What is S1 and S2 due to?
- S1
- Closing of mitral and tricuspid valves, start of systole
- S2
- Closing of aortic and pulmonary valves, start of diastole
What can cause heart murmur?
- Abnormal valve
- Increased volume or velocity of blood
- Abnormal openings between chambers, usually congenital
Where are the 4 valves listened for?
- Aortic
- 2nd right intercostal
- Pulmonary
- 2nd left intercostal
- Tricuspid
- 4th left intercostal
- Mitral
- Apex (5th left mid-clavicular line)
What are causes of added heart sounds
- S3
- Heard in diastole
- Below 40 physiological, over 40 left ventricular failure and mitral regurgitation
- S4
- Just before S1
- Left ventricular hypertrophy
- Snaps
- Mechanical valves
- Pericardial rub
What do you comment on for radial pulse
- Rate
- Rhythm
- Regular, regularly irregular, irregularly irregular
- Volume
- Normal, bounding, full, thready, low
- Character
- Normal, slow rising, collapsing
Angular stomatitis and sore red tongue
Iron deficiency anaemia
Xanthelasmata and corneal arcus?
Hypercholesteraemia
How long do you hold checking for oedema
15 seconds
What is normal JVP
<4cm
Heaves
Left ventricular hypertrophy
Thrills
Palpable murmur, usually systolic
What do you commen on in auscultation?
Heart sounds S1 and S2
Added sounds (S3, S4)
Murmurs
What are systolic murmurs?
Aortic stenosis
Mitral regurgitation
What are diastolic murmurs?
Aortic regurgitation
Mitral stenosis
For BP how far above estimate do you go
30mmHg
What is normal BP, stage 1 and stage 2 hypertension?
- Normal
- 120/80
- Stage 1
- 140/90
- Stage 2
- 160/100
How do you analyse ECG?
- ARIBAR
- A
- Activity?
- R
- Rhythym (count 30 big squares and multiple by 10)
- I
- Irregular or regular
- B
- Broad or narrow QRS complex (should be <0.12s) from start of Q to end of S
- A
- Is atrial activity present
- R
- Relationship between atrial and ventricular activity
- Is P followed by QRS, is QRS preceeded by P
- PR interval should be 0.12-0.2s)
Where do ECG limb leads to?
- Red
- Right arm
- Yellow
- Left arm
- Green
- Left leg
- Black
- Right leg
Where do ECG chest leads to?
- V1
- 4th left intercostal
- V2
- 4th right intercostal
- V3
- Between V2 and 4
- V4
- Apex beat
- V5
- Between V4 and 6
- V6
- Horizontally aligned with apex beat on mid axilla line
