myxoma
Carcinoma, mesothelioma, fibrosis, pus (bronchiectasis, empyema, abscess)
Cirrhosis, inflammatory bowel disase, coeliac
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.
: Intensity rises then falls, greatest
mid-systolic. Aortic stenosis, atrial septal defect, pulmonary stenosis.
: Constant intensity. Mitral regurgition, tricuspid
regurgitation, ventricular septal defect.
: hypertrophic obstructive cardiomyopathy.
: Mitral/tricuspid stenosis.
: Aortic regurg (rarely pulmonary regurgitation): Blowing
(high-pitched) & begin with 2nd sound.
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".
Heard immediately after 2nd. Due to early passive filling of
ventricle. In > 40y consider heart failure or volume overload.
Heard immediately before 1st. Caused by atrial contraction. In younger
patients abnormal & due to ventricular stiffness assoc with
hypertension, AS, acute MI.
: muscle/fat, pleural effusion, pneumothorax,
emphysema, pericardial effusion
: volume overload (eg AR/MR, shunts)
(palpable 1st beat): mitral (rarely tric) stenosis,
pressure loaded: Aortic stenosis, hypertension
Small volume and slow rising
Large volume and collapsing
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.
Alternate loud/soft HS in LV failure
2 distinct impulses with each pulse beat in
severe combined aortic valve stenosis and regurgitation, hypertrophic obstructive cardiomyopathy
: Ankle oedema, ascites, tiredness, hepatomegaly, raised JVP, peripheral
: Shortness of breath, frothy red sputum, orthopnoea, PND
Roth spots (“target lesions” in
Janeway lesions (
nodules on hands)
Puffy face, capillary distension in region of SVC (i.e. above nipples)
causing discoloration. ↑JVP, non-pulsatile. 50% have small cell
Grey opaque line surrounding the margin of the
cornea, separated from it by an area of clear cornea. Due to raised lipids.
Butterfly distribution on face associated with lesions to the mitral valve especially with rheumatic fever.