Cardiovascular exam Flashcards
1
Q
General inspection
A
“Don’t mind me/feel like I’m staring”
Pt:
- comfortable/calm at rest
- alert, breathless, pallor, cyanosis, obvious scars or deformities, syndromes feature (Down’s / Marfan’s)
- hear any mechanical heart balances
- malar flush (MS)
Around the bed:
- oxygen, medications (GTN spray?), IV drip, ECG machine, walking aids
2
Q
Hands
A
Look at both
Nails:
- clubbing (congenital, cyanotic heart disease, infective endocarditis, atrial myxoma)
- splinter haemorrhages (IE), koilonychia, Quinke’s sign (AR: visible nail bed palpitations)
- peripherals cyanosis
Palms:
- sweaty/ clammy (ACS)
- extensor tendon xanthomatas, Osler’s bodes (IE), Janeway lesions (IE, painless on palms)
- test for perfusion (temp and sweatiness, cap refill <2 sec)
3
Q
Arms
A
- bilaterally look for extensive brushing
- take radial pulse on R side (rate, rhythm)
- radio radio delay (aortic coarctation)
- offer to do radial femoral delay
- collapsing pulse (water hammer pulse = aortic regurgitation): ask about pain in shoulder, take radial pulse with 3 fingers of right hand and lift arm quickly above head
- offer to do lying and standing BP bilaterally (narrow pulse pressure = AS, wide pulse pressure = AR)
4
Q
Head
A
Inspection:
- pallor, malar flush (MS), swollen cyanotic face (SVOC)
Eyes:
- conjunctival pallor, corneal arcus, xanthelasma
Mouth:
- stick out tongue, tongue to roof of mouth
- central cyanosis under tongue, dental hygiene, signs of dehydration, angular stomatitis (IDA), gum hyperplasia
- high arched palate (IE)
5
Q
Neck
A
- assess JVP (marker of R atrial pressure: <4cm)
- elicit hepatojugular reflex (positive sign is suggestive of R sided HF/ tricuspid regurgitation)
- take carotid pulse bilaterally (assess character and volume, slow rising pulse in AS)
- look for CORRIGAN’s sign (visible carotid pulsation due to AR)
6
Q
Chest inspection
A
- look for midline sternotomy scars and asymmetries
- ask pt to lift up arms, look in axilla
- look for obvious pacemakers
- listen for clicking of artificial valve
7
Q
Chest palpatio.
A
- palpate for apex beat (5th ICS MCL)
- feel for heaves (LVH) and thrills (palpable murmur)
8
Q
Chest Auscultation
A
- palpate the carotid/ subclavian at same time
- aortic (2nd ICS, R sternal edge)
- pulmonary ( 2nd ICS, L sternal edge)
- tricuspid (4th ICS, L sternal edge)
- mitral (5th ICS, MCL)
9
Q
How do you exaggerate the mitral murmurs?
A
MS:
- ask pt to roll onto L side
- ask them to take a deep breath in and out and hold
- listen with bell in mitral area
MR:
- with pt still on side
- ask them to take a deep breath in and out and hold
- listen with diaphragm in axilla
10
Q
How do you exaggerate the aortic murmurs?
A
AS:
- listen to R carotid for radiation of murmur with bell
- listen to both carotid for bruits whilst pt holds their breath. Use BELL
AR:
- ask of to sit up and lean forward
- listen over lower sternal edge during expiration with diaphragm
11
Q
What extra things would you ask about?
A
- as pt is sitting upright and forward, listen to king bases for crackles
- feel for any sacral oedema
- inspect legs for scars on back of calf (vein harvesting)
- palpate for peripheral oedema
12
Q
What important things to mention when you present to examiner?
A
- mention BP
- no paraphernalia of cardiovascular disease around bed
- on closer inspection of hands, face, chest they were all unremarkable
- no radial radial delay and no collapsing pulse
- JVP was not elevated and carotid pulse was of normal character/volume
- apex beat was undisplaced and there were no heaves/thrills
- on auscultation, Heart sounds I&II were present with no added sounds, no carotid bruits
- lung bases were clear, no sacral or pedal oedema
13
Q
How would you complete the exam?
A
- Full history and full peripheral vascular exam
- basic observations
- fun so spot (hypertensive retinopathy, papilloedema)
- urine dipstick (proteinuria, haematuria)
- 12 lead ECG (MI or arrhythmias)
- blood tests for CRP, 12 hour Troponin
- Echo, chest X-ray
