Cardiovascular Examination Findings

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Questions and Answers

Describe the physical examination finding that suggests hypertrophic obstructive cardiomyopathy (HOCM) when palpating the apex beat.

A double impulse apex beat, feeling two beats within a single systole.

What is the normal change in systolic arterial blood pressure during inspiration and what physiological mechanism compensates for it?

Systolic arterial blood pressure can decrease by up to 10 mmHg during inspiration, and the pulse rate increases to compensate.

List three possible causes of pulsus paradoxus, a condition where the decrease in systolic blood pressure during inspiration is exaggerated.

Cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy.

What is the significance of observing scars on a patient during a peripheral vascular examination?

Scars may indicate previous surgical procedures related to the vascular system, such as bypass surgery, or healed ulcers, suggesting a history of compromised blood flow. Signup and view all the answers

Explain the relationship between smoking and tar staining observed on the skin.

Tar staining, a discoloration of the skin caused by nicotine deposition, is directly linked to smoking. Smoking is a major risk factor for cardiovascular diseases, including PVD, coronary artery disease, and hypertension. Signup and view all the answers

What are the two most common causes of an absent radial pulse, excluding congenital absence?

Iatrogenic causes, such as after catheterization, and aortic dissection involving the subclavian artery. Signup and view all the answers

How can the presence of xanthomata on a patient indicate a potential cardiovascular risk?

Xanthomata, raised yellow deposits containing cholesterol, are associated with hyperlipidemia. Hyperlipidemia is a significant risk factor for cardiovascular diseases, including PVD and coronary artery disease. Signup and view all the answers

Describe the procedure for assessing radio-radial delay, a finding suggestive of asynchronous radial pulses.

Palpate both radial pulses simultaneously, and note if they occur at the same time. If the pulses are out of sync, it is considered radio-radial delay. Signup and view all the answers

Name two conditions that can cause a wide pulse pressure, defined as a difference of over 100 mmHg between systolic and diastolic blood pressure.

Aortic regurgitation and aortic dissection. Signup and view all the answers

Describe the characteristics of a limb that is experiencing poor arterial perfusion.

A limb with inadequate arterial perfusion will be cool and pale, indicating a reduced blood flow to the tissues. Signup and view all the answers

Explain the difference between peripheral pallor and peripheral cyanosis in terms of skin color and associated medical conditions.

Peripheral pallor is a pale skin color indicative of poor perfusion, while peripheral cyanosis is a bluish discoloration associated with low SpO2 (oxygen saturation) in affected tissues. Signup and view all the answers

What are the possible reasons for a patient to have a missing limb or digit?

The absence of a limb or digit can be due to amputation, a procedure often performed in cases of critical ischemia, where blood flow to the affected area becomes severely compromised. Signup and view all the answers

Describe the appearance of ischemic rubor and its typical cause.

Ischemic rubor is a dusky-red discoloration of the leg that develops when the limb is dependent. It is commonly associated with reduced blood flow to the legs. Signup and view all the answers

What is the purpose of assessing capillary refill time (CRT) during a peripheral vascular examination?

Capillary refill time (CRT) is a measure of peripheral perfusion, assessing how quickly blood returns to the capillaries after pressure is applied. A prolonged CRT indicates poor blood flow to the extremities. Signup and view all the answers

Why is it essential to note any dressings and limb prostheses during a general inspection of a patient?

Observing dressings and prosthetic limbs can provide insights into the patient’s current condition and previous medical interventions. Dressings suggest recent surgical procedures, while prostheses indicate limb loss, possibly due to vascular disease. Signup and view all the answers

How can the presence of peripheral cyanosis be linked to peripheral vascular disease (PVD)?

Peripheral cyanosis, a bluish discoloration of the skin, occurs due to low oxygen saturation in the affected tissues. In PVD patients, poor perfusion can lead to reduced oxygen levels in the extremities, resulting in cyanosis. Signup and view all the answers

When assessing for radio-femoral delay, what two pulses are palpated simultaneously?

The femoral pulse and the radial pulse are palpated simultaneously. Signup and view all the answers

What is the significance of a bruit heard over the femoral artery?

A bruit heard over the femoral artery is significant as it suggests either femoral or iliac stenosis. Signup and view all the answers

How are the fingers positioned when palpating the popliteal pulse?

This positioning allows for compression of the popliteal artery against the tibia, making it easier to feel the pulse. Signup and view all the answers

Describe the location of the posterior tibial pulse.

The posterior tibial pulse is located posterior to the medial malleolus of the tibia. Signup and view all the answers

Why is it important to compare the pulse strength of the posterior tibial and dorsalis pedis pulses between the feet?

Comparing the pulse strength helps identify any discrepancies which may indicate a problem with blood flow to one foot compared to the other. Signup and view all the answers

During Buerger's test, what color change in the limbs indicates inadequate arterial supply?

Pallor, or paleness, in the limbs indicates inadequate arterial supply. Signup and view all the answers

What is the clinical significance of Buerger's angle?

Buerger's angle refers to the angle at which pallor develops during the test, and a lower angle (<20º) suggests severe limb ischemia. Signup and view all the answers

What specific blood pressure measurement can be used to identify aortic dissection?

Blood pressure measurements should be taken in both arms, and significant discrepancies between the two arms can be suggestive of aortic dissection. Signup and view all the answers

What condition is indicated by ischaemic rubour in the lower limbs?

Ischaemic rubour indicates loss of capillary tone associated with peripheral vascular disease (PVD). Signup and view all the answers

Describe the typical characteristics of venous ulcers.

Venous ulcers are typically large, shallow, have irregular borders, and are mildly painful, often developing over the medial aspect of the ankle. Signup and view all the answers

What are the common locations for arterial ulcers?

Arterial ulcers most commonly develop on the toes, feet, or bony areas, and are small, well-defined, and very painful. Signup and view all the answers

What are the typical appearances of gangrene?

Gangrene typically presents as tissue necrosis with changes in skin color, such as red or black, and breakdown of associated tissue. Signup and view all the answers

What does a capillary refill time (CRT) greater than two seconds indicate?

A CRT greater than two seconds indicates poor peripheral perfusion. Signup and view all the answers

Where can the femoral pulse be palpated?

The femoral pulse can be palpated at the mid-inguinal point, halfway between the anterior superior iliac spine and the pubic symphysis. Signup and view all the answers

What are xanthomata, and what condition are they associated with?

Xanthomata are raised yellow cholesterol-rich deposits associated with hyperlipidaemia. Signup and view all the answers

What does a cool and pale limb suggest in the context of lower limb inspection?

A cool and pale limb suggests poor arterial perfusion. Signup and view all the answers

What is the normal heart rate range for adults in beats per minute (bpm)?

The normal heart rate range is between 60-90 bpm. Signup and view all the answers

How does a regular pulse rhythm differ from an irregular one?

A regular pulse rhythm has evenly spaced pulses of equal strength, while an irregular rhythm has varying spacing and strength. Signup and view all the answers

What does a weak pulse imply about blood flow?

A weak pulse can indicate poor blood flow or a decrease in cardiac output. Signup and view all the answers

What characterizes a waterhammer pulse, and what condition is it typically associated with?

A waterhammer pulse has a sharper upstroke and increased amplitude, typically caused by aortic regurgitation. Signup and view all the answers

Describe the characteristics of a pulsus bisfiriens pulse.

Pulsus bisfiriens has two narrowly separated peaks during systole, caused by mixed aortic stenosis with aortic regurgitation. Signup and view all the answers

What is the cause of a slow-rising pulse and its significance?

A slow-rising pulse, typically caused by aortic stenosis, has a slower upstroke and reduced amplitude. Signup and view all the answers

What does pulsus alternans indicate about a patient's heart function?

Pulsus alternans indicates left ventricular systolic impairment, with alternating low and high volume pulses. Signup and view all the answers

Study Notes

Peripheral Vascular Examination

A peripheral vascular examination assesses the blood vessels outside the heart.
General inspection involves checking for missing limbs or digits, potentially due to amputation or critical ischaemia.
Scars may indicate past surgeries (e.g., bypass surgery) or healed ulcers.
Medical equipment like dressings and prosthetics offer clues about a patient's history.
Mobility aids (wheelchairs, walkers) indicate current mobility.
Vital signs (e.g., blood pressure, heart rate) track a patient's current and changing physiological status.
Prescriptions provide information about recent medications.

Upper Limbs

Inspection: Inspect and compare upper limbs for abnormalities.
Finger tip necrosis: A sign of Buerger's disease.
Tar staining: Indicates smoking, a major risk factor for cardiovascular issues.
Tendon xanthomas: Raised yellow cholesterol deposits, linked to hyperlipidaemia.
Limb pallor: Pale skin, indicating poor blood circulation.
Cyanosis: Bluish discolouration of skin, linked to low blood oxygen levels (SpO2).
Gangrene: Tissue necrosis (death) due to poor blood circulation, often showing black or red discolouration.

Lower Limbs

Inspection: Note the lower extremities' colour, including potential pallor.
Peripheral pallor: Pale skin color, indicating poor perfusion.
Peripheral cyanosis: Blue discoloration, showing low blood oxygen.
Ischemic rubour: Dusky-red discoloration, seen with dependent limbs.
Venous ulcers: Large, shallow, irregular borders that are moderately painful.
Arterial ulcers: Small, well-defined, deep ulcers that are severe and typically occur in distal areas.
Gangrene: Tissue death, marked by changes in skin color (red, black).
Missing limbs/toes/fingers: Secondary to critical ischaemia.
Scars: Previous surgical procedures (e.g., bypass surgery or healed ulcers).
Hair loss/Muscle wasting: Indicators of chronic, peripheral vascular disease (PVD).
Xanthomata: Raised yellow deposits, associated with hyperlipidaemia.
Paralysis: Severe limb ischaemia may cause weakness and paralysis.

Temperature and Capillary Refill Time (CRT)

Temperature: Assess upper and lower limbs' temperature using the dorsal aspect of hands.
Healthy limbs are typically symmetrical and warm, suggesting adequate perfusion.
A cool and pale limb indicates poor arterial perfusion.
CRT: Applying five seconds of pressure to a finger or toe, then releasing, to see how quickly colour returns.
Normal CRT returns to normal colour in under 2 seconds.
A slow CRT suggests poor perfusion.

Pulse Character

Rate: Number of pulses per minute (bpm). Normal resting rate is 60-90 bpm.
Rhythm: Regular, evenly spaced pulses. Irregular rhythm can indicate a problem with the heart's electrical system.
Volume: Strength of the pulse; strong pulses indicate good blood flow, while weak ones suggest poor flow or decreased cardiac output.
Character: Shape and duration of the pulse wave. A regular shape and duration are characteristic of a normal pulse. Irregular shapes/durations can indicate problems with heart structure or function.

Pathological Pulses

Waterhammer pulse: Sharp upstroke, increased amplitude, usually due to aortic regurgitation.
Slow-rising/Anacrotic pulse: Gradual upstroke, reduced amplitude, characteristic of aortic stenosis.
Pulsus bisferiens: Two prominent peaks during systole, suggesting mixed aortic stenosis and regurgitation.
Pulsus alternans: Alternating strong and weak pulses, indicative of left ventricular systolic impairment.
Double impulse apex beat: Two palpitations during the single heartbeat, indicating hypertrophic obstructive cardiomyopathy.
Pulsus paradoxus: Pulse decreases during inspiration, associated with conditions like cardiac tamponade, constrictive pericarditis, and severe asthma.

Absent Radial Pulse

A radial pulse that is missing or cannot be palpated, possible causes include post-catheterization, congenital absence, aortic dissection involving the subclavian artery, peripheral artery embolism, compression by the cervical rib, and Takayasu's arteritis.

Buerger's Test

Buerger's test assesses arterial supply to the legs.
Patient lies supine, and legs raised to 45 degrees, for 1-2 minutes.
Observe limb colour changes; pallor indicates poor arterial perfusion.
A Buerger's angle below 20 degrees shows significant ischaemia.

Further Assessments and Investigations

Measure blood pressure in both arms to look for discrepancies indicative of aortic dissection.
Assess the cardiovascular system.
Complete ankle-brachial pressure index (ABPI) measurement.
Conduct a neurological examination of the upper and lower limbs.

Instrumental Methods for Exam of Arterial Perfusion

Blood tests assess conditions like high cholesterol, triglycerides, or diabetes.
Ultrasound of the legs and feet to visualise blood flow.
Angiography (using X-rays, MRI scans or CT) helps to identify blockages in arteries using dye (contrast).

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Description

This quiz focuses on key physical examination findings related to cardiovascular health, including hypertrophic obstructive cardiomyopathy and pulsus paradoxus. Additionally, it examines the significance of scars during vascular assessments, signs of poor arterial perfusion, and the impact of smoking on skin appearance. Test your knowledge of these important clinical indicators.