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Cardiac condition signs

Valve replacement

  • See viva notes on valve replacements
  • Midline sternotomy
  • Abnormal S1 = mitral
  • Abnormal S2 = aortic

Assess for valve function: signs of regurgitation or stenosis of replaced valve

Assess for signs of cardiac decompensation: signs of heart failure

Assess for signs of infective endocarditis: splinter haemorrhages, Osler’s nodes/Janeway lesions

Assess for complications of over-anticoagulation: bruising, pale conjunctiva

Assess for haemolysis: jaundice, pale conjunctiva

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

Signs of associations: low set ears/prominent epicanthic folds/flat nasal bridge (Down’s syndrome), hypoplastic triphalangeal thumb/radial hypoplasia (Holt-Oram syndrome)

Signs of complications: loud P2 (pulmonary hypertension), peripheral oedema (right heart failure); cyanosis (Eisenmenger’s syndrome – late reversal of shunt)

Ventricular septal defect

  • Pansystolic murmur (loudest at left lower sternal edge)
  • Associated thrill
  • RV heave/loud P2

Signs of complications: raised JVP/peripheral oedema (right heart failure)

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

Signs of aetiology: end-inspiratory crepitations (pulmonary fibrosis),clubbing (idiopathic pulmonary fibrosis), signs of COPD

Hypertrophic obstructive cardiomyopathy

  • Pacemaker/implantable cardioverter defibrillator
  • Jerky pulse/pulsus bisferiens
  • Double apex beat
  • Ejection systolic murmur (left lower sternal edge)
  • S4

Signs of complications: signs of heart failure

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

Signs of associations: syndromic features

Signs of complications: aortic regurgitation, raised JVP/peripheral oedema (right heart failure)

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

Signs of associations: short/webbed neck/short 4th metacarpals (Turner syndrome)

Signs of complications: splinter haemorrhages/Osler’s nodes/Janeway lesions (infective endocarditis), severe hypertension, signs of heart failure

Characteristics of the JVP pulsation that help differentiate it from the carotid pulsation  

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Some examination OSCE stations

  1. Mitral regurgitation
  2. Valve replacement
  3. Atrial fibrillation
  4. Aortic stenosis
  5. Lots more here!
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