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Phase 2b > Cardiac Examination > Flashcards

Cardiac Examination Flashcards

1
Q

Roughly outline the sections of a cardiac exam?

A

1.Introduction
2. End of bed
3. Hands
4. Nails
5. Wrists
6. Arm
7. Face
8. Eyes
9. Mouth
10 Neck
11. Chest inspection
12. Palpation

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2
Q

What are you looking for on general inspection?

A

Clinical signs

Objects equipment

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3
Q

What clinical signs are you looking for?

A 
Cyanosis 
SOB 
Pallor 
Malar flush 
Oedema
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4
Q

What is malar flush?

A

Plum red discolouration of cheeks associated with mitral stenosis

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5
Q

What does pallor indicate?

A

Underlying anaemia - haemorrhage

Poor perfusion - congestive heart failure

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6
Q

What objects and equipment might be relevant?

A

Pillows = congestive heart failing resulting in inability to lie flat

Vital signs

Fluid balance

Prescriptions GTN

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7
Q

What would you look at in the hands?

A 
Feel temperature and check CRT 
Peripheral cyanosis 
Tendon xanthalasma 
Osler nodes and janeaway lesions 
Tar staining 
Arachnodactyly
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8
Q

What are you expecting with the colour and temperature of the hands?

A

Warm and well perfused or peripherally shut down = CRT >2s

Cyanosis may indicate PVD, Raynauds, CCR

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9
Q

What does tendon xanthalasma indicate?

A

Hypercholesterolaemia

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10
Q

What do roth spots and Janeaway lesions indicate?

A

IE

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11
Q

What is arachnodactyly?

A

Abnormally long fingers and toes

A feature of Marfan’s syndrome which is associated with mitral/aortic valve prolapse and aortic dissection

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12
Q

What would you look for in the nails?

A

Finger clubbing - IE, CHD, atrial myxoma
Koilonychia - iron def anaemia
Splinter haemorrages - IE, trauma

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13
Q

What would you look for in the wrist?

A

Radial pulse and brachial pulse

+ Rate
+ Rhythm
+ Volume
+ Character

Collapsing pulse
+ “Is your shoulder sore at all?”
+ Grasp pt tight wrist with your right hand
+ Place your metacarpal heads over pt radial artery
+ Quickly but gently left their arm about their head and palpate for collapsing pulse

Assess for radio radio delay (cervical rib, aortic coartication/dissection, embolism) and radio femoral delay (coarticatoins/dissection, embolism)

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14
Q

What would you assess in the arm?

A

I would now measure blood pressure in each arm

Wide pp (more than 100)  AR 
Narrow pp (less than 25) AS
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15
Q

What are the types of pulse character?

A

Normal
Slow rising - aortic stenosis
Bounding - aortic regurgitation and CO2 retention
Thready - Intravasc hypovolaemia

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16
Q

What are the thresholds for hyper and hypotension?

A

Hyper > 150/90

Hypo <90/60

17
Q

What would you asses for in the face?

A

Malar flush - mitral stenosis

18
Q

What would you assess for in the eyes?

A

Corneal arcus and xanthalasma - hypercholesterolaemia

Conjunctival pallor

19
Q

What would you assess for around the mouth?

A

Central cyanosis - lung disease, cardiac shunt, abnormal Hb

Poor dentition - RF for IE

High arches palate - Marfans - M/A prolapse and aortic diss

20
Q

What would you assess for in the neck?

A

Carotid pulse -
Exaggerated (Corrigans sign) - AR

AUSCULATE BEFORE PALPATING for bruits

Palate for pulse character

JVP

21
Q

Describe how you would assess JVP and HJRT?

A

Pt at 45 degrees, head turned slightly to the right, neck well lit (not too much)

Look for double pulsation on the left side of neck

Estimate height above sternal angle in cm (3-4)

“Do you have a sore stomach at all”

Push on RUQ and watch neck to see JVP rise

Check JVP rapidly falls back down - persistent elevation indictese RHF/volume overload

22
Q

What are you looking for when inspecting the chest?

A

Scars

+ Pacemaker / ICD under either clavicle
+ Midline sternotomy - CABG, valve replacement
+ Left submammary - mitral valvotomy, pericardial window
+ Legs - vein harvesting

Visible heave - apical (LVH) or parasternal (RVH)

23
Q

What do you palpate in the chest?

A

Apex beat
+ Locate and count rib spaces
+ Assess character
+ 5ic mid clavicular line

Left parasternal heave - RVH

Thrills - palpable murmur

24
Q

What do you auscultate in the chest?

A 
4 Primary valve areas 
Apex - mitral (B,D)
LLSE - tricuspid (D)
2nd left IC space - pulmonary (D)
2nd right IC space - aortic (D)

Areas of murmur radiation
Axilla - MR (D)
Carotid (B) - hold breath with patient

Manoeuvres to amplify

  • Apex pt on LHS, breath held in expiration = MS
  • LLSE, pt sitting forward breath held in expiration = AR
25
Q

What are you examining for in the back and legs?

A

Auscultate lung bases for crepitations - LHP

Palpate for sacral oedema - RHF

Palpate for peripheral oedema - RHF

26
Q

How would you conclude this examination?

A

Thank pt
Wash hands
Allow to redress
Summarise

27
Q

To complete examination…

A 
BP 
Peripheral vasc exam - PVD
12 lead ECG - arrhythmias 
Dipstick - proteinuria.haematuria
blood glucose - diabetes
28
Q

What clues do surgery scars give during examination?

A

Midline sternotomy + leg scar = CABG

Midline sternotomy + no leg scar = valve replacement most likely

29
Q

What are they key JVP abnormalities?

Elevated = 
Elevated with decreased BP = 
Elevated and fixed = 
Cannon A waves = 
Giant V waves =
A

Elevated = RHF, volume overload, PE, constrictive pericarditis

Elevated with decreased BP = Tension pneumothoraz, cardiac tamponade, massive PE, severe asthma

Elevated and fixed = SVC obstruction

Cannon A waves = Complete heart block

Giant V waves = TR

30
Q

Causes of central cyanosis?

A
  • Hypoxic lung disease
  • ## Right to left cardiac shunt
31
Q

Causes of peripheral cyanosis?

A
  • Peripheral vascular disease
  • Raynauds syndrome
  • Heart failure
  • Shock
32
Q

What is pulsus paradoxus?

A

An exdaggerations of the normal situation in which BP falls during inspiration, to such an extent that the peripheral pulse may not be felt despite LV contraction

33
Q

Causes of pulsus paradoxus?

A

Tamponade, constrictive pericarditis, restrictive cardiomyopathy, severe asthma / COPD

Phase 2b (2 decks)

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