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Clinical Skills > Cardiac Exam > Flashcards

Cardiac Exam Flashcards

1
Q

First thing to do in cardiovascular exam

A
  • general inspection from 5 feet away:
    a) distressed?
    b) body habitus ( size an shape of the person - refer to the person’s bmi i.e. they have a very high bmi rather than they are morbidly obese)
    c) well vs. unwell appearance (combo of skin colour,, level of distress, breathing pattern, level of consciousness, body habitus, facial expression ect)
  • well nourished
  • well perfused
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2
Q

After general inspection hat comes next

A

Vitals

  • BP
  • HR
  • RR
  • O2 sat
  • pulsus paradoxus
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3
Q

Pulsus paradoxus

A

A decrease in systolic pressure during inspiration and/or an increase in systolic pressure during expiration
-when difference in systolic pressures is greater than 10 mmHg it is considered abnormal

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4
Q

When does pulsus paradoxus occur

A

Occurs with:

a) cardiac tamponade
b) severe volume depletion
c) severe asthma

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5
Q

Things to check for on the hands/wrists/fingers

A

1) Clubbing
2) Cyanosis (peripheral)
3) Capillary refill
4) Radial and brachial pulses
5) Splinter haemrrhage
6) Janeway lesions
7) Osler’s nodes
8) Raynaud’s phenomenon

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6
Q

Clubbing

A
  • a bulbous swelling of the soft tissue at the nail base
  • loss of normal angle between the nail an the proximal nail fold (angle inreases to 180 +)
  • nail bed feels spongy or floating
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7
Q

Mechanism of clubbing

A

-still not completely known

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8
Q

Conditions that cause clubbing

A

X

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9
Q

Signs of bacterial endocarditis

A
  • splinter haemorrhages
  • janeway’s lesions
  • osler’s nodes
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10
Q

Splinter haemorrhage

A

X

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11
Q

Janeway’s lesions

A

X

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12
Q

Osler’s nodes

A

X

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13
Q

Reynaus phenommenon

A

Vasoconstriction in the fingers

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14
Q

Capillary refill

A

The tine reqiured for finger nail to return to the pink colour after it has been squeeze

  • normal is < 2 seconds (brisk)
  • abnormally long times usually indicate poor circulation (a number of causes)
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15
Q

Things to note on examination of the radial pulse

A

1) Amplitude of the pulse = the size or strength of the pulse
2) Upstroke- how quickly the pulse reaches it maximum
3) Rate = frequency of pulse
4) Rhythm = description of regularity of pulse

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16
Q

Technique for palpation of an artery

A
  • gently (too much pressure will occlude the artery an the pulse will be absent)
  • use to figers
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17
Q

Things to inspect on legs

A

1) Pedal oedema
2) Pulses (femoral, popliteal, dorsalis pedis, posterior tibialis)
3) temperature
4) Signs of chronic poor circulation (loss of hair, discoloration, ulcers)
5) Achilles tendon xanthomata

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18
Q

Achilles tendon xanthoma

A
  • disfiguring cholesterol deposits
  • appreciable by palpation and visualization of the achilles tendon
  • sign seen in familial hypercholesterolemia
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19
Q

Things to exam in eyes

A

Eyes:

  • corneal arcus
  • xanthalosma
  • fundoscopic exam
  • colour of conjunctiva (pale or pink)
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20
Q

Corneal arcus

A
  • a gray color arc or circle that is superimposed on the outer edge of the iris (colored part of the eye)
  • can be a sign of high cholesterol (also common in elderly = arcus senilus where is not representative of cholesterol level)
21
Q

Xantholasma

A
  • fatty deposits in the skin that surround the eye

- sign of high cholesterol

22
Q

Importance of fundoscopic exam

A

Is the only place in the body where we can directly see arteries and veins

23
Q

Things to exam in mouth

A

1) Petechia (petechiae)
2) Dentition
3) Central cyanosis

24
Q

Signs/ Cause of petechiae of oral mucosa

A
  • red/purple spot
  • cause by minor haemorrage (broken capillary vessel)
  • occurs with bacterial endocarditis
25
Q

Dental pathology - importance

A

May alert the examiner to the risk for endocarditis

26
Q

Central cyanosis

A

-cyanosis of the oral mucosa (not the lips which can appear cyanotic in a patient who is cold)

27
Q

Things to examine in the neck

A

1) Accessory muscle use
2) Carotid auscultation
3) Carotid palpation
4) JVP inspection
5) Thyroid gland

28
Q

Order of examination of the carotid + why

A

Carotid auscultaation should precede palpation because if there is a bruit then atherosclerotic stenosis might be present and if so then a plaque could be dislodged by palpation

29
Q

Things to comment on during inspection of carotid pulse

A
  1. Amplitude
  2. Upstroke
  3. Rate
  4. Rhythm
30
Q

Pulsus parvus and tardive-define + causes

A

Small weak pulse
-upstroke may feel slowed an the peak prolonge
Causes
1) decreased stroke volume (i.e. heart failure, hypovolemia, severe aortic stenosis)
2) Increased peripheral resistance (exposure to cold, severe heart failure)

31
Q

Waterhammer pulse

A
  • a large, bounding pulse
    -the rise and fall are rapid, the peak is brief
    Causes:
    1) Increased stroke volume decreased peripheral resistance or both (anemia, hyperthyroidism, aortic regurg, arteriovenous fistulas , PDA)
    2) Increased stroke volume because of slow heart rate (bradycardia) and cmlpete heart block
    3) Decreased compliance of aortic walls (aging, artherosclerosis)
32
Q

Inspection of JVP- things to note (vs. carotid)

A
  1. Biphasic vs. monophasic
  2. Changes with position vs. does not
  3. Increase with AJR vs. does not
  4. Changes with respiration vs. does not
  5. Non-palpable vs. palpable
  6. Obliterable vs. not
33
Q

JVP changes with position

A

Drops as the patient becomes more upright

34
Q

JVP changes with increase in AJR

A

Height increases with increase in pressure

35
Q

JVP changes with respiration

A

Height of pulsations fall with inspiration

36
Q

Signs of respiratory distress

A
  • use of accessory muscles

ex: sternocleidomastoid

37
Q

Inspection of the back

A
  1. Percuss the lungs
  2. Auscultate the lungs
  3. Sacral oedema
38
Q

Things to note when auscultating/percussing lungs

A
  • equal air entry bilaterally

- no adventitious sounds heard (crackles, wheezes)

39
Q

What do crackles indicate

A

Pulmonary oedema

Pulmonary fibrosis

40
Q

What do wheezes indicate

A

Early interstial oedema

Asthma/COPD

41
Q

When does sacral oedema frequently develop

A

In persons who have been lying down for a long time

42
Q

Examination of the chest -general

A
  1. Inspect
  2. Palpate
  3. Percuss/ausculate lungs
  4. Ausculate heart
43
Q

things to inspect on the chest

A
  1. Cardiac pulsations
  2. Scars and pacemakers
  3. Pectus excavatum, pectus carinatum
44
Q

Cardiac pulsations to observe

A
  1. Apex beat
  2. Visible lifts
  3. Pulmonary artery pulsations (visible in severe hypertension)
  4. Valve positions
45
Q

Pectus excavatums

A

Hollowed chest

46
Q

Pectus carinatum

A

Protrusion of sternum and ribs (due to overgrowth of cartilage causing sternum to protrude forward)

47
Q

Things to palpate on chest

A

1) Apex
2) Right ventricular heave
3) Pulmonary artery
4) 4 valve areas for thrills

48
Q

Apex

A 
-most lateral position 
Note
-size (how many interspaces)
-mono vs. bi vs. triphsic
- duration (sustained or not)

Clinical Skills (5 decks)

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