Cardiovascular exam - chest findings

Question 1

What are you looking for on closer inspection of the chest

Answer 1

Scars from previous cardio surgery
Pectus excavatum
Pectus carinatum
Visible palpitations - LVH?

Question 2

What is this

Answer 2

Pectus excavatum
May indicate Marfan’s

Question 3

What is this

Answer 3

Pectus carinatum
May indicate Marfan’s or Ehlers-Danlos

Question 4

What must you always inspect for scars

Answer 4

The axilla

Question 5

Name the cardiac scars and indications for each

Answer 5

Question 6

What to palpate

Answer 6

Heaves
Thrills
Apex beat

Question 7

Causes of apex beat displacement

Answer 7

LVH

Question 8

Causes of Heaves

Answer 8

RVH

Question 9

Causes of Thrills

Answer 9

Turbulent blood flow through valve

Assess all valves

Question 10

Valve locations

Answer 10

Mitral valve: 5th intercostal space in the midclavicular line.
Tricuspid valve: 4th or 5th intercostal space at the lower left sternal edge.
Pulmonary valve: 2nd intercostal space at the left sternal edge.
Aortic valve: 2nd intercostal space at the right sternal edge.

Question 11

How to acentuate Aortic stenosis

Answer 11

Auscultate the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath to listen for radiation of an ejection systolic murmur caused by aortic stenosis.

Question 12

How to accentuate aortic regurgitation

Answer 12

Sit the patient forwards and auscultate over the lower left sternal border (3rd/4th intercostal space) with the diaphragm of the stethoscope during expiration to listen for an early diastolic murmur caused by aortic regurgitation

Question 13

How to accentuate mitral regurgitation

Answer 13

Roll the patient onto their left side and listen over the mitral area with the diaphragm of the stethoscope during expiration to listen for a pansystolic murmur caused by mitral regurgitation. Continue to auscultate into the axilla to identify radiation of this murmur.

Question 14

How to accentuate mitral stenosis

Answer 14

With the patient still on their left side, listen again over the mitral area using the bell of the stethoscope during expiration for a mid-diastolic murmur caused by mitral stenosis.

Question 15

Final steps of cardiac exam

Answer 15

Inspect and ascultate posterior chest wall
Test for sacral odeoma
Inspect and palpate legs

Question 16

Posterial wall findings

Answer 16

Inspect the posterior chest wall for any deformities or scars (e.g. posterolateral thoracotomy scar associated with previous lung surgery).

Coarse crackles are suggestive of pulmonary oedema (associated with left ventricular failure).
Absent air entry and stony dullness on percussion are suggestive of an underlying pleural effusion (associated with left ventricular failure).

Question 17

Leg findings on cardiac exam

Answer 17

Inspect and palpate the patient’s ankles for evidence of pitting pedal oedema (associated with right ventricular failure).

Inspect the patient’s legs for evidence of saphenous vein harvesting (performed as part of a coronary artery bypass graft).

Question 18

Indications for clamshell incision

Answer 18

Bilateral access to chest
Malignancy
Heart lung transplant
Traumatic injury

Question 19

Run through exam steps

Answer 19

refer to geeky medics checklist