Cardiovascular Assessment Flashcards
A focussed cardiovascular Hx will inlude the most common and most important cardiac symptoms…
Presenting Complaint:
- Chest pain, tightness or discomfort
- Shortness of breath
- Palpitations
- Syncope(blackouts, faints, collapse) or dizziness
Past Medical Hx:
- Related cardiovascular Hx including Transient Ischaemic Attacks, Strokes, Peripheral Arterial Disease and Peripheral Oedema
Drug Hx:
- Medications (including compliance)
Family Hx:
- Ask about Hypertension, Coronary Heart Disease, Stroke, Diabetes, Hyperlipidaemia, Congenital Heart Disease.
- ? Any early deaths (particularly before the age of 60) in the family.
Social Hx:
- Lifestyle
- Obesity
- Diet
- Physical Activity/Inactivity
- Occupation
- Stress Levels
Cardiovascular Examination
General appearance - Global overview
Hands
Pulse
Neck - Vein Distention(JVP)
Chest:
- Look - Inspect
- Feel - Palpate
- Listen - Auscultate
Physical Examination - Considerations
Environment
Informed Consent
Position
Privacy & Dignity
Systematic Approach - Inspect, Palpate, Auscultate
Greet the Pt
General Appearance - BIG sick / Little sick
Level of consciousness / Responsiveness
Distress / Dyspnoea?
Cyanosis Peripheral / Central?
Age
Gender
Obese / Cachectic (wasted/weight loss++)
Hands
Warm hands = Well perfused
? Tremor ‘Liver flap’ / Asterixis
Nails & Hands:
- Cyanosis
- Clubbing
- Splinter Haemorrhages
- Tar staining
- Osler’s Nodes
- Xanthomas
Splinter Haemorrhages - Bacterial Endocarditis
Osler’s Nodes - Bacterial Endocarditis
Radial Pulse
Rate
Regularity:
- regularly irregular
- irregularly irregular
Volume & Character
Radial-Radial Delay?
BP
Face & Neck
Eyes
Conjunctiva & Sclera
Xanthelasma
Arcus Senilis
Carotid Arteries
Jugular Venous Pressure
Anaemia
Jaundice
Xanthelasma
Arcus Senilis
Carotid Pulse
Press gently
Elderly people have calcified arteries - you do not want to dislodge atheroma
Character:
- slow rising - aortic stenosis
- collapsing(‘waterhammer’) - aortic incompetence
- pulsus paradoxus - pulse pressure changes with inspiration & expiration - asthma, upper airway obstruction
Carotid Bruit
Gently listen over each carotid artery
Turbulent flow creates noise, narrowing creates turbulence
Atheromatous plaques lead to narrowing - can rupture and form emboli > stroke
Jugular Venous Pressure (JVP)
Pt should be semi-recumbent - 45º
Head turned slightly away from the mid-line
Look for pulsating wave-form between the 2 heads of sternocleidomastoid
Usually only just visible - if raised it suggests right-sided heart failure / fluid overload
JVP:
DON’T look at the External Jugular Vein - note if there is a visible wave form above the sternal angle.
Chest (Precordium)
Expose the whole chest. NB - Dignity, privacy, warmth, etc.
Look for:
- scars
- deformity
- pacemaker
Locate the Apex of the heart
Apex
Position:
- 5th intercostal space
- Left mid-clavicular line
- Dsiplaces down & lateral
Apex Character:
- Tapping (NORMAL)
- Heaves or Thrills
Palpate from beneath/lateral, working toward the apex
Apex Location
Heart Sounds
What do you hear?
1st heart sound is tricuspid & mitral valves closing - start of ventricular systole.
2nd heart sound is aortic & pulmonary valves closing - start of diastole.
Remember: Heart sounds are generated by the valves slamming shut, NOT by muscular contraction.
Auscultation
Use the diaphragm of the stethoscope.
Listen for:
- Aorta - R of sternum @ 2nd intercostal space
- Pulmonary - L of sternum @ 2nd intercostal space
- Tricuspid - L of sternum @ 3/4/5 intercostal space
- Mitral - mid-clavicular line @ 5th intercostal space
Auscultation locations
Systolic Murmur
Mitral / Tricuspid regurgitation(incompetence)
Aortic / Pulmonary stenosis(narrowing)
Diastolic Murmur
Mitral / Tricuspid stenosis(narrowing)
Aortic / Pulmonary reurgitation(incompetence)
Finally…
Check for Oedema:
- Peripheral
- Sacral (especially in bed-ridden Pt)
Blood Pressure:
- Correct cuff size
- Pt @ 45º
- Look for postural drop - Lying/seated or seated/standing, suggests early shock
ECG
