Cardiology examination Flashcards
1
Q
What do you look out for inspection of the patient?
A
- Environment-GTN spray, O2, other medications and mobility aids
- Patient-look out for SOB, cyanosis, pallor
- Chest- visible pulsations/scarring
- Legs-peripheral oedema, saphenous venous graft
2
Q
What do you look out in hands?
A
- Capillary refill time-<2 seconds. Prolonged-> shock, or low cardiac output states (mitral, aortic stenosis etc)
- Hands-tar staining, peripheral cyanosis, osler’s nodes (IE), janeway lesions (IE), tendon xanthomata (hyperlipidemia on dorsal extensor tendons)
- Nails-splinter haemorrhages (IE), finger clubbing-cyanotic heart disease/infective endocarditis
- Nails-de quinke sign in infective endocarditis
- arachnodactyly-marfan’s syndrome
- pale palmar creases-anaemia; palmar erythema-polycythaemia from pregnancy
- Radial pulse-assess rate, rhythm, volume and character. Check for collapsing pulse (aortic regurgitation) and radio-radio delay (aortic coarctation)
3
Q
What are the causes of clubbing in hands?
A
- congenital cyanotic heart defects
- tetralogy of fallot
- subacute bacterial endocarditis
- atrial myxoma
4
Q
What do you look out for in the arms?
A
Arms:
- Brachial pulse- medial to biceps tendon
- Offer blood pressure
- IV track mark use-risk factors of infective endocarditis
- bruising-from anticoagulation
- forearm venous grafting
5
Q
What do you look out in face?
What do you look out for in the mouth?
What do you look out in neck?
A
- Eyes-corneal arcus (creamy yellow discolouration) ; xanthelasmata (hyperlipidemia); conjunctival pallor
- Tongue-central cyanosis; poor dental hygiene-infective endocarditis
- high arched palate-marfan’s syndrome
- hydration
- Carotid pulse. Palpate between larynx and SCM. Then listen for bruits on held inspiration with diaphragm. Never assess both. Assess for rate, rhythm, volume and character.
- Assess JVP-elevated in Right sided heart failure. Internal jugular vein deep to SCM; measure between top of pulsation and sternal angle. Pathological if more than 4cm.
6
Q
What do you look out in precordium?
A
Inspection
- Chest wall deformities-pectus excavatum; carinatum
- Scars-midline sternotomy (previous valve replacement or CABG); lateral thoracotomy (mitral valve replacement); infraclavicular scar (pacemaker bulge obvious); back scars-aortic dissection
Palpation
- apex beat-5th ICS space
- Left parasternum (w palm of your hand)-lifted up in right ventricular hypertrophy.
- Thrill-palpable murmur
7
Q
What kind of scars are these?
A
8
Q
What kind of apex beats do you get?
- forceful
- heaving apex beat
- double
A
What kind of apex beats do you get?
- forceful
- aortic stenosis and left ventricular hypertrophy
- heaving apex beat
- mitral or tricuspid regurgitation
- double
- hypertrophic obstructive cardiomyopathy
9
Q
Where do you listen to in precordium?
- Aortic
- Pulmonary
- Tricuspid
- Mitral
A
- Aortic-2nd ICS rt
- Pulmonary-2nd ICS lt
- Tricuspid-5th ICS lt parasternum
- Mitral-5th midclavicular lt ICS
10
Q
Which valvular defects are accentuated by inspiration/expiration?
A
Remember RILE
- Inspiration-right sided murmurs as it lowers intrathoracic pressure
- expiration-left sided murmurs
11
Q
How do you perform a accentuation maneouvre?
A
- Mitral stenosis-in 5th ICS lt midclavicular. Ask patient to roll over and hold on expiration. Auscultate towards axilla. (w bell)
- Aortic regurgitation-3rd/4th ICS lt. Ask patient to hold on expiration (w diaphragm)
12
Q
What else do you look out for in peripheries?
A
- lungs-check for bibasal crackles in pulmonary oedema
- Sacral oedema-RSHF
Legs
- look for saphenous venous grafting scarsbr
- Check for temperature (cold in limb ischaemia), loss of hair, thin skin, brittle nails; check cap refill
- Check in between toes and ball of foot for pressure ulcers (especially when bed bound)
13
Q
What type of scars are these and what do they indicate?
A
