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Year 3 OSCE > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

1
Q

What can a radial-femoral delay indicate?

A

Aortic coarctation - a genetic abnormality of the aorta, which causes the aorta to narrow, not often picked up until adulthood.

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2
Q

What could a bounding pulse indicate?

A

anaemia, hypertension, anxiety

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3
Q

What could a weak pulse indicate?

A

hypotension or hypovolaemia due to blood loss, fluid loss or sepsis

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4
Q

What could an irregular pulse indicate?

A

Atrial fibrillation (AF)

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5
Q

What could bradycardia indicate?

A

Heart block, medication or an athlete

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6
Q

What could tachycardia indicate?

A

Pain, infection or arrythmias

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7
Q

How do you differentiate between the internal jugular vein and the carotid artery? (3)

A
  1. Position - IJV is right in front of the sternocleidomastoid muscle
  2. Waveform - A double tap is IJV, if it’s a single pulsation then its the carotid
  3. Strength - IJV is not palpable, carotid pulse is
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8
Q

What is the muscle in front of the jugular vein called?

A

Sternocleidomastoid muscle

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9
Q

What is distended right-sided jugular veins a sign of?

A

Right-sided heart failure, pulmonary hypertension or cardiac tamponade

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10
Q

How do you measure JVP?

A

Look for a visible pulsation of the jugular vein on the right-hand side of the neck. Take a pen to the level of the pulsation, and put a ruler on the sternal notch and measure the line of pulsation. If pulsation is over 4cm, this is indicative of jugular distension.

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11
Q

Why do we look at the right-sided jugular vein?

A

Because it is the most direct route down to the right atrium

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12
Q

What other test could you do to test for JVD?

A

Hepatic reflex - press on the liver and the JVD increases

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13
Q

Why does heart failure cause pitting oedema?

A

The blood backs up into the system and the hydrostatic pressure causes oedema.

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14
Q

How long does the indentation need to stay in pitting oedema for it to be considered cardiac in origin?

A

> 15 seconds

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15
Q

What two places do we look for pitting oedema?

A

The ankles and the sacrum

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16
Q

What would you say at the beginning of the cardiovascular assessment?

A

done my history taking and general

need patient at 45 degree angle

expose the chest

ask about pain

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17
Q

What is pitting oedema a sign of?

A

Left-sided heart failure

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18
Q

How do you test for pitting oedema?

A

Press on the distal tibia for 5 seconds and then release

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19
Q

How do you look for DVT?

A
  • If there is any swelling or reddening of the calf, or pain on palpation of the deep veins on the posterior aspect of the lower leg.
  • Compare both legs to see if they are the same size.
  • Feel down the centre of the calf.
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20
Q

What are the risk factors of DVT to ask the patient?

A
  • Have you had any DVTs in the past?
  • Any recent long-haul flights?
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21
Q

What are varicose veins?

A

Swollen and enlarged veins - blood pools in the distal veins

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22
Q

What does varicose veins put the patient at increased risk of?

A

DVTs

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23
Q

What are you looking for in an anterior chest inspection? (Cardiac)

A
  1. Scars - pacemaker? cardiac surgery? angioplasty?
  2. Deformities - Flail chest? Pigeon/funnel chest?
  3. Bruises
24
Q

What are heaves and what can it indicate?

A

Forceful contraction of the heart
It can indicate Left Ventricular Hypertrophy

25
Q

What does heaves feel like on palpation and where do you palpate for heaves?

A

Like your hand is being pushed very forcefully.

Palpate the apical beat.

26
Q

What are thrills and what do they feel like on palpation?

A

Palpable heart murmurs. Feels like tiny vibrations on the hand.

Shouldn’t be able to feel anything on palpation.

27
Q

Where is the aortic valve best felt/heard?

A

2nd ICS, right sternal border

28
Q

Where is the pulmonary valve best felt/heard?

A

2nd ICS, left sternal border

29
Q

Where is the tricuspid valve best felt/heard?

A

5th ICS, left sternal border

30
Q

Where is the mitral valve best felt/heard?

A

5th ICS, left mid-clavicular line

31
Q

Where is Erb’s point and what is it used for?

A

3rd ICS, left sternal border - best to hear all general heart sounds

32
Q

What is happening during S1 sounds?

A

Tricuspid and Mitral valves are closing at the beginning of systole

33
Q

What is happening during S2 sounds?

A

Aortic and Pulmonary valves are closing at the end of systole / beginning of diastole

34
Q

What is an S1 sound?

A

Lub

35
Q

What is an S2 sound?

A

Dub

36
Q

What does S3 sound like?

A

Low pitched - Lub de DUB
After S1 and S2

37
Q

What is happening during an S3 sound and what can cause it?

A

Energetic filling of the ventricles. This can be caused by heart failure, however it can be normal in pregnancy, children and adults under 40

38
Q

What does S4 sound like?

A

(low pitched) LE lub dub - before S1 and S2.

39
Q

What is happening during an S4 sound and what can cause it?

A

Forceful atrial contractions against stiffened ventricles - always pathological. This can be a sign of heart failure, left ventricular hypertrophy or ischaemia.

40
Q

What does splitting of S2 sound like?

A

High pitched - Split of DUB (de-dub)

41
Q

What is splitting caused by?

A

Closure of the semilunar valves not in sync - pulmonary valve is later than aortic valve. Can indicate a LBBB.

42
Q

What is a murmur?

A

Turbulent blood flow

43
Q

What are the two causes of a murmur?

A
  1. Stenosis - Valve does not fully open - caused by calcification of the valve - when blood passes through the valve it makes a whooshing sound
  2. Regurgitation - The valve collapses in on itself when it closes, causing a backflow of blood through the heart - causing a whooshing sound
44
Q

What sounds is the diaphragm on the steth best used for?

A

High pitched sounds - S1 and S2

45
Q

What is the bell on the steth best used for?

A

Low pitched sounds - S3 and S4

46
Q

Auscultate which valve in the left lateral position and why?

A

Mitral valve - to hear for murmurs

47
Q

Auscultate which valve leaning forward, slightly to the left and why?

A

Aortic valve - to hear for murmurs

48
Q

Use the _____ side of the stethoscope to auscultate carotid bruits

A

bell

49
Q

What do you do during auscultation of carotid bruits?

A
  1. Palpate the carotid pulse whilst auscultating the apical impulse
  2. Ask patient to hold breath and listen to the carotid artery
50
Q

What sound is normal when auscultating carotid artery?

A

Absent sound

51
Q

What sound indicates carotid bruits?

A

Whooshing sound

52
Q

What are carotid bruits and what causes it?

A

Turbulent blood flow - caused by atherosclerosis. This can lead to CVAs or TIAs.

53
Q

What is the order of the cardiovascular assessment?

A
  1. Pulse checks
  2. JVD
  3. Oedema and varicose veins
  4. Anterior chest inspections
  5. Apical impulses
  6. Palpate for heaves and thrills
  7. Auscultation of heart sounds
  8. Auscultation of carotid arteries (bruits)
54
Q

What are you looking for when palpating carotid pulse and auscultating apical pulse?

A

The upward stroke of the carotid pulse should be the same as S1. This is used for timing of murmurs.

55
Q

What could unequal pulses indicate?

A

Aortic dissection - a tear in the aorta

56
Q

When palpating the apical impulse, what are you feeling for?

A

5th ICS, mid clavicular line. Feeling for a pulse.

If the apical impulse is displaced laterally towards the axilla, then this can indicate left ventricular hypertrophy

57
Q

What causes an apical beat?

A

The ventricle contracts and rotates and hits the wall of the chest

Year 3 OSCE (5 decks)

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