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How to Examine for a collapsing pulse
Apex beat position
Apex beat character
Parasternal heave
Thrills
Auscultate all heart valves, using the stethoscope diaphragm unless otherwise stated. Simultaneously palpate the carotid pulse. Note S1 and S2 intensity and any splitting, S3/S4, clicks/snaps, rubs, and murmurs. If you hear a murmur, note: site heard loudest, pulse timing, character, volume and radiation.
Tips on Auscultation
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
What are 2 causes of aortic stenosis?
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What are 2 causes of aortic regurgitation?
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What are the causes of mitral regurgitation?
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What are the causes of mitral stenosis?
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Name the five eponymous signs of aortic regurgitation?
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What is an Austin Flint murmur?
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How would you differentiate between aortic stenosis and aortic sclerosis?
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How would you differentiate between mitral regurgitation and tricuspid regurgitation?
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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
Corneal arcus: 2008 Loren A Zech Jr and Jeffery M Hoeg; ยฉ 2008 Zech and Hoeg; licensee BioMed Central Ltd; licensed under the Creative Commons Attribution 2.0 Generic license (https://creativecommons.org/licenses/by/2.0/deed.en), edited. Sourced from: https://commons.wikimedia.org/wiki/File:Four_representative_slides_of_corneal_arcus.jpg
Xanthelasma: 2005 Klaus D. Peter; licensed under the Creative Commons 3.0 Germany licence (https://creativecommons.org/licenses/by/3.0/de/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Xanthelasma.jpg
Pectus excavatum: 2006 Ahellwig, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/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:Pectus1.jpg
Pectus carinatum: 2010 Tolson411, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en), edited. Sourced from: https://commons.wikimedia.org/wiki/File:Ben_Fraser_pectus_carinatum.jpg
Pitting oedema: 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://en.m.wikipedia.org/wiki/File:Combinpedal.jpg
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management