Cardio Flashcards
Position of the patient
45 degrees, expose the chest
And ask if they have any pain
General inspection
Bedside equipment
Comfortable at rest or SOB?
Hands
Splinter haemorrhages finger clubbing colour (hypoxia) temperature/sweaty Janeway lesions Oslers nodes Tar staining Xanthelasma Cap refill
Splinter hemorrhages suggestive of…
bacterial endocarditis (seen on nail bed)
Finger clubbing test
place nails of index fingers together
should see small window (Schamroth’s window)= normal
loss of window=abnormal
Finger clubbing suggestive of…
infective endocarditis
congenital cyanotic heart disease
Cool peripheries suggestive of…
poor cardiac output / hypovolaemia
Sweaty/clammy hands suggestive of…
acute coronary syndrome
Janeway lesions, what are they and what do they suggest?
Non tender maculopapular erythematous nodules
bacterial endocardities
Oslers nodes, what are they and what do they suggest?
Tender red nodules on finger pulps
infective endocarditis
Xanthomata?
raised yellow lesions tend to be on wrist
hyperlipidaemia
What pulses do you feel?
Radial pulse Radio-radial delay Collapsing pulse (check BP here) carotid pulse
What do you assess when feeling a pulse?
Rate, rhythm, volume and character
Radio-radial delay?
Aortic coarctation
Collapsing pulse?
Check the patient has no pain in shoulder before performing!!!!
Physiological in fever and pregnancy
Pathological causes of collapsing pulse?
Pathological: aortic regurg, patent ductus arteriosis, anaemia or thyrotoxicosis
Carotid pulse
Auscultate for bruit first!! As palpation could dislodge emobli or thrombus > stroke
How to measure JVP?
cm from sternal angle to upper border of pulsation
What causes raised JVP?
fluid overload
RVF
Tricuspid regurg
Eye signs and what they mean.
Conjunctival pallor > anaemia
Corneal arcus- yellow/greyish ring surrounding the iris > hypercholesterolaemia
Xanthelasma- yellow nodules surrounding eyes> hypercholesterolaemia
Mouth signs
Central cyanosis
Angular stomatitis > iron deficiency
high arched palate
dental hygiene
Why is dental hygiene important?
Endocarditis
What is important about a high arched palate?
Suggestive of Marfans > increased risk of aortic dissection/aneurysm
Clavicular scar
Pacemaker
Pectus excavatum
sunken chest
Pectus carinatum
pigeon chest- chest is pushed out
Chest process
Inspect
Palpate
Auscultate
Chest inspection
Scars
remember to check underarms
Palpation
Heaves, thrills, apex beat
Heaves
L sternal edge = Ventricular hypertrophy
What is a thrill?
Palpable murmur
Where is the apex beat?
5th intercostal space, midclavicular line
point this out to the examiner
Displacement of the apex beat?
Cardiomegaly
During auscultation what do you do?
Palpate the carotid as well to time the pulse
Use diaphragm and bell
Location of aortic valve
R upper sternal edge (2nd intercostal space)
Location of pulmonary valve
L upper sternal edge (2nd intercostal space)
Location of tricuspid valve
L lower border of sternum (4th/5th intercostal space)
Location of mitral valve
Apex (5th intercostal space, midclavicular line)
What murmur radiates to the axilla?
Mitral regurg
What murmur radiates to the carotids?
Aortic stenosis
Auscultation manoeuvre for mitral murmur
Roll onto left side and listen at apex with bell
Auscultation manoeuvre for aortic murmur
Lean forward and listen with diaphragm and L lower sternal edge and during held expiration
To end precordial exam:
Auscultate posterior lower lung bases (for pulmonary oedema- LVF)
Palpate for sacral oedema (RVF)
Suggestion for further exam
peripheral vascular examine 12 lead ECG Fundoscopy if hypertensive Urine dipstick if hypertensive BG level if diabetic
Peripheral vascular examine includes…
Upper AND lower limb
and potentially abdomen for aorta
Inspection of the legs
Scars hair loss- PVD discolouration pallor- poor perfusion missing limbs or toes- look between toes and posterior leg! ulcers muscle wasting- PVD ask patient to wiggle their toes
Palpation of leg
Temperature
Cap refill
Pulses
What pulses do you palpate in lower limb?
Femoral
Popliteal
Posterior tibial
Dorsalis pedis
Femoral pulse
Halfway between ASIS and pubic symphasis
Assess for radio-femoral delay (coarctation of aorta)
Popliteal pulse
Flex knee to 45 degrees
Place thumbs on tibial tuberosity
Place fingers in popliteal fossa, press quite hard as it is a deep pulse
Posterior tibial pulse
Posterior to medial malleolus of tibia
compare to other foot
Dorsalis pedis
lateral to EHL tendon
Over 2nd/3rd cuneiform
compare to other foot
Buerger test
patient is supine
raise patients feet to 45 degrees for 2-3 mins
note any pallor
then ask patient to place legs over the edge of bed- watch for any extreme redness
Suggestion for further exam
ABPI
lower limb neuro exam
