Cardiac Physical examination

Question 1

1) Look at the patinet

Answer 1

• How do they look physically- obesity, SOB
• Marfans syndrome- tall with long arms in relation to their body.
• Are they well- in pain/distress
• Look at the patients Hands
• Nicotine staining
• Cold, clammy- feel hands make sure warm and perfused

Question 2

Looking at the hands

Answer 2

• Splinter haemorrhages- IE
• Clubbing
• Osler nodes- (IE) bulky, tender in the finger/toe tips
• Janeway lesions- (IE) non-painful in the palms of hands/feet
• Roths spots- (IE) in the retina

Question 3

Observations

Answer 3

• Cardiac monitoring
• SpO2 monitoring
• Radial Pulse
• Blood pressure in both arms
• Temperature
• Respirations
• Urine output

Question 4

Measure JVP

Answer 4

• Use the right internal jugular vein- measure of fluid within the body
• Patient should be at a 45 degree angle
• Head turned to the left
• If possible have a tangenital light source that shine oliquely from the left
• Locate surface markings of the IJV- runs medial end of clavicle to ear lobe
• Locate the JVP- look for double waveform pulsation
• Measure the level of the JVP by measuring the vertical distance

Question 5

Causes of raised JVP

Answer 5

• Heart failure
• Restrictive pericarditis- reduced cardiac filling causes backflow
• Cardiac tamponade- blood in the pericardial sac
• Fluid overload- IVF,
• Superior vena cava obstruction

Question 6

Face

Answer 6

• Eyes: Xanthelasma (cholesterol around the eyes), Corneal Arcus (white ring around the iris- high Che)

Question 7

Chest

Answer 7

• Feel apex
• Feel for thrills hand horizontally: Hand over valves (feeling for murmur- feels like vibrations)
• Feel for heave: Feeling chamber enlargement (RV hypertrophy)

Question 8

Listening to heart sounds

Answer 8

• All patients tell me
• Aortic, Pulmonary, Tricuspid, Mitrial

Question 9

Auscultation

Answer 9

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