Cardiovascular Examination Flashcards
What are the introductory steps?
Wash hands and PPE Introduce yourself to the patient - name and role Confirm patient - name and DOB Explain procedure Gain consent Adjust bed to 45 degree angle Expose the patient Ask if they are experiencing any pain
What are the general steps?
Introduction General inspection Hands Pulses and blood pressure - arm then carotid JVP Face Close inspection of chest Palpation Auscultation Final steps - oedema etc Complete the examination
What do you do in the general inspection?
Inspect for clinical signs suggestive of underlying pathology
Look for equipment on or around the patient
What underlying pathology are you looking out for in the general inspection?
Cyanosis SOB Pallor Malar flush Oedema
What is cyanosis?
A bluish discolouration of the skin due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g. right-to-left cardiac shunting).
What does SOB indicate?
Underlying cardiovascular (e.g. congestive heart failure, pericarditis) or respiratory disease (e.g. pneumonia, pulmonary embolism).
What does is pallor?
A pale colour of the skin that can suggest underlying anaemia (e.g. haemorrhage, chronic disease) or poor perfusion (e.g. congestive cardiac failure). It should be noted that a healthy individual may have a pale complexion that mimics pallor, however, pathological causes should be ruled out.
What is malar flush?
Plum-red discolouration of the cheeks associated with mitral stenosis.
What is oedema?
Typically presents with swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites) - congestive heart failure is the main culprit.
What do you do in the hand inspection?
Inspect the hands
Assess and compare temperature of hands
Assess capillary refill time
What clinical signs do you look out for in the hand examination?
Colour
Tar staining
Xanthomata
Finger clubbing
What does the colour of the hand tell you?
Colour: pallor suggests poor peripheral perfusion (e.g. congestive heart failure) and cyanosis may indicate underlying hypoxaemia.
What does tar staining tell you?
Tar staining: caused by smoking, a significant risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension).
What is xanthomata?
Raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow. Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), another important risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension).
What is finger clubbing?
Finger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
