cardio Flashcards
What cardio symptoms should you enquire about in a history
palpitations chest pain, dyspnoea Orthopnea Paroxysmal nocturnal dyspnoea ankle oedema cough, sputum, haemoptysis Dizziness Light-headness, syncope, haemoptysis Nausea and sweating Claudication Systemic symptoms
What is the basic order of a cardio exam
Inspect,
Hands and arms,
Head
Neck
Chest (inspect, palpate, auscultate)
the Rest (listen to lung bases, hepatomegaly, ankle oedema)
Say you would: Blood pressure, Femoral pulses, ECG, Opthalmoscopy
How should you initiate a cardio examination?
Wash hands, Introduction, Identification, Consent,
Any pain?
Ask patient to remove shirt and position at 45 degrees
General inspection of surroundings and patient:
(Well or ill, Distress, Pale, Sweaty, Cyanosed, Tachypnoeic, Scars, Clues)
What should you look for on hands?
Temperature and sweating Nails: clubbing, splinter haemorrhages, Capillary refill Peripheral cyanosis, tendon xanthomas Oslers nodes and Janeway lesions Tar staining, Pallor of palmar creases,
What examinations should you do on the arms
Radial pulses: rate and rhythm, radio-radial delay,
Brachial pulse: character (e.g. slow rising, collapsing ect)
-Waterhammer!
Say you would do the blood pressure
What would you examine on the Head?
Eyes: subconjunctival pallor, xanthelasmata, corneal arcus
Face: malar flush (sign for mitral stenosis)
Mouth: dental caries, central cyanosis, high arched palate (sign for Marfan’s)
How should you examine the neck
Palpate the carotids one at a time and LISTEN for bruits using bell
JVP: ensure patient is at 45 degrees, ask patient to turn head away from you, observe for JVP (should be 2-4cm above sternal angle)
Hepatojugular reflex
Chest examination
Inspect for: scars- describe them
Severe pectus excavatum (indent) or kyphoscoliosis, visible pulsation.
Palpate for apex peat, parasternal heave and thrills.
Auscultation: listen to all heart areas with diaphragm then bell.
Then ask patient to roll onto there left and listen to the mitral using the bell, on held expiration, then tell patient they can breath normally while you listen to there axilla.
Sit patient forward and listen to 4th IC space at left sternal margin on held inspiration for aortic regurgitation.
What constitutes the rest in cardio exam?
Listen to lung bases for sacral oedema, (90 degrees)
Lie patient flat and palpate for hepatomegaly, if ascites suspected percuss for shifting dullness.
check for pitting oedema at the ankles
What things do you say you would do but not actually do in the osce?
Blood pressure
ECG
Ophthalmoscopy for diabetic retinopathy
Check femoral pulses (radio femoral delay in aortic coarctation)
