Cardiovascular examination Flashcards
What are the first part of an the introduction?
Wash hands
Introduce self
Pt details (Name, DOB +/- age)
Explain a cardiac examination to a patient
I’ve been asked to examine you heart which will involve me having a general look at the hands, arms, face and chest before having a feel and listen to your chest.
Does that sound okay?
What else would you say after gaining consent in the introduction?
exposure of pt (cardiac = top off is that okay?)
chaperone?
any pain or discomfort?
What do you inspect in a cardiac exam?
General
Bedside
Hands
Neck
Face
Eyes
Mouth
Chest
When inspecting the patient generally what are you looking for?
Inspect the general appearance (colour, breathing, comfort, position, build).
When inspecting the bedside what are you looking for?
Any treatments or adjuncts (GTN spray, O2, medication, mobility aids.
When inspecting the dorsum of the hand in a cardiac exam what are you looking for?
Splinter haemorrhages
Finger clubbing
Tar staining
What could the following signs indicate in a cardiac examination?
a) Splinter haemorrhages; (1)
b) Finger clubbing; (2)
c) Tar staining; (1)
a) Infective endocarditis.
b) Infective endocarditis.
Cyanotic congenital heart disease.
c) Smoking = risk factor for cardiovascular disease.
When inspecting the palm of the hand in a cardiac exam what are you looking for?
Colour;
Janeway lesions;
Osler’s nodes;
Tendon xanthomas;
What could the following signs indicate in a cardiac examination?
a) Peripheral cyanosis
b) Janeway lesions
c) Osler’s nodes
d) Tendon xanthomas
a) Hypoxia
b) IE
c) IE
d) Hyperlipidaemia
Describe the appearance of Janeway lesions
Non-tender maculopapular erythematous palm pulp lesions
Describe the appearance of Osler’s nodes
Tender red nodules on finger pulps/thenar eminence
What would you assess in the hands in a cardiac examination?
CRT
Temperature (bilat to compare)
What is a normal CRT?
If CRT is raised what may it suggest?
<2
Hypovolaemia
During a cardiac examination what pulses are examined?
Radial
Radio radial delay
Brachial
Collapsing
Carotid
What do you assess when feeling the following pulses?
a) radial
b) brachial
c) carotid
a) rate and rhythm (find BPM)
b) character and volume
c) character and volume (1 AT A TIME)
For both the brachial and carotid pulses what do the following suggest?
a) Slow rising
b) Collapsing
a) Aortic stenosis
b) Aortic regurg
How do you assess for a collapsing pulse?
Ensure no shoulder pain in pt
palpate radial pulse
wrap hand around the wrist whilst still palpating the pulse.
Raise their arm above their head briskly
What are you feeling for when checking for a collapsing pulse?
Feel for a tapping impulse through the muscle bulk of the arm as blood empties from the arm very quickly in diastole, resulting in palpable sensation.
What does a water hammer pulse suggest?
Aortic Regurg
What is a Radio-radial delay associated with?
Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection.