Cardiovascular Examination 🫀 Flashcards
In the general observation what are you looking for ?
Does the patient look well ?
Are they in respiratory distress?
Do they have cachexia?
Signs of Marfans and Down syndrome, Turner’s syndrome - associated with cardiac abnormalities.
Malar flush
Oedema
What are then hand sighns in the cardiacvascular system? 7
Pallor of the Palmer creases
Finger clubbing
Splinter haemorrhages
Tendon xanthomata
Tar staining
Peripheral cyanosis /cap refill
Arachnodactyly (‘spider fingers’)
What do you look for in the face ? 10
Open or closed moth breathing
Sighns of pain
Sweating
Skin chenages rash
Pallor of the conjunctiva
Osler’s nodes
Janeway lesions
Corneal arcus
Kayser-Fleischer rings
Xanthelasma
What signs do you look for in the month
Dentition
Recent essential work
Missing teeth
Angular stomatitis
High arched palate
What are the things you look for in the neck ?
Jugular venous pressure
Carotid pulse
hepatojugular reflux test
What do you look for at the wrist and arm ?6
Temperature
Radial pulse
Radial radial delay
Collapsing pulse
Brachial pulse
Blood pressure
Inspection of the chest?
Scars
Chest wall abnormality’s
Visible pulsations
Bruises /rash ect
What do you palpate for ?
Apex beat
Heaves
Thrills
Auscultation
The four heat valves listening with the bell and the diaphragm
The neck
The axilla
What do you look for on the posterior chest
nspect the posterior chest wall for any deformities or scars
Auscultate the lung fields posteriorly
Lower limb to look for on the cardio exam
Leg oedema
Sacral oedema
evidence of saphenous vein harvesting
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Further assessments and investigations
Peripheral vascular examination: to identify peripheral vascular disease, which is common in patients with central cardiovascular pathology.
Record a 12-lead ECG: to look for evidence of arrhythmias or myocardial ischaemia.
Dipstick urine: to identify proteinuria or haematuria which can be associated with hypertension.
Bedside capillary blood glucose: to look for evidence of underlying diabetes mellitus, a significant risk factor for cardiovascular disease.
Perform fundoscopy: if there were concerns about malignant hypertension, fundoscopy would be performed to look for papilloedema.
Chest X-ray, troponin
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).
Cyanosis
may indicate underlying cardiovascular (e.g. congestive heart failure, pericarditis) or respiratory disease (e.g. pneumonia, pulmonary embolism).
Shortness of breath
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.
Pallor
plum-red discolouration of the cheeks associated with mitral stenosis.
Malar flush
typically presents with swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites). There are many causes of oedema, but in the context of a cardiovascular examination OSCE station, congestive heart failure is the most likely culprit.
Oedema
Look at the background for
Medical equipment: note any oxygen delivery devices, ECG leads, medications (e.g. glyceryl trinitrate spray), catheters (note volume/colour of urine) and intravenous access.
Mobility aids: items such as wheelchairs and walking aids give an indication of the patient’s current mobility status.
Pillows: patients with congestive heart failure typically suffer from orthopnoea, preventing them from being able to lie flat. As a result, they often use multiple pillows to prop themselves up.
Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.
Fluid balance: fluid balance charts will give an indication of the patient’s current fluid status which may be relevant if a patient appears fluid overloaded or dehydrated.
Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.
suggests poor peripheral perfusion (e.g. congestive heart failure) and cyanosis may indicate underlying hypoxaemia.
pallor
caused by smoking, a significant risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension).
Tar staining
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).
Xanthomata
fingers and toes are abnormally long and slender, in comparison to the palm of the hand and arch of the foot. Arachnodactyly is a feature of Marfan’s syndrome, which is associated with mitral/aortic valve prolapse and aortic dissection.
Arachnodactyly (‘spider fingers’)
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. associated with several underlying disease processes, but those most likely to appear in a cardiovascular OSCE station include
congenital cyanotic heart disease, infective endocarditis and atrial myxoma (very rare).
To assess…..
Finger clubbing
Ask the patient to place the nails of their index fingers back to back.
In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window)
When finger clubbing develops, this window is lost.
a longitudinal, red-brown haemorrhage under a nail that looks like a wood splinter. Causes include local trauma, infective endocarditis, sepsis, vasculitis and psoriatic nail disease.
Splinter haemorrhages
