Cardiovascular exam

Question 1

Introduction

Answer 1

Clean hands
Introduction
Check name and DOB/age
Explanation and gain consent

Question 2

End of Bed

Answer 2

Immediate intervention required?
In pain? Breathless?
Sputum pots/oxygen mask/NEWS chart/ medication

Question 3

Hands and arms

Answer 3

Tar staining
Temperature
Compare nail colour (peripheral cyanosis)
Clubbing
Splinter haemorrhages (infective endocarditis)
Capillary refill time
Fine tremor
Radial pulse - rate, rhythm, volume, character
IV track marks
Blood pressure

Question 4

Head

Answer 4

JVP
Malar flush
Conjuctivae (pallor/anaemia)
Xanthelasma or corneal arcus (hyperlipidaemia)
Lips and tongue (central cyanosis)

Question 5

Chest

Answer 5

Listen to lung bases

crackles = left sided heart failure?

Question 6

Lower limbs

Answer 6

Pitting oedema
Varicose veins
Peripheral pulses

Question 7

Precordium inspection

Answer 7

Inspection - pectus excavatum, scars, pacemaker, visible pulsation

Question 8

Precordium palpation

Answer 8

Palpation - tracheal position, apex beat, heaves, thrills

Question 9

Precordium auscultation

Answer 9

4 valve areas with diaphragm and then the bell
Listen for S1 + S2 + (0) while palpating carotid
Over carotids for bruits and aortic systolic murmur
Patient on left side - listen over apex and in axilla with the diaphragm for mitral regurgitation and the bell for mitral stenosis
Patient sat forward - left sternal edge for aortic regurgitation

Question 10

Peripheral pulses

Answer 10

Brachial
Carotid
Femoral (radio-femoral delay)
Popliteal
Posterior tibial
Dorsalis pedis
(auscultate carotids and femorals for bruits)

Question 11

Closure

Answer 11

Thank patient
Help them dress
Clean hands
Document findings