Cardiovascular Exam Flashcards
What signs do you look for in the nails
Clubbing, splinter haemorrhages
What signs do you look for in the fingers and hands
Osler’s nodes, Janeway lesions, tendon xanthomata
What signs do you look for in the mouth
Dental state, central cyanosis
What signs do you look for in the eyes
Conjunctival rim pallor, corneal arcus
What are splinter haemorrhages and what can they indicate
Thin reddish brown lines of blood under the nails
Infective endocarditis
What is xanthomata and what can it indicate
fat build-ups under the surface of the skin. Raised, waxy-appearing, frequent yellow-ish skin colour lesions.
Hypercholesterolaemia
What are Osler’s nodes and Janeway lesions and what can they indicate
Non-tender, haemorrhagic nodes on the palms or soles
Infective endocarditis
What can clubbing indicate
Infective endocarditis and congenital heart disease
What capillary refill time is normal
Less than 2 seconds
What do you assess in radial pulse
Rate and rhythm
What does radial-radial delay indicate
Co-arctation of the aorta
What can a collapsing pulse indicate
Aortic regurgitation
Where is the bicep pulse
Medial to the biceps tendon (and slightly under)
What does a raised JVP indicate
Right heart failure
What is a positive hepatojugular reflex sign
A sustained rise of >=4cm
What is corneal arcus and what does it indicate
Grey, white or yellow depositions in the peripheral cornea
Could indicate hyperlipidaemia
What does conjunctival pallor indicate
Anaemia
What do you inspect the chest wall for
Deformities and scars
Which chest scars could indicate what
Central chest - sternotomy or thoracotomy
Clavicular - Pacemaker
Left mid-axillary line - Subcutaneous ICD
Underarm - Lateral thoracotomy
What can a parasternal heave indicate
Right ventricular hypertrophy
Radiation to the carotid of an ejection systolic murmur is often heard in what
Aortic stenosis
How can you make aortic and mitral murmurs to be louder
Perform accentuation manoeuvres: Aortic murmur (Aortic stenosis) - sit up Mitral murmur (Mitral regurgitation) - Roll over to the left
Get the patient to exhale and hold
What do coarse crackles in lung auscultation indicate
Pulmonary oedema secondary to left ventricular failure
What does sacral oedema indicate
Right ventricular heart failure
What does pedal oedema indicate
Right ventricular heart failure
What examinations are necessary to complete findings
full peripheral cardiovascular exam
ECG
Measure blood pressure
What is a normal heart rate
60-100
Lower in sportspeople
What can a weak pulse indicate
Poor circulating volume/stroke volume
Possible causes include hypovolaemia (haemorrhage, dehydration), shock (cardiac, septic) or peripheral vascular disease
What can a high volume pulse indicate
Increased cardiac output
Could be due to pregnancy, emotion, aortic regurgitation, fever and hyperthyroidism
What do you look for in inspection from the end of the bed
Shortness of breath
Cyanosis
Pallor
Oedema
If you cant see the JVP, how can you ensure it isn’t too high
Lie patient flatter and look for a pulse entering the neck
Hepatojugular reflex
filling and emptying the external jugular
Where can you check for a pulse in the feet
Dorsalis Pedis Pulse (lateral to tendon of Extensor Hallucis longus)
Posterior tibial (posterior and inferior to Medial Malleolus)
