Cardiovascular Examination Flashcards
In a cardiovascular exam, what hand signs are you looking for?
Xanthomata, finger clubbing, osler nodes (digits), janeway lesions (palm), tar staining, pale palmar creases, capillary reflill, splinter haemorrhages
What is a xanthomata and what does it indicate?
Cholesterol-rich deposits along tendons
Associated with hyperlipidaemia which is a risk factor for cardiovascular disease
What heart defects is Marfan’s syndrome associated with?
Mitral/aortic valve prolapse and
aortic dissection
In a cardiovascular examination, what can finger clubbing be a sign of?
Congenital cyanotic heart disease
(sub acute) Infective endocarditis
Atrial myxoma
What signs in the hand are associated with infective endocarditis?
Splinter haemorrages, Janeyway lesions (palm), and Osler nodes (digits)
In a cardiovascular examination what initial observations might you look for?
Cyanosis, shortness of breath, pallor, malar flush, oedema
What is a malar flush associated with?
Mitral stenosis
In a cardiovascular examination, what can cool sweaty/clammy hands be a sign of?
Acute coronary syndrome
What can prolonged capillary refill be a sign of?
Hypovolemia, congestive heart failure
What checks should be done in the pulse part of a cardiovascular examination?
Radial pulse (rate, rhythm, character), radio-radial delay, radio-femoral delay, collapsing pulse, brachial pulse, carotid pulse, blood pressure
Name some causes of radio-radial delay
Subclavian artery stenosis, aortic dissection, aortic coarctation
Name some causes of collapsing pulse
Normal physiological states -Fever/pregnancy
Cardiac - aortic regurgitation, patent ductus arteriosus
High output states - anaemia, hyperthyroidism, arteriovenous fistula
What can a thready pulse be a sign of?
Hypovolaemia/sepsis
What can a bounding pulse be a sign of?
CO2 retention/aortic regurgitation
What can a slow rising pulse be a sign of?
Aortic stenosis
A narrow pulse is less than 25 mmHg between systolic and diastolic. What can cause this?
Aortic stenosis, congestive heart failure, cardiac tamponade
i.e. problems with pumping
A wide pulse is more than 100 mmHg between systolic and diastolic. What can cause this?
Aortic regurgitation and aortic dissection
i.e. problems with blood pooling
What can blood pressure difference between each arm indicate?
Aortic dissection
What does the presence of a bruit in the carotid artery suggest?
Carotid stenosis
In a cardiovascular examination what order do you 1. palpate the carotids 2. auscultate the carotids and why
Auscultate first to listen for bruits, important because palpating may dislodge causing ischaemic stroke
What are cardiac causes of a raised JVP?
Right-sided heart failure
Pulmonary hypertension (raised pressure in pulmonary arteries due to COPD/lung disesase)
Tricuspid regurgitation (due to infective endocarditis/rheumatic heart disease)
What eye signs are relevant to the cardiovascular system examination?
Conjunctival pallor
Corneal arcus
Xanthelasma
Kayset-Fleischer rings (Wilsons disease from abnormal copper processing)
What mouth signs are relevant to the cardiovascular system examination?
Central cyanosis from lips/tongue, angular chelitis, high arched palate, poor dental hygiene
What could the presence of a median sternotomy scar indicate?
Cardiac valve replacement
or
Coronary artery bypass graft (CABG)
