Cardiovascular Exam Flashcards
What are the main steps in a cardio exam?
Prepare the patient Hand hygiene General inspection Hands Radial pulse BP Head and neck JVP Carotid pulse Chest inspection Chest palpation Chest auscultation Lower limbs Conclude and close assessment
How do you prepare the patient?
Introduction and consent
Explanantion
Exposure: undress to underwear; provide gown
Position: examine from the right; bed at 45 degrees
What is included in the general inspection
Environment
Patient
What do you inspect in the hands?
Fingers and nails
Palmar creases
Capillary refill
Nicotine stains
What qualities are you measuring when taking the radial pulse?
Rate
Rhythm
What do you inspect at the head and neck?
Conjunctivae
Lips, tongue, and palate
How do you measure JVP?
Sternocleidomastoid muscle relaxed, view pulse in line with neck
Locate sternal angle
Measure vertical distance using fingers from sternal angle to upper level of pulsation
On which side do you take the carotid pulse?
Both
Where do you palpate the chest?
Locate and palpate apex beat
Demonstrate position relative to mid-clavicular line and 5th intercostal space
What do you auscultate in the chest?
Listen with bell to - Apex beat - Lower left sternal edge - Upper left sternal edge - Upper right sternal edge Listen with diaphragm to - Apex beat - Lower left sternal edge - Upper left sternal edge - Upper right sternal edge Listen to lung bases
What do you assess in the lower limbs?
Assess for pitting oedema in both feet - Palpate behind medial malleolus - Press thumb down hard for 3 sec - Run fingers over area Pulses in both feet - Dorsalis pedis - Posterior tibial
What is clubbing?
Deposition under nails
General sign
What are you looking for in the palmar creases?
Pale lesions = anaemia
What are you examining the conjunctivae for?
Pallor = anaemia
What are you examining the lips, tongue, and palate for?
Cyanosis
Why might the JVP be elevated?
Raised pressure in the right side of the heart
What might it mean if the apex beat has shifted laterally?
Left ventricular hypertrophy
Why do you listen to the lung bases?
Crackles of heart failure
What is the normal height for JVP?
Less than 2-3 cm
Where is the superior heart border?
Line between 2nd L and 3rd R costal cartilages, 2 cm from sternal edge
Where is the right heart border?
Line between 3rd and 6th R costal cartilages, 2 cm from sternal edge
Where is the left heart border?
Line between 2nd L costal cartilage, 2 cm from sternal edge, and 5th L intercostal space, in mid-clavicular line
Where is the inferior heart border?
Line between 5th L intercostal space, in mid-clavicular line, and 6th R costal cartilage, 2 cm from sternal edge
Where are the heart valves located?
Oblique line behind sternum 6th R to 2nd L costal cartilage Superior to inferior - Pulmonary - Aortic - Mitral - Tricuspid
What valve do you auscultate at the apex?
Mitral
What valve do you auscultate in the 5th intercostal space to the left of the sternum?
Tricuspid
What valve do you auscultate in the 2nd intercostal space to the left of the sternum?
Pulmonary
What valve do you auscultate in the 2nd intercostal space to the right of the sternum?
Aortic
