Cardiovascular Examination Flashcards
In what position should the patient and bed be in for a basic cardiovascular examination
The patient should be on the bed comfortably supported by a pillow with the bed/their chest at an angle of 45 degrees. (This may not be possible if the patient is too sick to sit up)
Briefly name the 15 steps as listed in the PCP handbook for the basic CV examination
- Prepare patient
- Hand hygiene
- General inspection
- Inspection of the hands
- Measurement of the radial pulse/radio-radial delay*
- Measurement of blood pressure (ideally in both arms)/brachial pulse assessment*
- Examination of the head and neck
- Examination of the jugular venous pulse/hepatojugular reflux*
- Examination f the carotid artery pulse
- Inspection of the chest
- Palpation of the chest (apex beat/heaves*/thrills*)
- Auscultation of the heart
- Examination of the posterior chest
- Examination of the lower limbs
- Complete the examination
During the general inspection, what are you looking for?
Patient’s general mental state
Alertness
Respiratory effort/SOB at rest*
Malar flush*
Apparent comfort of patient: does the patient look in pain*
Treatments or adjuncts: Use of supplemental O2, GTN spray*, medications*, mobility aid*
Missing limbs or digits*
Cachexia (cardiac cachexia)*
During inspection of the hands, what are you looking for? (11 signs listed)
Nicotine stains
Clubbing
Pale palmar creases
Splinter haemorrhages*
Dusky bluish discolouration*
Temperature*
Sweaty/clammy hands*
Janeway lesions*
Osler’s nodes*
Xanthomata*
Capillary refill*
What do you note when measuring radial pulse?
- Rate (60-100bpm is normal), rhythm (regular vs irregular)
- radio-radial delay*
- radio-femoral delay*
- collapsing pulse*
(The character and volume of pulse are better assessed from palpation of the brachial or carotid arteries)
During examination of the head and neck what clinical signs are you looking for and what do they indicate?
Conjunctival pallor - anaemia
Lips and tongue - central cyanosis
Corneal arcus* - hypercholesterolaemia
Xanthelasma* - hypercholesterolaemia
Angular stomatitis* - iron deficiency
High arched palate* - suggestive of marfans syndrome
Dental hygiene* - important if considering causes of infective endocarditis
Sclera* - icterus/jaundice
Mucosa - petechiae suggestive of infective endocarditis
Which type of lighting is best for examining the JVP?
Natural light where possible
Which JVP is conventionally inspected?
Right side; internal jugular
Is the head rotated to look for JVP? Why, why not?
No as it will tense the sternocleidomastoid muscle
Which jugular vein is best for examining the cardiac wave form? Why?
The internal jugular vein as it is in a straight line with the right atrium. The external jugular vein is usually easier to see but can be falsely elevated due to external pressure.
How is JVP measured?
The height is measured as the vertical distance between the sternal angle and the upper level of pulsation of the internal jugular vein
What is an abnormal JVP and what does it indicate?
A measurement greater than 3cm indicates raised pressure in the right side of the heart: fluid overload, right ventricular failure, tricuspid regurgitation
When examining the carotid arteries, why should you check for bruits first?
Checking for bruits allows you to ascertain whether there is a partial obstruction to the artery. If an obstruction present is due to atherosclerosis/plaque, it may dislodge and embolise to the brain
REMEMBER TO GO THROUGH EACH SIGN AND DEFINE THEM. EG WHAT IS A BRUIT
hi :)
Why might checking both carotid pulses at the same time be problematic?
Decreasing significant amounts of blood flow to the brain may cause LOC
During inspection of the praecordium, what may be found?
Pulsations of apex beat - a forceful beat may be visible*
Scars - thoractomy*, sternotomy*, clavicular*
Chest wall deformities* - pectus excavatum, pectus carinatum
Where is the apex beat usually found? What other horizontal markers may the apex beat be found?
Mid clavicular line in the fifth intercostalspace/6th rib. Anterior axillary line (AAL) and the mid-axillary line (MAL)
What does dusky bluish discolouration of the hands suggest?
Cyanosis indicates hypoxia
What sign is present in these pictures and what does it suggest?

Cyanosis indicates hypoxia
What sign in present in this picture and what does it suggest:

Janeway Lesion indicate infective endocarditis
What sign is present in this picture and what does it suggest?

Osler’s nodes indicate infective endocarditis
What sign is present in this picture and what does it suggest:

Splinter haemorrhages* - bacterial/infective endocarditis
What sign is present in the following pictures

(tendon) Xanthomata indicate hyperlipidaemia
Name the sign

Tendon xanthomata

















