Cardiovascular examination Flashcards
In what order should you complete the cardiovascular exam?
Look: Hands, face, neck, legs
Feel: Chest signs and palpitation
Auscultation
In the cardiovascular exam, how should you first look at the patient?
Stand at the end of the bed and look at patient
In the cardiovascular exam, what 7 signs should you look for when standing at the end of the bed?
Does patient look comfortable or uncomfortable
Pallor
Peripheral edema in limbs
Ascites in abdomen
Cyanosis
Dyspnea
Thoracic scars
Where is a midline sternotomy scar on the chest, and what cardiovascular condition does it indicate?
Vertical 6-8 inches scar on middle of sternum, going down to xiphoid process
Previous coronary artery bypass graft, valve replacement or congenital heart defect correction
Where is a mini-sternotomy scar on the chest, and what cardiovascular condition does it indicate?
Vertical 3-4 inches scar on middle of sternum, goes into a āJā shape towards the right
Aortic valve replacement
Where is a pacemaker scar on the chest, and what cardiovascular condition does it indicate?
Superiorly on left thorax in mid-clavicular line
Arrhythmias (abnormal heart beat): Sick sinus syndrome, atrial fibrillation, heart block
To prevent cardiac arrest
Where is an anterolateral thoracotomy scar on the chest, and what cardiovascular condition does it indicate?
From lateral border of the sternum to the mid-axillary line at the 4th or 5th intercostal space
Lobectomy, pneumonectomy, single lung transplant, open lung biopsy
Where is an posterolateral thoracotomy scar on the chest, and what cardiovascular condition does it indicate?
From mid-spinal line to the anterior axillary line
Lobectomy, pneumonectomy, single lung transplant, open lung biopsy
Apart from on the chest, where else should you look for thoracotomy scars?
Around axilla for axillary scars
What 5 signs should you look for on the dorsal surface of the hand?
Pallor
Tar staining
Arachnodactyly: fingers and toes are abnormally long and slender, in comparison to the palm of the hand and arch of the foot
Clubbing
Splinter haemorrhaging
What does tar staining on the fingers indicate, in the cardiovascular exam?
Indicates cigarette smoking
Significant risk factor for hypertension and coronary artery disease
What does arachnodactyly indicate, in the cardiovascular exam?
Indicates Marfan syndrome
Significant risk factor for aortic regurgitation
What 3 conditions can finger clubbing indicate, in the cardiovascular exam?
Congenital cyanotic heart disease
Infective endocarditis
Atrial myxoma
What signs should you look for on the palmar surface of the hand, in the cardiovascular exam?
Xanthomata
Janeway lesions
Osler nodes
What is xanthomata, and what does it indicate in the cardiovascular exam?
Yellow lipid deposits in the skin
Indicate hypercholesterolemia, which is a risk factor of hypertension and CAD
After looking for hand signs, what should you examine?
Palpate for temperature
What do cool and dry hands indicate in the cardiovascular exam?
Poor peripheral perfusion
Could indicate congestive heart failure, ACS
What do cool and clammy hands indicate in the cardiovascular exam?
ACS
After palpating the hands for temperature, what should you examine?
Capillary refill time
What is a normal capillary refill time, and what can CRT indicate?
Normal: 2 seconds
Longer that 2 seconds indicates poor perfusion
What should be auscultated over the carotid arteries?
Radiation of an ejection systolic murmur caused by aortic stenosis
This is done using the diaphragm of the stethoscope while the patient holds their breath.
Where should you auscultate for an early diastolic murmur caused by aortic regurgitation?
Lower left sternal border (3rd/4th intercostal space) during expiration
The patient should be sitting forwards for this assessment.
What type of murmur is associated with mitral regurgitation?
Pansystolic murmur
This is auscultated over the mitral area with the patient rolled onto their left side.
What is the position of the patient when auscultating for a mid-diastolic murmur caused by mitral stenosis?
On their left side
The bell of the stethoscope is used during expiration over the mitral area.
What is the purpose of having the patient hold their breath during carotid artery auscultation?
To listen for radiation of an ejection systolic murmur caused by aortic stenosis
This technique minimizes respiratory sounds that could interfere with auscultation.
When should the diaphragm of the stethoscope be used to listen for an early diastolic murmur?
During expiration
This is specifically when auscultating over the lower left sternal border for aortic regurgitation.
What additional area should be auscultated to identify radiation of the murmur caused by mitral regurgitation?
Into the axilla
This is done while listening over the mitral area on the left side.
