Table of Contents
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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