Cardiac Lesions and Severe Clinical Signs

AORTIC STENOSIS

  • Slow rising pulse
  • S4
  • Paradoxical splitting of the second heart sound
  • Aortic thrill
  • Length and harshness of murmur
  • LVH – displaced apex beat
  • LVF – a late sign

MITRAL STENOSIS

  • Small pulse pressure
  • Soft first heart sound
  • Early opening snap
  • Long diastolic murmur
  • Diastolic thrill @ apex
  • PHT signs

MITRAL REGURGITATION

  • Small volume pulse
  • Displaced forceful apex
  • Pansystolic murmur -> axilla
  • S3
  • Soft S1
  • A2 early
  • Early diastolic rumble
  • AF
  • LVF signs

AORTIC REGURGITATION

  • Collapsing pulse
  • Wide pulse pressure
  • Long decrescendo diastolic murmur
  • S3
  • Soft A2
  • Austin Flint murmur (low pitched rumbling mid-diastolic and presystolic murmur @ apex)
  • LVF

MITRAL VALVE PROLAPSE

  • Click -> high pitched late-systolic murmur extending throughout systole

TRICUSPID REGURGITATION

  • JVP: Large v-waves, elevated
  • Right ventricular heave
  • Pansystolic murmur @ the lower sternal edge (increases with inspiration)
  • Large, pulsatile liver
  • Ascites
  • Peripheral oedema

PULMONARY STENOSIS

  • Ejection systolic murmur peaking late in systole
  • Absent ejection click
  • S4
  • RVF signs

ASD

  • wide fixed splitting of S2
  • mid diastolic flow murmur over tricuspid area (when significant shunt present)

VSD

  • harsh pansystolic murmur @ left sternal edge
  • systolic thrill
  • mid diastolic flow murmur over mitral area (when significant shunt present)

PATENT DUCTUS ARTERIOSUS

  • continuous murmur over pulmonary area
  • mid diastolic flow murmur over mitral area (when significant shunt present)
CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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