Cardiac Physical Diagnosis Mnemonics

By : Dr. Subrahmanyam Karuturi

> No apex beat DOPES
Dextrocardia (don’t say this first!), Obesity, Pleural/Pericardial effusion, Emphysema, Shock.

 > 3rd Heart Sound FIPPY
Failure, Incompetence (mitral/tricuspid), Pregnancy/Pill/PE/Pericarditis, Youth

 > 4th Heart Sound SHIT
Stenosis (aortic/pulmonary), Hypertension/Heart Block, Ischaemic HD, Tamponade

> All Prostitutes Take Money
The order of resuscitation for heart sounds from right to left:
Aortic, Pulmonary, Tricuspid, Mitral

> JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium

> Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis
 

  > Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis/ Pericardial tamponade/ Pneumothorax
Emphysema
Sinus inversus/ Student incompetence/ Scoliosis/ Skeletal abnormalities (eg pectus excavatum)

> Murmurs: louder with inspiration vs expiration LEft sided murmurs louder with Expiration
RIght sided murmurs louder with Inspiration.

  > Murmurs: questions to ask SCRIPT:
Site
Character (eg harsh, soft, blowing)
Radiation
Intensity
Pitch
Timing

> Murmurs: innocent murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression

 
  > Murmur attributes "IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing
 

> Apex beat: abnormalities found on palpation, causes of impalpable HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia

> Murmurs: locations and descriptions "MRS A$$":
MRS: Mitral Regurgitation--Systolic
A$$: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.

> Heart murmurs "hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic

> Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

> Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".

> Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase

> Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].

> Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.

> Heart valve auscultation sites "All Patients Take Meds":
· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.
· Alternatively: Always Pumps Too Much.

  > Heart valve auscultation sites "All People Try Marijuana":
Aortic
Pulmonic
Tricuspid
Mitral

> Branham sign: definition BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.

> Heart ausculation sites: ribs Apt. M 225A:
Aortic valve
Pulmonary valve
Tricuspid valve
Mitral valve
· In order they correspond with the following landmarks:
2nd intercostal space (right)
2nd intercostal space (left)
5th intercostal space (left)
Apex (still the 5th intercostal space)

> Pain history checklist OLDER SAAB:
Onset
Location
Description (what does it feel like)
Exacerbating factors
Radiation
Severity
Associated symptoms
Alleviating factors
Before (ever experience this before)

> JVP: raised JVP differential PQRST (EKG waves):
Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)

 
  > JVP: raised JVP: extra-cardiac causes FAT PEA:
Fever
Anaemia
Thyrotoxicosis
Pregnancy
Exercise
A-V fistula
· These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).

> JVP MOP HAIR
Multiple wave form, Occludable, Postural changes
Hepatojugular reflex, Above (fills from), Impalpable, Respiratory changes

> Non-pitting lower limb oedema MI CHAM
Milroys, infection (filariasis), Congenital, Hypothyroid, Allergy, Malignancy

> Haemoptysis: causes CAVITATES:
CHF
Airway disease, bronchiectasis
Vasculitis/ Vascular malformations
Infection (eg TB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach

> Cyanosis: DDx COLD PALMS:
· Peripheral cyanosis:
Cold
Obstruction
LVF and shock
Decreased cardiac output
· Central cyanosis:
Polycythemia
Altitude
Lung dz
Met-, sulphaemoglobinaemia
Shunt

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