Cardiovascular Assessment Flashcards

Pulsus paradoxus is defined as a fall in systolic BP greater than 10 mmHg during inspiration. Which condition most commonly causes this finding?

Answer: Cardiac tamponade

Cardiac tamponade causes pulsus paradoxus because pericardial fluid restricts ventricular filling, exaggerating the normal inspiratory drop in left ventricular stroke volume.

During cardiovascular examination you note Kussmaul's sign — the JVP rises paradoxically on inspiration. This is most pathognomonic of which condition?

Answer: Constrictive pericarditis

Kussmaul's sign is pathognomonic for constrictive pericarditis, where a rigid, fibrotic pericardium prevents right heart expansion on inspiration, causing JVP to rise rather than fall.

A pansystolic murmur heard best at the cardiac apex that radiates to the left axilla is most consistent with which diagnosis?

Answer: Mitral regurgitation

Mitral regurgitation produces a pansystolic murmur loudest at the apex that classically radiates to the axilla, reflecting the direction of the regurgitant jet from the mitral valve.

With the patient at 45 degrees, you measure JVP pulsation 5 cm above the sternal angle. How do you interpret this finding?

Answer: Mildly elevated JVP

Normal JVP is ≤3–4 cm above the sternal angle at 45°; a measurement of 5 cm represents a mildly elevated JVP, suggesting impaired right heart filling or increased central venous pressure.

During the peripheral cardiovascular inspection, you observe yellow plaques at the medial canthi of both eyes. These are called xanthelasma and are associated with which risk factor?

Answer: Hyperlipidemia

Xanthelasma are cholesterol deposits in the periorbital skin, most strongly associated with hyperlipidemia and elevated cardiovascular risk.

You auscultate a mid-systolic click followed by a late systolic murmur at the apex. Which condition does this pattern most strongly suggest?

Answer: Mitral valve prolapse

The classic auscultatory hallmark of mitral valve prolapse is a mid-systolic click (leaflet billowing) followed by a late systolic murmur from resulting mitral regurgitation.

Which maneuver increases the intensity of the murmur in hypertrophic obstructive cardiomyopathy (HOCM)?

Answer: Standing

Standing reduces preload by decreasing venous return, which decreases left ventricular volume and worsens the dynamic outflow obstruction in HOCM, increasing murmur intensity.