Cardiovascular examination Flashcards
What position should the patient be in for a cardiovascular exam?
45 degree angle on couch
What should you look for in general inspection in a cardiovascular exam?
Medications on the side, devices, cigarettes, catheters, GTN spray, oxygen, IV fluids, number of pillows
What should you look for when inspecting the patient in a cardiovascular exam?
Shortness of breath/resp rate, oedema, cyanosis, pallor, malar flush, syndromic features, scars, ECG stickers/leads
What does a lot of pillows suggest?
Heart failure
How will a patient be laid if they have pulmonary oedema?
Upright as if they were flat the fluid in their lungs would make it hard to breathe
What syndromes are associated with cardiovascular disease?
Marfan’s, Down’s
What is malar flush and what does it indicate?
A red flush across the cheeks and face, associated with mitral stenosis, occurs because there is backflow in the heart which causes CO2 retention
What syndrome has a widened neck as a feature?
Turner’s syndrome
What cardiovascular problem is common in those with Turner’s syndrome?
Coarctation of the aorta and a biscuspid aortic valve (should be tricuspid)
What does clubbing indicate?
Low blood oxygen
What does tar staining indicate?
Smoking
What does peripheral cyanosis in the hands indicate?
Reduced cardiac output (especially in hyperkalemia), Brainiard’s disease
What does xanthoma look like?
Yellow skin or tender nodules with lipid deposition on the palmar and extensor surfaces of the hand
What does xanthoma indicate?
High cholesterol
What are some visible signs associated with infective endocarditis?
Clubbing
Poor dentition
Splinter haemorrhages
What do splinter haemorrhages look like?
Small brown lines on the nails
What to janeway lesions look like?
Small lesions on the palms
What are janeway lesions associated with?
Infective endocarditis
What do osler’s nodes look like and where are they found?
Small painful nodes on the ends of fingers and toes
What do osler’s nodes indicate?
Infective endocaridits
Why do Osler’s nodes occur?
Deposition of immune complexes
In a cardiovascular exam when inspecting the hands what should you look for on the nails?
Clubbing
Splinter haemorrhages
Quincke’s sign
Tar staining
What should you inspect for when looking at hands in a cardio exam?
Nails Cap refil time Temperature Peripheral cyanosis Xanthoma Osler's nodes Janeway lesions Arachnodactyly
What is Quincke’s sign and why does it occur?
Pulsation of the nail bed associated with aortic regurgitation
How do you test cap refil time? What is the normal response?
Squeeze the distal end of a patients fingers for 5 seconds and release the colour should return in less than 2 seconds
What may hot and sweaty hands indicate in a cardiological exam?
MI, fever
What might cold hands suggest in a cardiological exam?
Poor perfusion
What is arachnodactyly and why is it relevant in a cardiological exam?
It is a feature of Marfan’s syndrome where fingers are long, it helps identify marfan’s patients who may be at risk of mitral or atrial regurgitation
What are the 3 things you do in a cardiological exam when taking pulse?
Radial pulse (rate and rhythmn) Radio-radial delay Radio-femoral delay
How many bpm is classified as bradycardic?
< 60 bpm
What may cause bradycardia?
Being on beta blockers
Normal in younger people and athletes
Hypothyroidism
How many bpm is classified as tachycardic?
> 100 bpm
What may cause tachycardia?
Fever, pain, stress, hyperthyroidism, exercise, hypovolemia
If a heart beat is irregular what are the two ways it can be so?
Irregularly irregular ie completely spontaneous
Regularly irregular ie there is a pattern
What is an irregularly irregular heart rate associated with?
Atrial fibrillation
What is a regularly irregular heart rate associated with?
Heart block
Ectopic beats
What are ectopic beats?
When a heart beat is missed
How do you test for radial radial delay?
Feel the radial pulse on both arms and they should be synchronised
What may cause a radial radial delay?
Aortic dissection, subclavian artery stenosis or aortic cooptation
What do you assess when feeling the brachial pulse?
Character and volume
What characters may a brachial pulse be?
Slow rising or bounding
What would a slow rising brachial pulse indicate?
Aortic stenosis
What would a bounding brachial pulse suggest?
Carbon dioxide retention or aortic regurgitation
What pulses are felt for in a cardiological exam?
Radial, brachial
What would thready volume when taking a brachial pulse indicate?
Hypovolemia
How do you assess for collapsing pulse?
Take the radial pulse (and brachial pulse simultaneously) and lift their arm up briskly and you may feel their pulse collapse
What is collapsing pulse typical of?
Aortic regurgitation
What must you ask the patient before assessing for collapsing pulse?
If their shoulder is in any pain as you will have to quickly lift their arm
What blood pressure constitutes hypertension?
Greater than or equal to 140/90
What blood pressure constitutes hypotension?
Less than or equal to 90/60
Why do we check blood pressure in both arms?
If there is a difference of more than 20 mmHg between the 2 it could indicate aortic dissection or atherosclerosis
What is pulse pressure?
The difference between the systolic and diastolic blood pressure
What constitutes narrow pulse pressure?
<25mmHg difference
What constitutes wide pulse pressure?
> 100mmHg difference
What could narrow pulse pressure indicate?
Aortic stenosis or congestive heart failure
What could wide pulse pressure indicate?
Aortic regurgitation or aortic dissection
What is conjunctival pallor and what does it indicate in terms of cardiology?
Lack of colour when the eye is pulled down (anterior conjunctiva) indicates anaemia which is a risk factor for heart disease
What is coarctation of the aorta?
A birth defect where part of the aorta is narrower than it should be
What is Quincke’s sign?
Systolic pulsations after the nail bed is slightly compressed
