Cardiac

Question 1

Cardiac assessment overview

Answer 1

Focussed History

Inspection

• Face
• Eyes
• Mouth
• Hands
• Feet
• Chest

Palpation:

• Pulses (incl. Apical)
• Chest
• Vavles

Auscultation:

• Carotid
• APTM
• Aortic, Renal, Iliac Pulses

Question 2

Cardiac focussed history

Answer 2

1. Loss of consciousness (syncope)
2. Tiredness (fatigue)
3. SOB – day/night
4. Chest pain
5. Arm or jaw numbness
6. Previous MI, angina, hypertension
7. Surgery
8. Indigestion
9. Leg cramps

Question 3

Cardiac Inspection

Answer 3

1. Face
   
   • Colour - Yelowing, perfusions
   • Diaphoresis/dry (clammy/deydrated)
   • Xanthelasma (yellow raised lesions - high cholesterol)
2. Eyes
   
   • Sclera colour (yellowing = jaundie)
   • Eyelid colour ((pale = anaemia)
3. Mouth
   
   • Mucous membrane colour & oisture
   • Dental hygiene (most common cause of endocardititis)
4. Hands
   
   • Colour
   • Warmth
   • Splinter haemorhage
   • Clubbing
   • Koilonychias
   • Cap refill
   • Xanthomata (raised yellow lesions - build up of lipids)
5. Feet
   
   • Colour, warmth, clubbing, oedema
6. Chest
   
   • Colour
   • Scars
   • Symetry
   • Deformity incl pacemaker)
   • Abnormal movments (look tangentially)
   • JVP (>4cm = r sided HF/ high volume — <2cm not sig, may not be visible)
   • Apical beat (aka Point of Maximal Impulse)

Question 4

Cardiac Palpation

Answer 4

1. Pulses (Rate, rhythm, strengh, bilateral comparison)
   
   1. Radial
   2. Brachial
   3. Carotid
   4. Doraslis pedis
   5. Posterier tibial
   6. Popilitel
   7. Apical (5th intercostal - mid clav - ? abnormal location)
2. Chest
   
   1. Abnormal movments
   2. symetry
   3. Deformity
   4. Central cap refil (perfussion, hypovol, poor cardiac outptut, vasc disease
   5. Precordium (hand either side - heaves and thrills)
3. Valves
   
   1. APTM Should not be able to feel heaves or thrils
   2. Heaves = sustained thristin pulastion (RV enlargement)
   3. Thrills = shudderign (severe valvular disease)

Question 5

Cardiac Auscultation

Answer 5

1. Carotid (Bruits = vascular murmur due to turbulent flow form ostruction)
2. APTM (Bell = low pitch + Diaphragm = high pitch)
   
   • S1 = mitral valve closure mainly (louder in TM
   • S2 = AP valve closures - louder in AP
   • Murmurs
   • Extra sounds?
3. Pulses
   
   • Aortic
   • Rebal
   • Iliac