Cardiovascular Examination Flashcards
What are the general principles of a cardio exam?
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
What are you inspecting during your general inspection?
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.
THIS??? not on pp
What are the three signs of severe aortic regurgitation?
// Quinke’s pulse is a pulse at the nail bed
THIS
What are we inspecting the hands to see?
Vasodilation/sweat/cold
Staining
Clubbing - infective endocarditis or congenital heart disease
Xanthoma - fatty deposits
Splinter haemorrhages, jane-way lesions (painless red lesions)
What are you looking for at pulse points (radial and carotid?
Rate
Rhythm
Character - best at central
Symmetry - may be delays between radial and femoral, radial and apical or radial and radial between wrists.
THIS
What may call bradycardia (<60) or (>100) tachycardia?
Brady - heart block, hypothyroidism, normal, sleep, athleticism, medication…
What are the three main divisions of heart rhythm?
Regular Regularly irregular (sinus arrhythmia, bigeminy) Irregularly irregular (AF)
How would you test for a collapsing pulse?
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.
How would you measure BP?
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.
What may you inspect in the face?
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
What might the strength of a carotid pulse indicate?
Bounding - hypertension
Collapsing - AR or PDA
Weak pulse with delayed systolic peak - AS
Alternating weak or strong pulse - LV failure
What may cause a raised JVP (>8-9cm top of pulsation point i think)
Fluid overload RV failure Pericardial constriction/tamponade Tricuspid stenosis SVC obstruction
What would inspect at the chest?
Scars
Pectus excavatum (a dip in the chest)
Visible pulsations
Cardiac devices
IMAGE
Label these surgical scars.
/
Where is the apex beat and what may differences in it indicate?
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
IMAGE
Label these auscultation zones
//
What may you hear in aortic stenosis or mitral regurgitation?,
Aortic stenosis has an ejection systolic murmur
Mitral regurgitation has a pansystolic murmur.
If flipped, they have diastolic murmurs instead.
What can be heard in a patent ductus arteriosus? ??? spelt wrong
A murmur throughout the beat
THIS
What murmurs may be louder in inspiration or expiration?
/
Where would you feel the pulse in the leg?
Femoral pulse
Popliteal pulse
Pedis
What extra investigations might you do after an exam?
ECG CXR Urine Echocardiography Fundoscopy Peripheral dopplers
What heart murmur/valve dysfunction is associated with malar flush?
Mitral stenosis
What are splinter haemorrhages?
Marks under the nail like splinters, sign of infective endocarditis
What are janeway lesions and osler’s nodes?
Nodules on fingers on toes, small. Osler’s cause pain and are from immune deposits.
What can cause bradycardia?
Hypothyroidism
Medication e.g. beta blockers
Exercise
lots of causes
What can cause tachycardia?
Hyperthyroidism Shock Sepsis Post-exercise Anxiety
How do you assess for a collapsing pulse?
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.
What would difference between arms bp be a sign of?
Atherosclerosis or aortic dissection
If there’s a narrow difference between bp (top and bottom) what might this be a sign of?
Aortic stenosis, congestive failure
If there’s a wide difference between bp (top and bottom) what might this be a sign of?
Aortic regurgitation or dissection
What is a corneal arcus and xanthelasma a sign of?
High cholesterol
What is a high arched palate a sign of?
Marfan’s syndrome
Why might you do an abdominal examination in a cardio exam?
Checking for a triple A, enlarged liver or ascites.
