Cardiology - Cardiovascular Examination Flashcards
What angle should the bed be in a cardiovascular exam?
45 degrees
When you carry out a general inspection of the patient what should you be looking for?
Cyanosis
Shortness of breath
Pallor
Malar flush
Oedema
What does cyanosis suggest?
Poor circulation
- Peripheral vasoconstriction secondary to hypovolaemia
Inadequate oxygenation of blood
- Right-to-left cardiac shunting
What does SOB suggest?
Congestive heart failure
Pericarditis
Pneumonia
PE
What does pallor suggest?
Underlying anaemia
- Haemorrhage
- Chronic disease
Poor perfusion
- Congestive heart failure
What does malar flush suggest?
Mitral stenosis
What does oedema suggest?
Congestive heart failure
What does pallor of the hands suggest?
Congestive heart failure
What does cyanosis of the hands suggest?
Hypoxaemia
What does xanthomata on the hands suggest?
- Hyperlipidaemia (typically familial)
- Coronary artery disease
- Hypertension
What does Arachnodactyly (spider fingers) suggest?
Marfan’s syndrome
Associated with:
- Mitral valve prolapse
- Aortic valve prolapse
- Aortic dissection
What is clubbing of the fingers suggestive of?
- Congenital cyanotic heart disease
- Infective endocarditis
- Atrial myxoma
Loss of Schamroth’s window
What do splinter haemorrhages suggest?
- Trauma
- Infective endocarditis
- Sepsis
- Vasculitis
- Psoriatic nail disease
What do Janeway lesions suggest?
Infective endocarditis
What do Osler’s nodes suggest?
Infective endocarditis
What do cool hands vs cool and sweat hands suggest?
Cool hands
Congestive cardiac failure
Acute coronary syndrome
Cool and sweaty
Acute coronary syndrome
What does a capillary refill time of over two seconds mean?
Poor peripheral perfusion
Hypovolaemia
Congestive heart failure
What does radio-radial delay suggest?
Subclavian artery stenosis (compression by cervical rib)
Aortic dissection
Aortic coarctation
What causes a collapsing pulse?
- Pregnancy
- Fever
- Aortic regurgitation
- Patent ductus arteriosus
- Anaemia
- Arteriovenous fistula
- Thyrotoxicosis
What do these types of pulse mean when palpating brachial pulse?
Slow-rising
Bounding
Thready
Slow-rising
- Aortic stenosis
Bounding
- Aortic regurgitation
- CO2 retention
Thready
- Intravascular hypovolaemia e.g. sepsis
What causes narrow pulse pressure?
Aortic stenosis
Congestive heart failure
Cardiac tamponade
What causes wide pulse pressure?
Aortic regurgitation
Aortic dissection
What does a difference in blood pressure between arms suggest?
Aortic dissection
Why do you need to listen to the carotids first before palpating?
Rule out a bruit, as this suggests carotid stenosis making palpation dangerous
Risk of dislodging a carotid plaque
Be aware of aortic stenosis radiating
What causes raised JVP?
Right-sided heart failure Commonly due to left-sided
Tricuspid regurgitation
Infective endocarditis and rheumatic heart disease
Constrictive pericarditis
What is a positive hepatojugular reflux?
Pressure to liver, JVP rise should last for 1-2 cardiac cycles before falling
Sustained rise in JVP is positive
What do these signs suggest?
- Conjunctival pallor
- Corneal arcus
- Xanthelasma
- Kayser-Fleischer rings
Conjunctival pallor
- Anaemia
Corneal arcus
- In under 50s hypercholesterolaemia
Xanthelasma
- Hypercholesterolaemia
Kayser-Fleischer rings
- Wilson’s disease, can cause cardiomyopathy
What do these signs suggest?
- Central cyanosis
- Angular stomatitis
- High-arched palate
- Dental hygiene
Central cyanosis
- Hypoxaemia
Angular stomatitis
- Iron deficiency
High-arched palate
- Marfan’s (risk for mitral/aortic valve prolapse and aortic dissection)
Dental hygiene
- Infective endocarditis risk factor
What do these different chest scars suggest?
- Median sternotomy
- Anterolateral thoracotomy
- Infraclavicular
- Left mid-axillary
Median sternotomy
- CABG
Anterolateral thoracotomy
- Cardiac valve surgery
Infraclavicular scar
- Pacemaker insertion
Left mid-axillary scar
- Subcutaneous implantable cardioverter-defibrillator
What causes thrills and how do you assess them?
Turbulent blood flow (palpable murmur)
Assess at each of the heart valves and parasternal heave for right ventricular hypertrophy
What accentuation manoeuvres are used for aortic stenosis?
Auscultate carotids while patients holds their breath
What accentuation manoeuvres are used for aortic regurgitation?
Sit patient forwards, listen to aortic area during expiration for early diastolic murmur
What accentuation manoeuvres are used for mitral regurgitation?
Roll patient to left side, listen to mitral area during expiration for pansystolic murmur due to mitral regurgitation
Auscultate into axilla to identify radiation
What accentuation manoeuvres are used for mitral stenosis?
While patient on left side, use bell during expiration for a mid-diastolic murmur
When auscultating the posterior chest wall, what do coarse crackles suggest?
Pulmonary oedema
What does absent air entry and stony dullness on percussion suggest?
Pleural effusion, associated with left ventricular failure
Why do you need to carefully inspect the patients legs?
Evidence of saphenous vein harvesting
What do you need to “do” to complete your assessment?
- Measure BP
- Peripheral vascular examination
- 12-lead ECG
- Urine dip
- Blood glucose
- Fundoscopy
