Cardiology Flashcards
1
Q
Describe the patient introduction for a cardiology examination
A
- Introduce yourself and ask permission
- Ensure patient is warm
- Expose patient adequately preserving dignity
- General inspection for distress
- Observe particularly for malar flush
2
Q
What do you look for in the patients hands?
A
- Clubbing
- Cyanosis (hands cold or warm)
- Stigmata of endocarditis (splinter haemorrhages, oslers nodes, janeway lesions)
- Nicotine stains
- Capillary refill time
- Assess temperature of arms
3
Q
What do you look for in the examination of the arm?
A
- Assess whether pulse is regular or irregular
- Count pulse for 15 seconds and multiply by 4
- Count for a full minute if pulse is irregular
- Raise the arm to determine whether the pulse is collapsing or bounding (becomes more obvious when arm raised)
- Feel pulse in both wrists at same time
- Test for collapsing pulse by raising arm briskly
- Listen to brachial pulse
4
Q
Describe the process of taking blood pressure
A
- Position arm so anticubital fold is at the level of the heart
- Centre bladder of the cuff over the brachial artery approx 2cm above the anticubital fold
- Ensure index line falls between size marks when you apply the cuff
- Palpate radial pulse and inflate until pulse disappears
- Place diaphragm of stethoscope over the brachial artery
- Inflate the cuff to 30mmHg above the estimated systolic pressure
- Release pressure slowly (no more than 5mmHg per second)
- When you hear heart beats this is systolic pressure (can be determined by palpation of radial artery alone, 10mmHg higher using ausciltation)
- Lower pressure until sounds disappear (diastolic)
- Take in both arms on first encounter
5
Q
Describe examination of the face and arms
A
1- Tongue (for pallor and cyanosis)
2- Lower eyelid for anaemia
3- Is there a malar rash?
6
Q
Describe examination of the carotid pulse
A
- Place fingers behind the patients neck and compress carotid artery on one side with thumb or below the level of cricoid cartilage
- Press firmy, avoid compressing both sides a the saem time.
- Assess amplitude, contour and variations in amplitude between beats
- Repeat on both sides
7
Q
Describe the process of ausciltation for bruits
A
- Done if the patient is middle aged or elderly. Bruits are often a sign of arterial narrowing and risk of stroke
- Place bell of the stethoscope over each carotid artery in turn. Use diaphragm if the neck is highly contoured
- Ask patient to stop breathing for a moment
- Listen for a blowing or rushing sound. (Dont be confused by heart sounds or murmurs transmitted from the chest)
8
Q
Describe examination of the JVP
A
- Position the patient supine with the head of the table elevated 5 degrees
- Use tangential side lighting to observe for venous pulsations in the neck
- Look for a rapid, double (sometimes triple) wave with each heart beat. Use light pressure just above the sternal end of the clavicle to eliminate the pulsations and rule out a carotid origin
- Adjust angle of table elevation
- Identify highest point of pulsation. Using a horizontal line from this point measure vertically from the sternal angle. Sternal angle is 5cm above atrium
- Measurement should be less than 4cm in a normal healthy adult
- Press on tummy and listen
9
Q
Describe the examination of the praecordial movement
A
- Position patient supine with the head of the table slightly elevated
- Inspect for precordial movement. Tangential lightning will make movements more visible
- Palpate for precordial activity in general. May feel extras (thrills or exaggerated ventricular impulses)
- Palpate for the point of maximal impulse (PMI or apical pulse) usually located in the 4th or 5th intercostal space just medial to the midclavicular line (apex beat)
- Note location size and quality of the impulse
10
Q
Describe auscultation of the heart
A
- Aortic valve 2nd ICS RSB
- Pulmonary valve 2nd ICS LSB
- Tricuspid 3rd/4th/5th ICS LSB
- Mitral valve 5th ICS MCL
- Use diaphragm for apex (mitral valve), and feel for carotid pulse. Listen in the axilla for radiation mitral regurgitation
- Ask the patient to roll onto their left side. Listen with the bell at the apex, this position brings out S3 and mitral murmurs. Ask to take a deep breath and hold
- Have patient sit up, lean forward and hold their breath in exhalation. Listen with diaphragm at the left 3rd and 4th ICS near sternum. This brings out aortic murmurs
- Record S1, S2, S3, S5 as well as the grade and configuration of any murmurs
- Use bell to listen to carotid arteries, ask patient to hold their breath
11
Q
Describe the assessment of hydration status
A
- Assess whether patient is overloaded by looking at the ankles (or sacrum if bed bound) for peripheral oedema and listen to lung bases for the sounds of pulmonary oedema
- Examine peripheral pulses (or suggest would do this)
- May offer to examine hepatomegaly (enlarged in right heart failure)
12
Q
List causes of abnormal JVP
A
- Pulmonary HTN, PE, Pericarditis or pericardial effusion
- Quantity of fluid (overload)
- Right heart failure
- Superior vena cava obstruction
- Tamponade
13
Q
Describe inspection of the chest
A
- Thoracotomy scar/ sternotomy scar
- Pacemaker
- Visible pulsation/ heaves
14
Q
Describe palpation of the chest
A
- Aortic area 2nd ICS right side
- Pulmonary ares 2nd ICS right ride
- Tricuspid area 4th ICS left side
- Mitral area 5th ICS MCL left side
- Feel for apex beat in the 5th ICS. Displaced in ventricular hypertrophy. Thrusting feeling. heave in mitral or aortic regurgitation.
- Palpate for heaves (pulsations on the chest wall) using the heel of the hand, hand is lifted off the chest if there is a heave
- Palpate for thrills (vibrations palpable murmurs). Feel in all valve areas with finger tips
15
Q
How are murmurs described?
A
- Site (where is it loudest)
- Character
- Radiation
- Intensity (grade)
- Pitch
- TIming (systolic or diastolic)
