Cpd - Heart Examination

Front 1

Causes of chest pain

Back 1

1. Angina pectoris
2. Pericarditis
3. Shingles:
4. Gastro esophageal reflux
5. Dissecting aortic aneurysm:
6. Musculoskeletal pain
7. Pleuritic pain

Front 2

Types of angina pectoris

Typical (stable)

Back 2

Etiology/Pathogenesis: Most common form. Critical stenosis [reduction of coronary artery to fixed stenosis]

Presentation: Crushing or squeezing substernal pain that may radiate down left arm.
Associated w/ increased demand- physical activity, emotional excitement

Relieving factors: Rest & Vasodilators

Front 3

Types of Angina pectoris

Prinzmetal (variant)

Back 3

Etiology/ Pathogenesis: Cause & mechanism not clear [may be due to coronary artery spasm]

Presentation: Occurs @ rest & awakens patient from sleep [not associated w/ physical activity]
Associated w/ ST segment elevation & indicative of transmural ischemia

Relieving factor: Vasolidators

Front 4

Types of Angina pectoris

Unstable (crescendo)

Back 4

Etiology/ Pathogenesis: Disruption of plaque w/ superimposed thrombosis & vasospasm [not complete occlusion YET]

Presentation: Harbinger of subsequent MI  Pre-infraction angina
Pain that occurs w/ progressively increasing frequency & is precipitated with progressively less effort. Often occurs at rest, & tends to be more prolonged in duration. Often accompanied by nausea & diaphoresis.

Relieving factors: Vasodilators but NOT rest

Front 5

Pericarditis

Back 5

Soreness behind the sternum, Aggravated w/ deep inspiration & movement

Front 6

Dissecting aortic aneurysm

Back 6

Severe persistent pain w/ tearing sensation between scapula

Front 7

Musculoskeletal pain

Back 7

Pain from chest wall

Front 8

Pleuritic pain

Back 8

Pain from parietal pleural layers

Front 9

Anxiety disorders

Back 9

Dyspnea not related to exertion, sighing excessively

Front 10

Palpitation: Abnormal awareness of heart beat & can be caused by ...

Back 10

Thyrotoxosis [hyperthyroidism], Caffeine products, Sympthmimetic drugs, Cardiac arrythmias [MVP, Extrasystoles, PSVT]

Front 11

Syncope: Sudden loss of consciousness due to reduced blood supply to the brain can caused by...

Back 11

cardiac arrhythmias, vasovagal response, postural hypotension, mictruation syncope, vertebro-basilar synocope

Front 12

Signs of Aortic regurgitation

Back 12

(1) Capillary pulsations in the nail bed [Quincke’s pulse]
(2) Femoral bruit [pistol shot] --> Durozier’s sign
(3) Head nodding with the pulses --> de Musset’s sign
(4) Mid diastolic murmur
(5) Austin Flint murmur

Front 13

Signs of Atrial septal defect

Back 13

(1) Wide, fixed splitting
(2) Pulmonary flow murmur
(3) EKG may show Right Bundle Branch Block [RBBB]

Front 14

Signs of Ventricular septal defect

Back 14

(1) Loud pansystolic murmur --> Maladie de Roger
(2) Forceful apex beat with a thrill
(3) Mitral diastolic flow murmur

Front 15

Signs of Eisenmenger’s syndrome

Back 15

(1) Clubbing
(2) Central cyanosis
(3) EKG will reveal right ventricular hypertrophy

Front 16

Signs of Hypertrophic cardiomyopathy [HCOM]

Back 16

(1) Angina on exertion
(2) Dyspnea on effort
(3) Syncope
(4) Sudden death in young adults

Front 17

Cardiac cycles

Back 17

i) S1: Closing of mitral & tricuspid valves [AV valves]
ii) S2: Closing of aortic & pulmonic valves
iii) S3: Rapid ventricular filling

Front 18

Large v wave JVP

Back 18

Tricuspid regurgitation

Front 19

Giant/cannon a waves JVP

Back 19

Hepatojugular reflux, Complete heart block

Front 20

Absent a waves JVP

Back 20

Atrial fibrillation

Front 21

Use ball of your hand to feel for thrills: Palpable murmurs

Back 21

turbulence of blood flow

Front 22

Heart sounds

Back 22

1/ S1: Closing of mitral & tricuspid valves [AV valves]
2/ S2: Closing of aortic & pulmonic valves
3/ S3: Rapid ventricular filling [low pitch]--> Mitral [5]
4/ S4: Atrial contraction [low pitch]-->Between [4] & [5]

Front 23

Cause and position of murmurs

Back 23

Due to: turbulence of blood flow

Position
(1) Between S1-S2: Systolic & high pitched
(2) Between S2-S1: Diastolic & low pitched & soft
Lateral decubitis position for MS [left-sided S3 & S4 diastolic murmur]: mitral area [5] (question image)
Position for AR [diastolic decrescendo murmur]: erb [3] (answer image)

Front 24

Peripheral signs of CVS dysfunction

Clubbing

Cardiac causes

Back 24

endocarditis, Cyanotic congenital heart diseases

Front 25

Peripheral signs of CVS dysfunction

Clubbing

Pulmonary causes

Back 25

Lung cancer, Empyma, Cystic fibrosis, Fibrosing alveolitis

Front 26

Peripheral signs of CVS dysfunction

Clubbing

GI causes

Back 26

Inflammatory bowel diseases [Chron’s disease, Ulcerative colitis], Cirrhosis

Front 27

Signs of infective endocarditis

Back 27

Splinter hemorrhages
Janeway lesions
Osler’s nodes
Roth's spots
Conjuctival/Scleric hemorrhages

Front 28

Back 28

Splinter hemorrhages: signs of infective endocarditis

Front 29

Signs of infective endocarditis: Janeway lesions

Back 29

Painless erythmatous hemorrhagic macular or nodular lesions on the palms of hands

Front 30

Signs of infective endocarditis: Janeway lesions

Back 30

Painless erythmatous hemorrhagic macular or nodular lesions on the palms of hands