Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Cardiac Clinical Findings

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Cardiovascular Examination Findings and Their Causes

Finding	Appearance	Possible Causes
Cyanosis	Bluish discoloration of the lips, fingertips, or skin	- Congenital heart disease - Severe heart failure - Pulmonary hypertension - Hypoxaemia (low blood oxygen levels)
Clubbing	Bulbous enlargement of the ends of the fingers or toes	- Infective endocarditis - Congenital heart disease - Cyanotic heart disease - Lung cancer (secondary cause affecting the heart)
Jaundice	Yellowing of the skin and sclerae (whites of the eyes)	- Right heart failure leading to hepatic congestion - Infective endocarditis with haemolysis - Congestive hepatopathy
Peripheral Oedema	Swelling of the ankles, feet, or legs	- Right heart failure - Chronic venous insufficiency - Nephrotic syndrome (secondary to heart disease) - Deep vein thrombosis (DVT)
Distended Jugular Veins	Prominent neck veins when sitting or standing	- Right heart failure - Constrictive pericarditis - Cardiac tamponade - Tricuspid regurgitation
Hepatomegaly	Enlarged liver, palpable below the right costal margin	- Right heart failure - Tricuspid regurgitation - Constrictive pericarditis - Cardiac cirrhosis
Ascites	Accumulation of fluid in the abdomen, causing distension	- Right heart failure - Constrictive pericarditis - Cardiac cirrhosis
Cachexia	Severe weight loss and muscle wasting	- Advanced heart failure - End-stage heart disease - Chronic illness affecting the heart (e.g., cancer, severe COPD)
Palmar Erythema	Reddening of the palms	- Chronic liver disease (secondary to heart failure) - Infective endocarditis - Rheumatic heart disease
Splinter Haemorrhages	Small, red or brown streaks under the fingernails	- Infective endocarditis - Vasculitis - Trauma (may not be cardiac-related)

Types of Pulses and Clinical Significance

Pulse Type	Characteristics	Associated Conditions
Normal Pulse	Regular rhythm and amplitude, easily palpable	Healthy individuals with normal cardiovascular function
Bounding Pulse	Strong, forceful pulse, often with a rapid upstroke	- Fever - Anaemia - Hyperthyroidism - Aortic regurgitation - Pregnancy
Thready Pulse	Weak, fine, and difficult to palpate; may be rapid	- Shock - Severe dehydration - Heart failure
Pulsus Paradoxus	Exaggerated decrease in pulse amplitude during inspiration (>10 mmHg drop in systolic BP)	- Cardiac tamponade - Constrictive pericarditis - Severe asthma - Chronic obstructive pulmonary disease (COPD)
Pulsus Alternans	Alternating strong and weak pulse beats	- Left ventricular failure - Severe heart failure
Pulsus Bisferiens	Two systolic peaks per cardiac cycle, best felt in the carotid artery	- Aortic regurgitation with aortic stenosis - Hypertrophic obstructive cardiomyopathy
Pulsus Tardus et Parvus	Slow rising and weak pulse	- Aortic stenosis
Pulsus Bigeminus	Normal beat followed by a premature beat, causing a regularly irregular rhythm	- Premature ventricular contractions (PVCs) - Digitalis toxicity
Pulsus Deficit	Difference between the apical pulse and peripheral pulse rate	- Atrial fibrillation - Premature ventricular contractions (PVCs)

Summary of Cardiac Murmurs and Clinical Findings

Murmur	Location	Timing	Clinical Findings
Aortic Stenosis	Right upper sternal border (2nd intercostal space)	Systolic ejection murmur	- Harsh, crescendo-decrescendo murmur - Radiates to the carotids - Associated with weak pulses and delayed carotid upstroke (pulsus parvus et tardus) - May present with angina, syncope, or heart failure
Mitral Regurgitation	Apex (5th intercostal space, midclavicular line)	Holosystolic murmur	- Blowing, high-pitched murmur - Radiates to the axilla - Associated with left atrial enlargement and pulmonary congestion - May present with dyspnoea, fatigue, and atrial fibrillation
Aortic Regurgitation	Left lower sternal border (3rd/4th intercostal space)	Diastolic decrescendo murmur	- Blowing, high-pitched murmur - Best heard with the patient leaning forward and exhaling - Associated with wide pulse pressure, bounding pulses, and head bobbing (de Musset's sign) - May present with dyspnoea, fatigue, and palpitations
Mitral Stenosis	Apex (5th intercostal space, midclavicular line)	Diastolic rumbling murmur	- Low-pitched, rumbling murmur with an opening snap - Best heard with the patient in the left lateral decubitus position - Associated with left atrial enlargement and pulmonary hypertension - May present with dyspnoea, haemoptysis, and atrial fibrillation
Tricuspid Regurgitation	Left lower sternal border (4th intercostal space)	Holosystolic murmur	- Blowing murmur, increases with inspiration (Carvallo's sign) - Associated with right ventricular enlargement and signs of right heart failure - May present with jugular venous distension, hepatomegaly, and edema
Pulmonic Stenosis	Left upper sternal border (2nd intercostal space)	Systolic ejection murmur	- Harsh, crescendo-decrescendo murmur - Radiates to the left shoulder - Associated with right ventricular hypertrophy - May present with dyspnoea, fatigue, and cyanosis (in severe cases)
Ventricular Septal Defect (VSD)	Left lower sternal border	Holosystolic murmur	- Loud, harsh murmur - No radiation - Associated with left-to-right shunt, may lead to heart failure - Large defects may present with dyspnoea, poor feeding, and failure to thrive in infants
Patent Ductus Arteriosus (PDA)	Left infraclavicular area	Continuous "machine-like" murmur	- Murmur heard throughout systole and diastole - Best heard in the left infraclavicular area - Associated with bounding pulses and wide pulse pressure - May present with signs of heart failure in severe cases

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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