Cardiac condition signs

Valve replacement

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

Advanced signs

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

Advanced signs

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

Advanced signs

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

Advanced signs

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

Advanced signs

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

Advanced signs

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

Advanced signs

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  

Oops! This section is restricted to members.

Now try some Viva questions

What is Eisenmenger syndrome?

Oops! This section is restricted to members.

What are the different types of valves that can be used for a valve replacement?

Oops! This section is restricted to members.

How would you differentiate between left and right sided heart failure based on clinical findings?

Oops! This section is restricted to members.

Which conditions would cause a crescendo-decrescendo systolic murmur?

Oops! This section is restricted to members.

What are the different types of cardiomyopathies?

Oops! This section is restricted to members.

What is the tetrad of abnormalities of Tetralogy of Fallot?

Oops! This section is restricted to members.

Some examination OSCE stations

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

Your email address will not be published. Required fields are marked *

Join our email list!
For free OSCE tips and updates