Cardiovascular Exam Flashcards
How would you explain and gain consent for a CV exam?
“I’ve been asked to do an examination of your heart today.
It will involve me having a look at your hands, face, neck and chest and having a listen to you heart.
You will have to be exposed from the waist up and the examiner will act as a chaperone today - IS THAT OK?”
- Are you in any pain at all?
What is the general layout of the CV exam?
1) WIPE
2) Gen inspection
3) Hands look
3. 5) Pulse (radial, radial delay, collapsing)
3. 75) Lying and standing BP
4) Face look
5) neck look
6) chest inspection
7) chest palpation
8) chest ausculation
9) lungs ausc, sacral / periph oedema
what do you look for on general inspection in a CV exam?
1) Bedside
- oxygen
- GTN
- medication
2) patient
- cyanosed?
- alert?
- SOB?
- body habitus?
- pain?
What do you look for on inspection of the hands in a CV exam?
1) temparature? clammy/sweaty?
2) cap refill <2s
3) Palms:
- janeway lesions
- osler’s nodes
- pale palmar creases
4) back of hand:
- tendon xanthoma
- nicotine staining
5) Nails
- clubbing
- splinter haemorrhages
What do you look for on a radial pulse ?
Radial pulse:
Rate - tachy, brady
Rhythm - regularly regular, irregular,
Character - weak or bounding
What are the cardiac causes of atrial fibrillation?
- heart failure
- MI / ischaemic heart disease
- Atrial dilation (secondary to mitral stonosis or regurg)
- Cardiac surgery
- hypertension
What are the non cardiac causes of atrial fibrillation?
- infection
- thyrotoxicosis (hyperthyroid)
- alcohol
- pulmonary embolism
What are the signs of infective endocarditis?
- Janeway lesions
- osler’s nodes
- splinter haemorrhages
- roth spots
What is radial radial delay a sign of?
- if left pulse is delayed compared to right then this is a sign of co-arctation of the aorta proximal to the L subclavian artery
what is a collapsing “water hammer” pulse a sign of?
aortic regurgitation
what pulse would indicate aortic stenosis?
slow rising pulse
What murmur would indicate aortic stenosis?
ejection systolic murmur that radiates to the carotids
when taking bood pressure what would indicate:
- aortic stenosis
- aortic regurg
- aortic stenosis has a slow rising pulse and narrow pulse pressure
- Aortic regurg has a collapsing pulse and a wide pulse pressure
What do you look for when inspecting the face in a CV exam?
1) Face :
general colour ?
malar flush of mitral stenosis?
2) Eyes:
- Xanthelasma
- corneal arcus
- conjuctival pallor
* *fundoscopy for roth spots
3) Lips:
- peripheral cyanosis
- angular stomatitis
4) Mouth:
- under tongue for central cyanosis
- mouth - high arched palate (marfans)
- dental hygiene
What do you look for in the neck during a CV exam?
2) Raised JVP (patient at 45 degrees - say you would in ilicit a hepatojugular reflux)
3) Carotid pulse and listen for bruit
What do you look for when inspecting the chest in a CV exam?
- scars (sternotomy for heart bypass / thoracotomy)
- Pacemaker
- chest drain
- chest wall deformities (pectus carinatum, pectus excavatum, barrel chest)
- visible pulsation or heaves.
- look at legs for vessel graft scars.
what is barrel chest a sign of
COPD
What do you palpate in a CV exam?
1) Apex Beat (5th intercostal space mid-clav line)
2) Heaves (indicate LVH or RVH)
3) Thrills (palpable murmurs in all 4 valve areas)
Where can you palpate the apex beat?
5th intercostal space mid clavicular line
Where do you listen to the mitral valve?
Mitral valve
5th intercostal space mid clavicular line
where do you listen for the tricuspid valve?
Tricuspid valve
4th intercostal space - left sternal border
where do you listen for the pulmonary valve?
Pulmonary valve
2nd intercostal space - left sternal border
Where do you listen for the aortic valve ?
aortic valve
2nd intercostal space - right sternal border
How do you listen for mitral stenosis?
listen at mitral area with bell and patient leaning to left hand side (it makes it easier to hear the low pitched disatolic murmur of mitral stenosis during expiration)
How would you describe the murmur of mitral stenosis?
rumbling mid diastolic murmur best heard in expiration with patient on their left side.
How do you listen to mitral regurgitation?
mitral regurgitation radiates to the axilla it can be heard as a pansystolic murmur.
How do you listen for aortic regurgitation?
- sit patient up
- lean them forward
- listen at the left lower sternal edge (tricuspid region)
- listen with diaphragm in expiration
- murmur will be high pitched early diastolic .
how do you listen for aortic stenosis?
ejection systolic murmur that is heard in aortic area and radiated to carotids. (best heard when leaning forwards and in expiration)
what are the causes of systolic murmurs?
Aortic stenosis - ejection systolic murmur
Mitral regurgitation - Pansystolic murmur
what are the causes of diastolic murmurs?
Aortic regurg - early diastolic (high pitched)
mitral stenosis - mid diastolic (rumbling)
Describe the entire process of auscultation in a CV exam?
1) auscultate the 4 heart valves (listen with diaphragm)
1. 5) listen for CAROTID BRUITS.
2) lean patient to left
- listen with bell
- at mitral valve
- during expiration for MITRAL STENOSIS - mid diastolic rumble
3) whilst leant to the left
- listen with bell
- at axilla
- for radiation of MITRAL REGURG - pansystolic murmur.
4) Sit patient up,
- listen with bell
- at carotid for AORTIC STENOSIS ejection systolic murmur.
5) lean patient forward
- listen with bell
- at aortic area for AORTIC REGURGITATION ( early diastolic murmur high pitched)
6) lung bases for crackles
