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Sem. A - PAM 1 > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

1
Q

A focussed cardiovascular Hx will inlude the most common and most important cardiac symptoms…

A

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
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2
Q

Cardiovascular Examination

A

General appearance - Global overview

Hands

Pulse

Neck - Vein Distention(JVP)

Chest:

  • Look - Inspect
  • Feel - Palpate
  • Listen - Auscultate
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3
Q

Physical Examination - Considerations

A

Environment

Informed Consent

Position

Privacy & Dignity

Systematic Approach - Inspect, Palpate, Auscultate

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4
Q

Greet the Pt

A

General Appearance - BIG sick / Little sick

Level of consciousness / Responsiveness

Distress / Dyspnoea?

Cyanosis Peripheral / Central?

Age

Gender

Obese / Cachectic (wasted/weight loss++)

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5
Q

Hands

A

Warm hands = Well perfused

? Tremor ‘Liver flap’ / Asterixis

Nails & Hands:

  • Cyanosis
  • Clubbing
  • Splinter Haemorrhages
  • Tar staining
  • Osler’s Nodes
  • Xanthomas
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6
Q

Splinter Haemorrhages - Bacterial Endocarditis

A
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7
Q

Osler’s Nodes - Bacterial Endocarditis

A
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8
Q

Radial Pulse

A

Rate

Regularity:

  • regularly irregular
  • irregularly irregular

Volume & Character

Radial-Radial Delay?

BP

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9
Q

Face & Neck

A

Eyes

Conjunctiva & Sclera

Xanthelasma

Arcus Senilis

Carotid Arteries

Jugular Venous Pressure

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10
Q

Anaemia

A
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11
Q

Jaundice

A
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12
Q

Xanthelasma

A
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13
Q

Arcus Senilis

A
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14
Q

Carotid Pulse

A

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
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15
Q

Carotid Bruit

A

Gently listen over each carotid artery

Turbulent flow creates noise, narrowing creates turbulence

Atheromatous plaques lead to narrowing - can rupture and form emboli > stroke

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16
Q

Jugular Venous Pressure (JVP)

A

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

17
Q

JVP:

DON’T look at the External Jugular Vein - note if there is a visible wave form above the sternal angle.

A
18
Q

Chest (Precordium)

A

Expose the whole chest. NB - Dignity, privacy, warmth, etc.

Look for:

  • scars
  • deformity
  • pacemaker

Locate the Apex of the heart

19
Q

Apex

A

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

20
Q

Apex Location

A
21
Q

Heart Sounds

A
22
Q

What do you hear?

A

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.

23
Q

Auscultation

A

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
24
Q

Auscultation locations

A
25
Q

Systolic Murmur

A

Mitral / Tricuspid regurgitation(incompetence)

Aortic / Pulmonary stenosis(narrowing)

26
Q

Diastolic Murmur

A

Mitral / Tricuspid stenosis(narrowing)

Aortic / Pulmonary reurgitation(incompetence)

27
Q

Finally…

A

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

Sem. A - PAM 1 (4 decks)

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