18. Examination of the Cardiovascular System Flashcards
What is the examination routine of the CVS?
General examination, inspection, palpation, auscultation.
What is looked at in the general examination?
General inspection of: hands, arms (pulse and BP), neck (pulse and jugular venous pressure), face, and chest.
What is looked for on the hands in CVS examinations?
Cyanosis - peripheral discolouration of the skin, splinter haemorrhages, clubbing, Janeway lesions/Osler’s nodes, tar staining.
How should the pulse rate be measured in CVS examination?
Count beats for 15 seconds and multiply by four if regular, feel for longer if irregular. Character assessed at carotid artery.
What is hypertension a major risk factor for?
Coronary heart disease, atrial fibrillation, cerebro-vascular accident, renal failure.
What are the bloop pressure of hypotension and hypertension?
Hypo - 140/90.
How is the jugular venous pressure examined?
Patient supported at 45 degrees with head turned to the left. Look for pulsation along the line of the internal jugular vein.
What is looked for on the face in CVS examinations?
Eyes - corneal arcus, xanthalasma, mouth - central cyanosis, dentition, mitral facies.
Where should be palpated in CVS examinations?
Apex beat in 5t ICS mid clavicular line - test more laterally too for enlarged heart. Heaves and thrills (palpable murmurs).
How are heaves tested for?
Use palm resting just left of sternum, normally there is no impulse felt but if there is, then it’s due to right ventricular enlargement or severe left atrial enlargement.
What are the four main areas of auscultation and where are they listened to?
Mitral - MCL 5th ICS, tricuspid - left sternal edge 4th ICS, pulmonary - left sternal edge 2nd ICS and aortic - right over sternum 2nd ICS.
What causes the S1 and S2 heart sounds?
S1 - closure of mitral and tricuspid valves.
S2 - closure of aortic and pulmonary valves.
What are S3 and S4 heart sounds caused by?
S3 - normal in young, fit adults.
S4 - pathological always.
What noise do murmurs make?
Humming or swishing from turbulent blood flow or increased velocity/ volume through a normal valve.
What are the following common murmurs heard?
a. mitral regurgitation.
b. mitral stenosis.
c. aortic stenosis.
d. aortic regurgitation.
a. left axilla.
b. over mitral area using bell with patient rolled to left.
c. carotid arteries.
d. patient sat forward, breathe in and hold and then listen at 5th ICS left sternal edge.
