Cardiovascular Exam

Question 1

Sections in a cardiovascular exam?

Answer 1

Initial Assessment
Introduction and Consent
General Overview
Peripheral examination
- Hands
- Arms
- Head
- Lung base
- Lower limbs
JVP
Precordium
Peripheral Pulses
Closure
Documentation

Question 2

What do you do in the initial assessment, and introduction?

Answer 2

Initial assessment

• does patient need life-saving intervention?
• are they well enough to proceed with examination?
• inspect environment (oxygen, vomit, sputum, medication)

Introduction

• Clean hands
• My full and role
• Check patient’s full name and date of birth
• Confirm with wristband
• Explain procedure and obtain informed consent
• Position bed at appropriate height and patient at 45deg
• Check charts if available

Question 3

What do you look for in the hands and arms during a cardiovascular exam?

Answer 3

Nails

• tar staining
• peripheral cyanosis
• clubbing
• splinter haemorrhages
• capillary refill

Fine tremor
Warmth of hands
Anaemia
Compare with own hands

Pulse

• Rate
• Rhythm
• Volume
• Character
• • collapsing pulse

IVDA

Question 4

What do you look for in the head/face during a cardiovascular exam?

Answer 4

Malar flush
Conjunctivae pallor - anaemia
Xanthelasmata and corneal arcus
Central cyanosis - tongue/lips
Sore/red tongue - anaemia
Angular stomatisis

Question 5

What do you look for in the thorax/lower limb cardiovascular exam? (not including precordium exam)

Answer 5

Listen to lung bases for crackles
- LHF

JVP

• vertical height from sternal angle
• normal <4cm

Pitting oedema - legs/sacrum
Arterial disease
- ischaemia (cold, smooth, hairless, ulceration, poor capillary refill)
Varicose veins - ask patient to stand

Question 6

What do you do during the examination of the precordium?

Answer 6

Inspection
Palpation
Auscultation

Inspection

• Chest deformities - kyphoscoliosis, pectus excavatum
• scarring
• pacemaker

Palpation

• tracheal position
• cardiac pacemaker
• apex beat
• heaves (L sternum) with palm
• thrills -valve areas with fingertips

Auscultation

• listen in 4 valve areas with diaphragm then bell
• palpate carotid simultaneously
• listen for systolic radiation in both carotids (AS), apex and L axilla (MR)
• listen for diastolic murmurs with bell at apex (lying on side, MS) and lower L sternum (sitting forward, AR)

Question 7

What is the procedure for examining peripheral pulses in a cardiovasular exam?

Answer 7

Compare both sides for each
Radial - rate, rhythm, character, volume (radial/radial delay)
Brachial
Carotid - auscultate for bruit
Femoral - radial/femoral delay, femoral/femoral delay, bruits
Popliteal
Posterior Tibial
Dorsalis Pedis