Cardio exam - GEEKY medics Flashcards
What should be looked for when general inspecting around the bedside?
•GTN / oxygen / mobility aids / medication
What things should you note when looking at the patient from the end of the bed?
- Are they comfortable at rest?
- SOB?
- Malar flush? - mitral stenosis
When inspecting the chest from the end of the bed what should be looked for?
- Scars?
* Visible palpitations?
When inspecting the legs from the end of the bed what should be looked for?
- Harvest site scars
- Peripheral oedema
- Missing limbs or toes
When inspecting the hands what should be looked for when the palms are facing down?
- Splinter haemorrhaging - bacterial endocarditis
* Finger clubbing - infective endocarditis / cyanotic congenital heart disease
When inspecting the hands, palms facing up, what should be looked for?
- Colour, cyanosis? - hypoxia
- Temperature, cool peripheries? - poor cardiac output / hypovolaemia
- Sweat/clamy - associated with acute coronary syndromes
- Janeway lesions - bacterial endocarditis
- Osler’s nodes - infective endocarditis
- Tar staining - Increased risk of cardiovascular disease
- Xanthomata - hyperlipidaemia
- Capillary refil - normal is <2s - if prolonged suggests hypovolaemia
What are you assessing in the radial pulse?
• Rate and rhythm
What does radial-radial delay suggest?
•Aortic coarctation
What is a collapsing pulse associated with?
• Aortic regurgitation
What are you assessing in the brachial pulse?
•Volume and character
What is a narrow pulse pressure associated with?
• Aortic stenosis
What is a wide pulse pressure associated with?
• Aortic regurgitation
What are you assessing in the carotid pulse?
• Character and volume
What is a slow rising character found in the carotid pulse associated with?
• Aortic stenosis
What does a raised JVP indicate?
- Fluid overload
- Right ventricular failure
- Tricuspid regurgitation
What does a positive hepatojugular reflex indicate?
- Right sided heart failure
* Tricuspid regurgitation
When inspecting the eyes what signs are you looking for?
- Conjunctival pallor - anaemia
- Corneal arcus - hypercholesterolaemia
- Xanthelasma - hypercholesterolaemia
When inspecting the mouth what signs are you looking for?
- Central cyanosis
- Angular stomatitis - iron deficiency
- High arched palate - suggestive of Marfans which means an increased risk of aortic aneurysm/dissection
- Dental hygiene - potential source of infective endocarditis
When closely inspecting the chest what should you be looking for?
- Scars: thoracotomy = minimal invasive valve surgery, sternotomy = CABG / valve surgery, clavicular = pacemaker
- Chest wall deformities: pectus excavatium and pectus carinatum
- Visible pulses: forceful apex beat = hypertension / ventricular hypertrophy
Where do you listen to the aortic valve?
•2nd intercostal space, right sternal edge
Where do you listen to the mitral valve?
• 5th intercostal space, midclavicular line
What is being listened for when the carotid artery is auscultated when the patient holds their breath?
• radiation of aortic stenosis murmur
what is indicated if there is radiation of heart murmur into the left axilla?
• mitral regurgitation
What is indicated if there is radiation of a heart murmur at there left sternal edge?
• aortic regurgitation
What accentuation manoeuvres are performed when auscultating?
- Roll onto left side and listen to mitral area with bell during expiration - mitral murmurs (stenosis and regurgitation)
- Lean over and listen over aortic area during expiration - aortic murmurs are louder (stenosis and regurgitation)
What would you do to complete the cardiovascular examination?
- Auscultate lung bases - crackles may suggest pulmonary oedema - left ventricular failure
- Sacral oedema and pedal oedema - may indicate right ventricular failure
What further assessments and investigations should you offer for the cardiovascular examination?
- Full peripheral examination
- Record a 12-lead ECG - arrhythmias / MI
- Dipstick urine - proteinuria / haematuria - hypertension
- Bedside capillary blood glucose - diabetes
- Perform fundoscopy - malignant hypertension - papilloedema
