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OSCEs > Cardiovascular exam > Flashcards

Cardiovascular exam Flashcards

1
Q

How should the patient be positioned during a cardiovascular exam?

A

at 45° with the chest exposed

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2
Q

What are you looking for upon general inspection of the patient during a cardiovascular exam?

A
  1. appear comfortable + well at rest (any SOB or malaria flushing/pallor?)
  2. Is the patient cyanosed?
  3. Any kind of medication (such as GTN spray, O2, mobility aids)
  4. Any scars/visible pulsations on the chest or chest wall deformities?
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3
Q

What might you see upon inspection of the hand and nails during a cardiovascular exam?

A

Nails:

  1. Splinter haemorrhages
  2. Clubbing

Hands:

  1. Colour (are they cyanosed?)
  2. Temperature
  3. Sweating/clammy
  4. Janeway lesions
  5. Osler’s nodes
  6. Tendon xanthoma
  7. Tar staining
  8. Capillary refill
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4
Q

What are splinter haemorrhages and what are they a sign of?

A
  • Reddish-brown streaks in the nail bed

- Indicate infective endocarditis

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5
Q

How do you test for clubbing, if it is present what is it a sign of?

A
  • Ask patient to make a heart shape with their index finger and thumbs
  • Normal: Small diamond shaped window called Shamroth’s window
  • Clubbing: window is lost
  • -> sign of infective endocarditis and cyanotic congenital heart disease
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6
Q

What do cool peripheries indicate?

A

Poor cardiac output/hypovolaemia

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7
Q

What are sweaty/clammy palms a sign of?

A

acute coronary syndrome
(decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies).

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8
Q

What are Janeway lesions and what do they indicate?

A
  • Non-tender, erythematous/haemorrhagic nodular lesions (on the palm pulp)
  • indicative of bacteria endocarditis
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9
Q

What are Osler’s nodes and what do they indicate?

A
  • painful, red raised lesions (on finger pulps/thenar eminence
  • indicative of infective endocarditis
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10
Q

What is (tendon) xanthoma and what is it a sign of?

A
  • raised yellow lesions
  • caused by hyperlipidaemia
  • tendon xanthoma can be associated with familial hypercholesterolaemia
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11
Q

Why is it important to look for tar staining on a cardiovascular exam?

A

indicates smoking which is a risk factor for cardiovascular diseases

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12
Q

What is the normal time for capillary refill? If it is prolonged, what does it indicate?

A
  • <2 seconds

- Prolonged = hypovolaemia

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13
Q

What is the next step in the cardiovascular exam, once inspection is complete?

A

Pulses:

  1. Radial pulse: assess for rate and rhythm
    - count for 15 seconds and multiply by 4 or 30 seconds and multiply by 2
    - can also roll artery for width/size of lumen/bounciness
  2. Brachial pulse: assess volume and character

(can do blood pressure at this step - separate flashcards on these)

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14
Q

What are the surface markings used to locate the radial pulse?

A

Lateral to the flexor carpi radials of the wrist

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15
Q

What are the surface markings used to locate the brachial pulse?

A

Medial and little underneath the biceps tendon

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16
Q

What is the next step in the cardiovascular exam, once pulses/BP are complete?

A

Neck

  1. Carotid pulse: character and volume
    * explain to pt what you are doing before you touch their neck lol
  2. Jugular venous pulse (JVP)
    - ask pt to turn their head away form you
    - observe the neck for the JVP
    - measure the JVP (should be <3 cm from the vertical height of the sternal angle)
17
Q

What surface markings are used to locate the carotid pulse?

A

Carotid artery runs down the side of the thyroid cartilage, between the trace and the SCM, and just slightly under the SCM

18
Q

What is radio-radial delay a sign of?

A

Aortic coarctation

19
Q

What is collapsing pulse a sign of?

A

Aortic regurgitation

20
Q

Why is it important to look at the JVP?

A

Represents the preload on the heart (RA pressure) as it empties into it

21
Q

What does a raised JVP indicate?

A
  1. fluid overload
  2. right ventricular failure
  3. tricuspid regurgitation

(heart failure and impending decompensation)

22
Q

What does a non-visible or low JVP indicate?

A
  1. healthy

2. hypovolaemic

23
Q

How can you elicit the JVP?

A
  1. lie the patient flatter
  2. hepatojugular reflux
  3. filling and emptying the external jugular
24
Q

What surface markings are used to locate the JVP?

A

IJV enters the neck between the two heads of the SCM

25
Q

What are the 7 differences between the JVP and the carotid pulse?

A
  1. Waveform:
    - JVP = double
    - Carotid = single
  2. Positional change:
    - JVP = varies with position
    - Carotid = no change
  3. Respiration:
    - JVP = descends with inspiration
    - Carotid = no change
  4. Effect of palpation:
    - JVP = Impulse non-palpable
    - Carotid = Impulse palpable
  5. Pressure:
    - JVP = pressure occludes pulse and vein refills from above
    - Carotid = non-compressible
  6. Hepatojugular reflux:
    - JVP = elevates pulse
    - Carotid = no change
  7. Type of pulse:
    - JVP = venous pulse
    - Carotid = arterial pulse
26
Q

What is step in the cardiovascular exam follows carotid pulse and JVP?

A

Palpation of chest

  1. Apex beat
  2. Heaves + thrills
27
Q

What is the apex beat, where is it usually found? What does a displaced apex beat indicate?

A

It is the lowermost and outermost palpable cardiac impulse

  • normal apex beat is ~5th intercostal space in the mid-axillary line
  • displaced apex beat is either a result of:
    1. cardiomegaly (dilation/failure)
    2. heart being pushed as a result of a lung pathology
28
Q

What are heaves and thrills?

A
  1. Heaves = palpable cardiac impulse
    - parasternal heaves = right ventricular hypertrophy
  2. Thrills = palpable murmur
29
Q

What step in the cardiovascular exam follows palpation of the chest?

A

Auscultation

  • listen to the 4 main valve areas to identify normal heart sounds
  • always feel a central pulse (e.g. carotid) whilst auscultating in order to time the heart sounds in the cardiac cycle
  • listen to the 1st heart sound
  • 2nd heart sound (as the pulse drops away from fingers, is it split?)
30
Q

Where do you listen for each of the heart valves on the chest?

A
  1. Aortic valve = 2nd intercostal space
  2. Pulmonary valve = 2nd intercostal space
  3. Tricuspid = left sternal border (4th intercostal space)
  4. Mitral = apex/ 5th intercostal space mid-clavicular line
31
Q

During second heart sound the pulse may split, when is this a good/normal sign and a bad sign?

A
  • if it splits during respiration then this is normal

- if it split is fixed then this is a bad sign

32
Q

Where on the chest would you listen for aortic murmurs?

A

aortic area and left sternal edge in expiration and over the carotids

33
Q

Where on the chest would you listen for mitral murmurs?

A

Listen with the bell over the apex, and while patient is lying on left side, and in the left axilla

34
Q

What step in the cardiovascular exam follows auscultation?

A

Feet:

  • examine the feet/ankles for peripheral oedema
  • palpate the dorsalis pedis and posterior tibial pulses
35
Q

What surface markings are used to locate the dorsalis pedis?

A

Lateral to tendon of extensor hallucis longus

36
Q

What surface markings are used to locate the posterior tibial pulse?

A

Posterior and inferior to the medial malleolus

37
Q

What else would you auscultate, apart from valves + murmurs?

A

Lung bases (for fine crepitations/crackles) = may indicate pulmonary oedema secondary to left ventricular failure

38
Q

Where else should you look for oedema? Why?

A

Sacral oedema

- may indicate right ventricular failure

39
Q

What further assessments/investigations might you suggest at the end of a cardiovascular exam?

A
  1. Full peripheral vascular examination
  2. Record a 12-lead ECG – arrhythmias / myocardial ischaemia
  3. Dipstick urine – proteinuria / haematuria – hypertension
  4. Bedside capillary blood glucose – diabetes
  5. Perform fundoscopy – malignant hypertension – papilloedema

OSCEs (45 decks)

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