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Cardiac condition signs

Clinical examination > Cardiorespiratory

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

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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Some examination OSCE stations

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

Picture references

Peripheral cyanosis: 2011 James Heilman, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Cynosis.JPG

Clubbing: 2009 Desherinka, licensed under the Creative Commons Attribution-Share Alike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/), 3.0 Unported (https://creativecommons.org/licenses/by-sa/3.0/deed.en), 2.5 Generic (https://creativecommons.org/licenses/by-sa/2.5/deed.en), 2.0 Generic (https://creativecommons.org/licenses/by-sa/2.0/deed.en) and 1.0 Generic license (https://creativecommons.org/licenses/by-sa/1.0/deed.en) and GNU Free Documentation licence 1.2 (https://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License,_version_1.2). Sourced from: https://en.wikipedia.org/wiki/Nail_clubbing#/media/File:Dedos_con_acropaquia.jpg

Splinter haemorrhages: 2010 Splarka, in public domain. Sourced from: https://commons.wikimedia.org/wiki/File:Splinter_hemorrhage.jpg

Osler’s nodes: 2010 Robert J Galindo, licensed under the Creative Commons Attribution-Share Alike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/), 3.0 Unported (https://creativecommons.org/licenses/by-sa/3.0/deed.en), 2.5 Generic (https://creativecommons.org/licenses/by-sa/2.5/deed.en), 2.0 Generic (https://creativecommons.org/licenses/by-sa/2.0/deed.en) and 1.0 Generic license (https://creativecommons.org/licenses/by-sa/1.0/deed.en) and GNU Free Documentation licence 1.2 (https://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License,_version_1.2). Sourced from: https://commons.wikimedia.org/wiki/File:Osler_Nodules_Hand.jpg

Janeway lesions: 2015 Warfieldian; licensed under the Creative Commons Attribution-Share Alike 4.0 International license (https://creativecommons.org/licenses/by-sa/4.0/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Janeway_lesion.JPG

Cardiorespiratory

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