Cardiovascular Examination

Question 1

What are the general principles of a cardio exam?

Answer 1

General inspection
Hands (radial pulse and bp)
Face
Neck (carotid pulse, JVP)
Precordium (apex beat and auscultation and other manoeuvres)
Legs
Further examination (lungs, sacrum, femoral pulse, abdomen)
Investigations

Question 2

What are you inspecting during your general inspection?

Answer 2

Ensuring comfort.
Check for pallor/cyanosis
Check for GTN spray, ECG pads, oxygen, catheter
Amputations

Signs of severe cardiovascular failure: hypotension, tachycardia, tachypnoea, cold, pale, cyanosed, low urine output.

Question 3

THIS??? not on pp

What are the three signs of severe aortic regurgitation?

Answer 3

// Quinke’s pulse is a pulse at the nail bed

Question 4

THIS

What are we inspecting the hands to see?

Answer 4

Vasodilation/sweat/cold
Staining
Clubbing - infective endocarditis or congenital heart disease
Xanthoma - fatty deposits
Splinter haemorrhages, jane-way lesions (painless red lesions)

Question 5

What are you looking for at pulse points (radial and carotid?

Answer 5

Rate
Rhythm
Character - best at central
Symmetry - may be delays between radial and femoral, radial and apical or radial and radial between wrists.

Question 6

THIS

What may call bradycardia (<60) or (>100) tachycardia?

Answer 6

Brady - heart block, hypothyroidism, normal, sleep, athleticism, medication…

Question 7

What are the three main divisions of heart rhythm?

Answer 7

Regular
Regularly irregular (sinus arrhythmia, bigeminy)
Irregularly irregular (AF)

Question 8

How would you test for a collapsing pulse?

Answer 8

Feel it in the radial and brachial at the same time, lift the arm up and you may feel a bounding pulse in the brachial. Do check first that there is any pain or stiffness before you move their arm.

Question 9

How would you measure BP?

Answer 9

Machine or
Palpate brachial artery for the stethoscope, with the cuff over it. Listening for the korotkoff sounds I-II.
Ensure cuff is right size, 80% around arm with 20% of leftovers.

Question 10

What may you inspect in the face?

Answer 10

Cyanosis
Malar flush
Xanthelasma (fatty deposits)
Corneal arcus (white around the iris, normal in those over 50 but below may indicate cholesterol issues)
Dental disease
Dysmorphic features - marfan’s and down’s

Question 11

What might the strength of a carotid pulse indicate?

Answer 11

Bounding - hypertension
Collapsing - AR or PDA
Weak pulse with delayed systolic peak - AS
Alternating weak or strong pulse - LV failure

Question 12

What may cause a raised JVP (>8-9cm top of pulsation point i think)

Answer 12

Fluid overload
RV failure
Pericardial constriction/tamponade
Tricuspid stenosis
SVC obstruction

Question 13

What would inspect at the chest?

Answer 13

Scars
Pectus excavatum (a dip in the chest)
Visible pulsations
Cardiac devices

Question 14

IMAGE

Label these surgical scars.

Answer 14

/

Question 15

Where is the apex beat and what may differences in it indicate?

Answer 15

5th intercostal space, left mid-clavicular line.
Thrusting - volume overload
Tapping - mitral stenosis
Diffuse - left ventricular failure or cardiomyopathy
Heaves - pulsation from RV hypertropy, MS or AS
Thrills - palpable murmurs

Question 16

IMAGE

Label these auscultation zones

Answer 16

//

Question 17

What may you hear in aortic stenosis or mitral regurgitation?,

Answer 17

Aortic stenosis has an ejection systolic murmur
Mitral regurgitation has a pansystolic murmur.

If flipped, they have diastolic murmurs instead.

Question 18

What can be heard in a patent ductus arteriosus? ??? spelt wrong

Answer 18

A murmur throughout the beat

Question 19

THIS

What murmurs may be louder in inspiration or expiration?

Answer 19

/

Question 20

Where would you feel the pulse in the leg?

Answer 20

Femoral pulse
Popliteal pulse
Pedis

Question 21

What extra investigations might you do after an exam?

Answer 21

ECG
CXR
Urine
Echocardiography
Fundoscopy
Peripheral dopplers

Question 22

What heart murmur/valve dysfunction is associated with malar flush?

Answer 22

Mitral stenosis

Question 23

What are splinter haemorrhages?

Answer 23

Marks under the nail like splinters, sign of infective endocarditis

Question 24

What are janeway lesions and osler’s nodes?

Answer 24

Nodules on fingers on toes, small. Osler’s cause pain and are from immune deposits.

Question 25

What can cause bradycardia?

Answer 25

Hypothyroidism
Medication e.g. beta blockers
Exercise
lots of causes

Question 26

What can cause tachycardia?

Answer 26

Hyperthyroidism
Shock
Sepsis
Post-exercise
Anxiety

Question 27

How do you assess for a collapsing pulse?

Answer 27

Feel for the pulse on the right at the wrist and then raise the arm and the pulse will stop. Sign of aortic regurgitation, but can be in pregnancy or fever.

Question 28

What would difference between arms bp be a sign of?

Answer 28

Atherosclerosis or aortic dissection

Question 29

If there’s a narrow difference between bp (top and bottom) what might this be a sign of?

Answer 29

Aortic stenosis, congestive failure

Question 30

If there’s a wide difference between bp (top and bottom) what might this be a sign of?

Answer 30

Aortic regurgitation or dissection

Question 31

What is a corneal arcus and xanthelasma a sign of?

Answer 31

High cholesterol

Question 32

What is a high arched palate a sign of?

Answer 32

Marfan’s syndrome

Question 33

Why might you do an abdominal examination in a cardio exam?

Answer 33

Checking for a triple A, enlarged liver or ascites.