Table of Contents
Valve replacement
- See viva notes on valve replacements
- Midline sternotomy
- Abnormal S1 = mitral
- Abnormal S2 = aortic
Heart failure
- Tachypnoea/tachycardia
- Cool peripheries
- Raised JVP
- Displaced apex
- S3 (ventricular gallop)
- Bi-basal fine crepitations
- Peripheral oedema
Atrial septal defect
- Soft ejection systolic flow murmur (pulmonary area)
- Fixed, widely split S2
- RV heave
Ventricular septal defect
- Pansystolic murmur (loudest at left lower sternal edge)
- Associated thrill
- RV heave/loud P2
Cor pulmonale
- Plethoric facial appearance
- Central cyanosis
- Raised JVP (large ‘a’ waves)
- Giant V waves + pansystolic murmur (if secondary TR)
- Right ventricular heave
- Palpable/loud S2
- Pedal oedema
Hypertrophic obstructive cardiomyopathy
- Pacemaker/implantable cardioverter defibrillator
- Jerky pulse/pulsus bisferiens
- Double apex beat
- Ejection systolic murmur (left lower sternal edge)
- S4
Tetralogy of Fallot repair
- Sternotomy scar (from repair)
- Lateral thoracotomy scar (if had Blalock-Taussig shunt)
- Left pulse weaker (if had Blalock-Taussig shunt)
- Clubbing
- Loud pulmonary stenosis
Coarctation of aorta
Pre-repair
- Radio-femoral delay
- Weak left radial pulse (if stenosis proximal to left subclavian artery)
- Systolic vascular murmur over region of stenosis (most commonly left interscapular or left infraclavicular)
- Severe hypertension
Post-repair
- Left lateral thoracotomy scar
Characteristics of the JVP pulsation that help differentiate it from the carotid pulsation
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Now try some Viva questions
What is Eisenmenger syndrome?
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What are the different types of valves that can be used for a valve replacement?
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How would you differentiate between left and right sided heart failure based on clinical findings?
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Which conditions would cause a crescendo-decrescendo systolic murmur?
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What are the different types of cardiomyopathies?
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What is the tetrad of abnormalities of Tetralogy of Fallot?
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