Cardiovascular Exam

Question 1

Introduction of cardiovascular

Answer 1

INTRODUCTION:
• Greet the examiner.
• Greet the patient.
• Introduce yourself and establish rapport.
• Confirm patient’s identity.
• Briefly explain what the examination is about.
• Obtain consent.
• Ask for a chaperone.

Question 2

To the examiner

Answer 2

To the examiner:
I would like to:
• screen my patient for privacy.
• expose my patient (tell patient to take off shirt or singlet, lower limbs
must be exposed too).
• place my patient in cardiac position (45o angle).
• sanitize or wash my hands with running water and soap.
• Ask to perform a quick general examination:
• Points to note: Hair texture, sclera jaundice, conjunctival pallor, pe-
ripheral cyanosis, finger clubbing, lymphadenopathy, etc.

Question 3

Inspection

Answer 3

Inspect from the side to the foot of the bed or from head to toe.
• Points to note:
• Dyspnoea, pallor or cyanosis
• Symmetry of the chest wall
• Any deformity (pectus excavatum, pectus carinatum, etc.)

Question 4

What are the series of test to perform on the hand

Answer 4

The Hand:
• Begin by examining the pulse for: − rate
− rhythm
− volume
− character
− radioradial, radiocarotid, etc. synchronicity − radiofemoral delay
• Check for arterial wall thickness
• Check for collapsing pulse
• Check for locomotor brachialis
• Ask to take the blood pressure

Question 5

What should we exam in the neck

Answer 5

:
Check for jugular venous distension Perform a hepatojugular reflux tes

Question 6

What should observe on the precordium

Answer 6

Inspection: (focus should be on the precordium)
Look out for: precordial hyperactivity, cardiac impulses, bulge, etc.

Question 7

Palpation of the precordium

Answer 7

Palpation:
Apex beat:
Palpate the apex beat.
Localize the apex beat with the middle finger.
Indicate, with the fingers, the position of the apex beat (5th intercostal space, midclavicular line).
Thrills: Using the flat of your right hand, check for thrills on the four valve areas:

• Mitral valve area (apex beat)
• Tricuspid valve area (lower left sternal edge)
• Pulmonary valve area (left 2nd intercostal space) • Aortic valve area (right 2nd intercostal space)
Heaves: Using the heel of the hand, check for heaves on the:
Mitral valve area (left ventricular hypertrophy)
Left parasternal area (right ventricular hypertrophy)

Question 8

Auscultation of the precordium

Answer 8

Listen for heart sounds over the four valve areas using the diaphragm of the stethoscope
• Mitral valve area
• Tricuspid valve area
• Pulmonary valve area • Aortic valve area
Listen for heart murmurs over the four valve areas using the bell of the stethoscope
• Mitral valve area
• Tricuspid valve area
• Pulmonary valve area • Aortic valve area

Question 9

Back and leg auscultation

Answer 9

Auscultate the lung bases for fine crackles (heart failure) Check for sacral edema
Check for pedal edema