Cardiovascular Examination Flashcards
Briefly outline the examination
- Wash hands
- Introduce self, identify patient
- Explain procedure, consent
- Any questions, pain or discomfort
- End of bed assessment
- Hand examination & capillary refill time
- Radial Pulse, radial-radial delay, collapsing pulse
- respiratory rate & blood pressure
- feel temperature
- elbow examination
- Face examination - eyes and mouth
- JVP & hepatojugular reflex
- Carotid pulse
- Sacral oedema
- Inspection of chest
- Palpate 4 valves, heaves (measure location)
- Locate apex beat
- Auscultate four valves (whilst palpating carotid)
- Patient sitting up, hold on expiration, left lower sternal edge (AR)
- Patient on left side, apex (MS)
- Auscultate carotids (hold on expiration)
- Auscultate lung bases (from the back)
What are you looking for when examining the hands
- Palm - Xanthomata, osler nodes & janeway lesions, tar staining
- Dorsal surface - cyanosis, splinter haemorrhages, koilonychia
- finger clubbing
- Capillary refill time
What are you looking for when examining the face
- Eyes - Xanthelasma, corneal arcus, conjunctival pallor
- Mouth - angular stomatitis, cyanosis, dental hygiene, high arched palate
What causes parasternal heave
Right ventricular hypertrophy
What causes a) peripheral oedema b) sacral oedema
Peripheral oedema - RHF
Sacral oedema - RHF
Where is best to auscultate the base of the lungs
From the back
What is the best way to listen for an aortic regurgitation
Leaning forward, on held expiration at the left lower sternal edge
What is the best way to listen for a mitral stenosis
Patient on their left, on held expiration, apex
state the locations that are best for listening to each of the four heart valves
Aortic - Right sternal edge, 2nd ICS
Pulmonary - Left sternal edge, 2nd ICS
Tricuspid - Left sternal edge, 4th ICS
Mitral - Mid clavicular line, 5th ICS
When might the JVP be raised
Right heart failure
What would cause a) radio-radial delay b) collapsing pulse
A) aortic coarction
B) aortic regurgitation
What is a normal capillary refill time
Less than 2 seconds after a 5 second hold
What cardiac conditions could cause a) finger clubbing b) koilonychia c) splinter haemorrhages
A) Endocarditis, congenital heart disease, atrial myxoma
B) Iron deficiency anaemia
C) Local trauma, endocarditis, sepsis, vasculitis, psoriatic nail disease
Name some peripheral (eye, elbow, hand) signs of hyperlipidaemia
Xanthomata, Xanthelasma, corneal arcus
