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
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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)
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3
Q

What are the causes of clubbing in hands?

A
  • congenital cyanotic heart defects
  • tetralogy of fallot
  • subacute bacterial endocarditis
  • atrial myxoma
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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
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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.
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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
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7
Q

What kind of scars are these?

A
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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
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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
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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
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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)
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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)
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13
Q

What type of scars are these and what do they indicate?

A
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