Cardiovascular System : Physical Examination -IV

Cardiovascular System : Physical Examination -IV

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Collapsing pulse is associated with all of the following EXCEPT-

Correct! Wrong!

ANSWER -B
Collapsing pulse - associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance leading to the widened pulse pressure of aortic regurgitation.

Bisferiens pulse is seen in –

Correct! Wrong!

ANSWER -A
Bisferiens pulse is seen in : aortic regurgitation with or without concurrent aortic stenosis and severe HOCM..

When a prominent ‘a’ waves present in severe AS that reflects –

Correct! Wrong!

ANSWER -C
The jugular venous pulse is usually normal, but prominent a waves may be present, reflecting reduced right ventricular (RV) compliance due to hypertrophy of the interventricular septum. <
Bernheim effect – Aortic Stenosis – LVH – LV Pressure Overload - Bulging of the interventricular septum into the right ventricle - impedance in RV filling - elevated jugular venous pressure - prominent venous "a" wave- Right ventricular failure - right heart failure that sometimes precedes left heart failure.

Which type of Aortic Stenosis complication commonly result in Heart Block –

Correct! Wrong!

ANSWER -B
In calcific aortic stenosis - the calcification in and around the aortic valve can progress and extend to involve the electrical conduction system of the heart. If that occurs, the result may be heart block.

Severity of the AS correlates with all of the following EXCEPT –

Correct! Wrong!

ANSWER -A
Intensity of the systolic murmur does not correspond to the severity of aortic stenosis. Timing of the peak and the duration of the murmur corresponds to the severity of aortic stenosis.
The more severe the stenosis- longer duration of the murmur and peaks at late systole.

Hyperdynamic LV in a case of Aortic Stenosis Suggest –

Correct! Wrong!

ANSWER -C
Hyperdynamic LV in a case of AS - suggests concomitant aortic regurgitation or mitral regurgitation.

Ejection click in AS is common in –

Correct! Wrong!

ANSWER -A
Ejection click is common in children and young adults with congenital aortic stenosis – mobile valve leaflets.
Elderly individuals with acquired calcific aortic stenosis- cusps become immobile and severely calcified. Elderly individuals with acquired calcific aortic stenosis- cusps become immobile and severely calcified.

Pulsus paradoxus is common in all of the following EXCEPT –

Correct! Wrong!

ANSWER -D

Pulsus paradoxus refers to a fall in systolic pressure >10 mmHg with inspiration that is seen in patients with pericardial tamponade – 

also is described in those with – 

  • Massive pulmonary embolism, 
  • Hemorrhagic shock, 
  • Severe obstructive lung disease,
  • Tension pneumothorax

Pulsus paradoxus is present when the measured pressure difference exceeds – [SBP when korotkoff sound heard in expiration - SBP when korotkoff sound heard independent of respiration]

Correct! Wrong!

ANSWER -A
A pulsus paradoxus may be palpable at the brachial artery or femoral artery level when the pressure difference exceeds 15 mmHg.
Pulsus paradoxus is measured by noting the difference between the systolic pressure at which the Korotkoff sounds are first heard (during expiration) and the systolic pressure at which the Korotkoff sounds are heard with each heartbeat, independent of the respiratory phase.

Pulsus alternans is seen in patients with –

Correct! Wrong!

ANSWER -B
Pulsus alternans is seen in patients with severe LV systolic dysfunction

Which is FALSE regarding Bruit in Carotid Artery –

Correct! Wrong!

ANSWER -A
Absence of a bruit does not exclude the presence of significant luminal Obstruction.
Obstruction is usually severe - If a bruit extends into diastole or if a thrill is present.

All of the following are correct for S4 EXCEPT -

Correct! Wrong!

ANSWER -D
S4 SUGGESTS -

  • Palpable presystolic impulse
  • Reduced LV compliance
  • Forceful contribution of atrial contraction

Triple cadence beat at the cardiac apex is seen in -

Correct! Wrong!

ANSWER -C
HOCM sometimes cause a triple cadence beat at the apex - palpable S4 with two components of the Bisferiens systolic pulse.

Pulsus Paradoxux is present in -

Correct! Wrong!

Pulsus paradoxus typically manifests in patients with pericardial disease, notably, cardiac tamponade and constrictive pericarditis. Other cardiac causes include right ventricular infarction and restrictive cardiomyopathy.

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