Cardio Exam

Question 1

Summarise the steps of a cardio exam

Answer 1

Wash hands, identification, consent

1. Inspect bed/general appearance
2. Hands - look, temperature, capillary refill, clubbing (Schamroths finger). Spider fingers (Marfans)
3. Radial pulses - simultaneously. Rate and rhythm, radio-radio delay.
4. Brachial pulse - check pain in arm, collapsing pulse
5. Carotid pulse - auscultate and palpate
6. JVP + hepatojugular reflex
7. Look at face - malar rash, eyes, mouth (tongue underneath., dental work, high arch)
8. Inspect chest - scars, cardiac pulsation
9. Palpate location of apex + heaves and thrills over each valve location
10. Auscultate 4 valve areas, palpate carotid pulse if extra sounds + left axilla
11. Roll onto 45 degrees to left (with bell)
12. Sit forwards - auscultate at 4th/5th intercostal space to the left of the sternum - on held expiration
13. Auscultate lung bases + sacral oedema
14. If coarction suspected auscultate left spine in 3rd/4th intercostal space
15. Palpate hepatomegaly (if enlarged, feel pulsation), if suspect ascites = shifting dullness
16. Pitting oedema in ankles

Question 2

What extra tests/investigations would you add on to a cardiac examination

Answer 2

Check BP in both arms + lying and standing in one arm

Perform ophthalmoscopy for hypertensive retinopathy

Obtain 12-lead ECG

Question 3

What are spider fingers suggestive of

Answer 3

(Arachnodactyly)

Marfans syndrome = fingers and toes are abnormally long

Question 4

What is Marfans syndrome associated with

Answer 4

Mitral/aortic valve prolapse and aortic dissection

Question 5

What are the causes of radio-radio delay

Answer 5

Subclavian artery stenosis
Aortic dissection
Aortic coarction

Question 6

Describe a water hammer pulse

Answer 6

Forceful pulse that rapidly increases and subsequently collapses (collapsing pulse)

Question 7

What does a collapsing pulse feel like

Answer 7

Tapping impulse

Question 8

What do carotid bruits suggest

Answer 8

Carotid stenosis

Question 9

What would a high palate suggest

Answer 9

Marfans syndrome

Question 10

How do you locate heaves

Answer 10

Place heel of hand on left sternal edge

Heave can be felt with heel of hand lifted on each systole

Question 11

What are parasternal heaves associated with

Answer 11

Associated with right ventricular hypertrophy

Question 12

Describe thrills

Answer 12

Palpable vibrations caused by turbulent blood flow through the heart (palpable murmur)

Question 13

What is another word for a palpable murmur

Answer 13

Thrills

Question 14

Where is the mitral valve located

Answer 14

5th intercostal space in the midclavicular line

Question 15

Where is the tricuspid valve located

Answer 15

4th or 5th intercostal space at the lower left sternal edge

Question 16

Where is the pulmonary valve located

Answer 16

2nd intercostal space at the left sternal angle

Question 17

Where is the aortic valve located

Answer 17

2nd intercostal space at the right sternal angle

Question 18

How do you test mitral stenosis

Answer 18

Roll 45 degrees onto left - do with bell

Question 19

How do you test aortic regurgitation

Answer 19

Sit forwards, auscultate at 4th/5th intercostal space to left of sternum on held expiration

Question 20

If coaraction is suspected what do you do

Answer 20

Auscultate on the left of spine in 3rd/4th intercostal space