Clinical Examination - Cardiovascular System (IV) - Flashcards in University Medicine

1. Which investigation may indicate a thoracic aneurysm when a widened mediastinum is present?

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Displacement of the apex beat outward (towards the axilla) may be indicative of right ventricular hypertrophy
Can be palpated in the 4th intercostal space in the midclavicular line
Is caused by the left ventricle moving forwards and striking the chest wall during systole
Displacement of the apex beat outward and downwards may be indicative of left ventricular hypertrophy
Is defined as the most lateral and inferior position at which the cardiac impulse can be felt
When accessing the apex beat, a heave is a palpable impulse that noticeably lifts your hand
When accessing the apex beat, a thrill is a tactile equivalent of a murmur and is a palpable vibration

Mid-diastolic murmurs are usually caused by mitral stenosis, which is best heard at the apex with the bell of a stethoscope, where the patient is positioned on to their left
The typical associated murmur is caused from aortic regurgitation
A murmur of a tricuspid stenosis is rare but similar to that of mitral stenosis
Commonly associated murmur is caused from pulmonary regurgitation
Best heard at the left sternal edge, with the patient leaning forward in held expiration

Superior spatial resolution to investigate the aetiology of heart diseases (cardiomyopathy)
To detect the cardiothoracic ratio, which would indicate valvular heart disease and heart failure with figures >0.5
To provide an image of the coronary circulation and for revascularisation
Superior temporal resolution of coronary arteries, for patients with low to intermediate risk of coronary artery disease

Leads I, aVL, v5 and v6 are lateral leads
Shows the sound waves, which evaluate valve abnormalities
Leads v1 and v2 are considered as septal leads
Leads II, III and aVF are inferior leads
Illustrates the depolarisation wave movement with each heart beat (wave of positive charge)
Leads v3 and v4 are known as anterior leads