Cardiovascular Flashcards
What do you look for on general inspection?
Clues i.e. GTN
General appearance – colour, mood, breathing, comfort, position, build
What do you look for on inspection of the hands?
Temperature, sweating Tar staining Finger clubbing Splinter haemorrhages, Osler’s nodes and Janeway lesions (all infective endocarditis) Pallor, cyanosis, capillary refill Tendon xanthomas
What do you look for when assessing pulses?
Radial – both simultaneously, rate/rhythm
Brachial – ask patient if they have any pain their arm, assess character and volume – normal/slow rising/collapsing/waterhammer (aortic regurg)
Carotids – individually, character/volume
What do you look for on inspection of the eyes?
Subconjunctival pallor
Corneal arcus
Xanthelasmata
What do you look for on inspection of the face?
Malar flush (mitral stenosis - due to the subsequent CO2 retention and it’s vasodilatory effects)
Mitral facies - rosy cheeks (malar flush) + rest of the face is blue/cyanosed - found in severe stenosis
What do you look for in the mouth/lips?
Central cyanosis Dental caries (infective endocarditis)
How do you assess JVP?
Position patient at 45 degrees, look in between heads of SCM
A normal JVP = 2-4cm above sternal angle as a double wave pulsation (may not be visible, if can be found, can check it’s not carotid by compressing, should not pulse)
Can increase if low by performing hepatojugular reflux
Check for high JVP by sitting patient upright and looking near their earlobes for venous (double wave) pulsation
What do you look for on inspection of the precordium? (thorax over heart)
Sternotomy scar, severe pectus excavatum, severe kyphoscoliosis, visible cardiac pulsation
What do you look for on palpation?
Apex beat (normally 5th intercostal space just medial of left mid clavicular line) Parasternal heaves (palpable/visible impulse from heart or great vessels in cardiac/respiratory disease i.e. RHV, COPD, cor pulmonale etc) – felt with the heel of the hand rested to the left of the sternum with fingers lifted slightly off – heel of hand would be lifted with each systole Thrills (= a palpable murmur)
What do you look for on general auscultation?
Aortic – 2nd right intercostal space, right sternal boarder
Pulmonary – 2nd left intercostal space, left sternal boarder
Erb’s point – 3rd left intercostal space, left sternal boarder (S2 is heard best)
Tricuspid – 4th left intercostal space, left lower sternal boarder
Mitral – 5th left intercostal space, mid clavicular line
If extra sounds are heard, palpate the carotid pulse to time them with the 1st and 2nd heart sounds – start of pulse should be synchronous with the 1st
What else should be auscultated?
Left axilla – mitral incompetence, murmur radiates to the axilla
Apex – using the bell of the stethoscope and the patient rolled 45 degrees to the left, listen for mitral stenosis
4th/5th intercostal space left of sternum on held expiration – aortic regurgitation
Base of lungs + palpate for sacral oedema – if coarctation suspected, listen left of spine in the 3rd/4th intercostal space
Carotids – bruits or transmitted systolic murmurs
What else should be done to complete the examination?
“For the BEHOOF of the patient, I would like to…”
(definition: a benefit or advantage)
Blood pressure - in both arms and lying and standing in one arm
ECG - 12 lead
Hepatomegaly – lay patient flat and palpate for - if enlarged, feel for pulsation = tricuspid regurgitation (transmitted waves from R ventricular hypertrophy)
Oedema - check for pitting in the ankles over bony prominences, if present, check for ascites; If ascites suspected – test for shifting dullness
Opthalmoscopy - hypertensive retinopathy
Femorals - pulses and their synchrony with the radial pulse (radiofemoral delay in coarctation of the aorta)
