Cardiovascular Examination Flashcards
Cardio Exam - Intro
Introduce self
Explain examination
Gain consent
Get Vitals
Wash Hands
Check Patient Details
Ask about any pain
Cardio Exam - General Inspection
General mental state, alertness, respiratory effort
Supplemental oxygen?
Sweaty? colour? cyanosed? rash (shingels?) tenderness over location? Pulse? BP, resp, temp? pain? posture?
ECG, lines (IV), catheter, fluid/drugs
incisions, scars, dressings
Weight (BMI), cachexia, marfans?
Cardio Exam - Hands & Arms
erythema, pallor of palmar creases (anaemia), clubbing, nicotine
janeway lesions, osler’s nodes, splinter haemorrhages
radial artery (use brachial if grafted) pulse - rate and rhythm
BP sitting & standing
Cardio Exam - Head & Neck
Eyes: conjuntival pallor, jaundiced sclerae (CCF and hepatic congestion), arcus senilis
Mouth: lips & tongue (cyanosis), arched palate (Marfan’s)
Neck: JVP (<3cm), carotid (character, bruit)[bell]
Cardio Exam - Chest
Inspection - scars, apex pulsation, pacemaker
Palpation - apex beat (5th intercostal space, MAL),
Auscultation - heart sounds and murmurs, pericardial rub, lung bases (crackles), respiratory signs, pleural rub, pitting oedema of sacrum
Abdomen - liver tenderness (distension of capsule), palpate abdominal aorta
Chest Exam - Lower Limbs
Peripheral oedema (medial malleolus, anterior tibia)
Palpation of dorsalis pedis and posterior tibial
Cardio Exam - Completion
Murmur - Aortic Stenosis
pansystolic , crescendo-decrescendo
Murmur - Aortic Regurgitation
Soft A2
Murmur - Mitral Regurgitation
pansystolic, rectangular
Murmur - Mitral Stenosis
Loud S1
Heart Sounds - S1
Mitral and Tricuspid closure (mitral before tricuspid)
Indicates beginningo of ventricular systole
Heart Sounds - S2
Aortic and Pulmonary valve closure (aortic first)
Splitting of S2 may be audible in 70% of patients
Heart Sounds - S3
Turbulence during early ventricle filling, may be normal
Low-pitched [bell], mid-diastolic
Gallop rhythm - ‘Kentucky’
Sign ofleft ventricular failure and dilation, Aortic regurgitation, Mitral regurgitation, ventricular septal defect, patent ductus arteriosus
Heart Sounds - S4
turbulence during atrial contraction - high pressure atrial wave reflected back from poorly compliant ventricle
late diastolic, low-pitch
‘Tennessee’ tripple gallop
Sign of stiff ventricle -> HTN, Aortic stenosis, IHD, Hypertrophic cardiomyopathy
Causes of Clubbing
Common
CARDIOVASCULAR
Cyanotic congenital heart disease
Infective endocarditis
Left atrial myxoma
RESPIRATORY
Lung carcinoma (usually not small cell carcinoma)
Chronic pulmonary suppuration:
- Bronchiectasis
- Lung abscess
- Empyema
- TB
- Abcess
Idiopathic pulmonary fibrosis
NOT Chronic bronchitis or COPD
Uncommon
RESPIRATORY
Cystic fibrosis
Asbestosis
Pleural mesothelioma (benign fibrous type) or pleural fibroma
GASTROINTESTINAL
Cirrhosis (especially biliary cirrhosis)
Inflammatory bowel disease
Coeliac disease
THYROTOXICOSIS
Familial (usually before puberty) or idiopathic
Rare
Neurogenic diaphragmatic tumours
Pregnancy
Secondary parathyroidism
UNILATERAL CLUBBING
Bronchial arteriovenous aneurysm
Axillary artery aneurysm
Schamroth’s Sign
Loss of diamond-shaped space - evidence of clubbing
Splinter Haemorrhage
Evidence of physical trauma, endocarditis, vasculitis, rheumatoid arthritis, polyarteritis nodosa, haematological malignancy, antiphospholipid syndrome, sepsis.
Osler’s nodes
Rare manifestation of infective endocarditis
Red, raised, tender, palpable nodules on pulps of fingers, thenar, or hypothenar eminences
Janeway Lesions
Non-tender erythematous maculopapular lesions containing bacteria, occuring rarely in infective endocarditis.
Arcus senelis
Half or complete grey circle around outer perimeter of pupil associated with increased cardivascular risk
JVP waveform
Slides on Pulse Abnormalities
Carotid Waveforms
- Anacrotic
- Plateau
- Bisferiens
- Collapsing
- Small Volume
- Alternans
Causes of elevated central venous pressure
Right ventricular failure
Tricuspid stenosis or regurgitation
Pericardial effusion or constrictive pericarditis
Superior vena caval obstruction
Fluid overload
Hyperdynamic circulation
JVP - Causes of a dominant A wave
Tricuspid stenosis (also causing a slow y descent)
Pulmonary stenosis
Pulmonary hypertension
JVP - Causes of cannon A waves
Complete heart block
Paroxysmal nodal tachycardia with retrograde atrial conduction
Ventricular tachycardia with retrograde atrial conduction or atrioventricular dissociation
JVP - Causes of a dominant v wave
Tricuspid regurgitation
JVP - Causes of X descent changes (absence, exaggeration)
Absent: atrial fibrillation
Exaggerated: acute cardiac tamponade, constrictive pericarditis
JVP - Causes of Y descent changes (sharp, slow)
Sharp: severe tricuspid regurgitation, constrictive pericarditis
Slow: tricuspid stenosis, right atrial myxoma
