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Yr 3 examinations > cardio examination > Flashcards

cardio examination Flashcards

1
Q

what to look out for on general inspection

A

are they on oxygen or a cardiac monitor

IV drip

ECG machine

meds

legs

sputum pot

obs chart

are they comfortable at rest

breathing - is it laboured/tachy

colour of skin - pallor, cyanosis

alert

stable

obvious scars on the pericardium

age - gievs clues to path

syndromic features - marfans get aortic valve regurge, turners get aortic stenosis, downs

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2
Q

first things to do in an examination

A

WIIPPPPE

Wash hands

Introduce yourself

Identify pt

Permission - consent and explain

Pain?

Position at 45 degrees

Privacy

Expose chest to waist

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3
Q

what to look for in hands

A

temperature - use back of hand to their back of hand and progress up arm - see the perfusion of the arm

capillary refil time - squeeze finger = blanch - <2sec return normal

colour - peripheral cyanosis have to be v. cold and breathless

tar staining - yellow around nail and nail folds

blood glucose from finger tips

clubbing

Quincke’s sign - visible pulsation of capillary bed

extensor tendon xanthomata

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4
Q

summarise clubbing for cardio

A

reactive response to hypoxia = overgrowth of the tissue

causes:

  • cyanotic congenital heart disease eg teratology of Fallot (hole in heart = R to L shunt = deox blood around body)
  • subacute bacterial endocarditis - infect the heart valve
  • atrial myxoma - tumour in L atria
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5
Q

signs of infective endocarditis

A

splinter haemorrhages - emboli break off and block capillaries in nailbed (not specific eg also in psoriasis)

osler node (painful) immune complex deposited in skin

janeway lesion - vascular lesion localised to palms

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6
Q

quincke’s sign

A

aortic valve regurgitation

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7
Q

extensor tendon xanthomata

A

hyperlipidaemia

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8
Q

inspection of arms

A

radial pulse

bruising - anticoagulation

collapsing pulse

BP - large pulse pressure = aortic regurgitation, narrow pulse pressure = aortic stenosis

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9
Q

summarise investigation of the radial pulse

A

HR 60-100bpm normal

measure RR same time

rhythm: regularly regular, regularly irregular (2nd degree heart block) irregularly irregular (AF/ventricular ectopics)

if pulse weak = aortic stenosis

if collapsing = aortic regurgitation

look at both wrists, and wrists compared to femoral - if any delay = narrowing of aorta affecting how blood is distributed - aortic dissection/coarction, aortic arch aneurysm

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10
Q

how do you test for a collapsing pulse

A

ask if shoulder pain

then hold their arm straight down, holding their extended elbow with L hand and palpating radial pulse with fingers of R hand - release pressure so you can just feel it

then lift their arm upwars fast with L hand

in collapsing pulse the first few pulsations fell a lot stonger

if true bounding pulse - it is bounding for the first few

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11
Q

causes of a collapsing pulse

A

Normal physiological states (e.g. fever, pregnancy)

Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)

High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)

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12
Q

what do you investigate in the neck

A

carotid pulse

JVP

corrigan’s sign - visible carotid pulsation = aortic regurg

de Musset’s sign - head bobbing in time with pulse - aortic regurg

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13
Q

summarise the JVP

A

internal jugular vein

it is a reflection of the central venous pressure

pul hypertension = overload R side = cant pump = increased JVP

fluid overload in heart/liver failure = raised JVP

strain in lung eg PE/COPD - blood cant flow through vessels = back up

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14
Q

measure JVP

A

lay on back and look to L

internal JVP is between 2 heads of SCM - impalpable

from mid R atrium to sternal angle = 5cm

JVP should be no more than 3cm above sternal angle

assess the height and waveform

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15
Q

what is the hepatojugular reflex

A

ask pt if pain in tummy

get them to inhale then exhale, on exhale press the liver

if JVP is elevated, this reflex will elevate it more

if now see a transient rise - confirms that the pulse is below the clavical

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16
Q

what are the causes of raised JVP

A

PQRST:

  • pul hypertension/PE/PS/pericarditis/pericardial effusion
  • quantity of fluid - ie overload
  • RHF
  • SCV obstruction
  • Tamponade/TR
17
Q

investigate the carotid pulse

A

more median than the IJV

assess the character and volume

if regurgitation - it is bounding

slow rising vol = aortic stenosis

bounding/collapsing - aortic regurg or PDA

18
Q

investigate the face

A

malar rash - MS

flush

hyperlipidaemia - xanthalasma

hypercholesteraemia

lipid deposit around eye

pallor - anaemia

ruddy plethoric complexion - polycythaemia

swollen cyanotic face - SVC obstruction

conjunctiva for pallor (anaemia) or haemorrhages (IE)

corneal arcus

19
Q

investigate the mouth

A

dental hygiene - infectious endocarditis

marfan’s - disorder of fibrillin = high arched palate - effect elasticity of valve = aortic/mitral regurgitation, aortic dissection

central cyanosis

petechial haemorrhages - infectious endocarditis

20
Q

inspect the chest

A

scars - ask to lift up arms and breasts - midline sternotomy, thoracotomy, pacemaker scar near L shoulder

look at legs to assess scars eg did they take veins from legs

chest deformities - pectus excavatum/carinatum

visible apex beat

distended veins over precordium - SVC obstruction

21
Q

possible reason for midline sternotomy

A

valve replacement or bypass

22
Q

palpation of chest

A

apex beat - L ventricle 5th ICS MCL

use whole hand then localise to a finger

count down intercostal spaces with other hand

impalpable if obese, muscular or hyperinflated chest

displaced = LV dilation eg MR or AR

23
Q

apex beat quality

A

heaving - high pressure pulsation in LVH eg AS or systemic hypertension

thrusting = large area pulsation in volume overload eg MR or AR

tapping = MS

24
Q

effect of L ventricular hypertrophy

A

apex beat moves laterally and inferior

25
Q

what are heaves

A

secondary to a defective valve

parasternal heave associated with R ventricular hypertrophy

thump

place whole R hand over pts L parasternal area with a straight elbow

26
Q

describe thrills

A

palpable vibration - more fragile than heaves

from aortic stenosis

feel over valve areas with medial border of the hand

AS most common

palpable P2 = pulmonary hypertension

27
Q

describe auscultation of the chest

A

aortic valve - 2nd R ICS

pul valve 2nd L ICS

tricuspid - 4th L ICS

mitral 5th L ICS - mitral area

during auscultation palpate carotid/radial - fit withS2 - helps identify where the murmer is

see if radiation of murmer eg when aortic stenosis

bruits - terbulent flow over plaque

note S1 and S2 intensity and any splitting, S3, S4 clicks/snaps, rubs/murmers

if murmer heard - state site heard loudest, pulse timing, character, volume, radiation

28
Q

what are the heart sounds

A

S1 - tricuspid and mitral shutting

S2 - pulmonary and aortic valve shutting

physiological splitting of S2 - aortic shut slightly before pulmonary

29
Q

what is a heart murmer

A

change in blood flow over valve

systolic murmer - between S1 and S2

diastolic murmer - after S2

30
Q

auscultate the mitral valve

A

listen with pt lying (feel apex beat and place the stethoscope over it)

roll pt onto L side to accenuate it

then listen in L axilla for radiation (MR)

then listen with bell on expiration will still rolled over (MS low tones )

31
Q

auscultate the pul valve

A

listen for loud P2 - if loud compared to A2 = pul hypertension

32
Q

auscultate the aortic valve

A

listen with pt lying and then sitting up and forward - listen between rib 2 and 4 on L sternal edge on expiration (accenuates AR)

then listen over R carotid artery for radiation (also check bruits while here)

33
Q

why auscultate the back of lung

A

if HF = pul oedema = lung overloaded = fine crackles crackles

34
Q

final checks in cardio examination

A

legs - vein harvesting, oedema (pitting or not - push on tibia for more tha 10secs, the run finger over to feel for indent - RVF, hypoalbuminaemia)

sacral oedema

obs chart

fundoscopy

35
Q

to complete..

A

thank pt and cover

i would examine for peripheral pulses

feel for hepatomegaly (RVF)

look at observation charts and dipstick the urine (haematuria in IE)

36
Q

mumers you can hear over the different valves

A

aortic - ejection type murmer: AS, flow murmer

pulmonary area - ejection type murmer: PS, flow murmer

Tricuspid area - pansystolic murmer: tricuspid regurgitation, ventricular septal defect. Mid to late diastolic murmer: TS, atrial septal defect

mitral area - pansystolic murmer: MR. Mid-to-late diastolic murmer: MS

37
Q

systolic murmers

A

AS
MR

patent ductus arteriosus

38
Q

diastolic murmers

A

AR

MS

patent ductus arteriosus

Yr 3 examinations (10 decks)

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