Cardiovascular Exam Flashcards
General Inspection
Body habitus Well/ unwell Scars Breathless Cyanosed Obvious Syndromes e.g. Marfaans, Downs, Noonans Audible Click of Prosthetic Valve
Splinter Haemorrhages
Small streak like bleeds under nail beds.
One/ two are normal
Conditions: infective endocarditis, trauma, sepsis, RA, vasculitis
Clubbing
Infective endocarditis, cyanotic heart disease
Koilonychia
Spooning of the nails
Iron Deficiency Anaemia
Quincke’s sign
Rare- pulsating nail beds
Severe aortic regurgitation
Temperature and Capillary Refill Time
Press 5 secs- return of colour in <2 secs
Poor perfusion
Peripheral Cyanosis
Peripheral vascular disease, low cardiac output
Nails
Splinter haemorrhages
Clubbing
Koilonychia
Qunike’s sign
Hands
Temperature and cap refill Tar staining Xanthomata Janeway lesions Olser's nodes
Xanthomata
Raised Yellow lesions on tendons
Hyperlipidaemia
Janeway Lesions
Rare - non tender lesions on palm or finger pulps
Infective endocarditis
Osler’s nodes
Super rare - red tender nodules on fingers, hands and feet
Infective endocarditis
Pulses
Radial (rate and rhythm) Radio radial delay Radiofemoral delay? Collapsing pulse? Carotid pulse (volume and character)
Radial pulse
Rate and rhythm
Regular, regularly irregular, irregularly irregular
Tachycardia, bradycardia, AF, block, respiratory sinus arrhythmia
Radio- radial delay
Absence more likely than delay
aortic dissection and coarctation at the aortic arch
Radio- femoral delay
Offer in OSCE
Coarctation of the aorta (narrowing)
Collapsing pulse
Offer in OSCE
Lift patients arm and feel for pulse
Increase in the strength of the pulse- aortic regurgitation
Carotid Pulse
Volume and character
Weak (reduced cardiac output) - hypotension, cardiac failure
Bounding (increased cardiac output) - sepsis
Corrigan’s sign (visible exaggerated) - aortic dissection
Pulsus paradoxus (weaker on inspiration) - cardiac tamponade, constrictive pericarditis
Face
Mallar flush?
De Musset’s sign?
Mallar flush
Rosy cheeks Mitral stenosis (poor indication as many other causes of flush)
De Musset’s sign
Head nodding with pulse (rare)
Very severe aortic regurgitation
Eyes
Xanthelasma
Corneal arcus
Conjunctival pallor
Xanthelasma
Yellow raised lesions around the eyes
Hypercholesterolaemia
Corneal Arcus
Yellow ring overlying the iris - only significant if under 50
Hypercholesterolaemia
