Cardiovascular examination

Question 1

How should a patient consultation always be initiated?

Answer 1

Wash hands
Introduction
Patient consent
Explanation

Question 2

What should be identified during end of bed inspection?

Answer 2

Patient paraphernalia (e.g. mobility aids)
Medication (e.g. GTN spray, oxygen)
Signs of pain/ discomfort/ agitation
Obvious scars etc.

Question 3

What should be identified when examining the nails?

Answer 3

Splinter haemorrhages (bacterial endocarditis) 
Clubbing (infective endocarditis) 
Capillary refill time (hypovolaemia) 
Tar staining (smoking) 
Peripheral cyanosis (hypoxia)

Question 4

What should be identified when examining the hands?

Answer 4

Temperature (cool peripheries indicates poor circulation)
Osler's nodes (infective endocarditis)
Janeway lesions (bacterial endocarditis)

Question 5

What vital signs should be done?

Answer 5

Radio-radial delay (rate and rhythm, aortic coarctation) 
Collapsing pulse (aortic regurgitation) 
Brachial/ carotid (character and volume) 
JVP (right ventricular failure, tricuspid regurgitation, fluid overload)

Question 6

What should be identified when examining the eyes?

Answer 6

Corneal Arcus (hypercholesterolaemia)
Conjunctivae Pallor (anaemia) 
Xanthelasma (hypercholesterolaemia)

Question 7

What should be identified when examining the mouth?

Answer 7

Central Cyanosis (hypoxia) 
Angular Stomatitis (iron deficiency) 
Dentition (infective endocarditis)

Question 8

What should be identified when doing a chest inspection?

Answer 8

Pacemaker
Scars
Pectus excavatum/ Pectus carinatum
Visible pulsations (hypertrophy, hypertension)

Question 9

What should be palpated?

Answer 9

Apex beat (tension pneumothorax, cardiomegaly)
Heaves (right ventricular hypertrophy)
Thrills (turbulent blood flow through valves)

Question 10

What should be auscultated?

Answer 10

Pulmonary valve (2nd ICS, L sternal edge)
Aortic valve (2nd ICS, R sternal edge)
Tricuspid valve (4th/5th ICS, L sternal edge)
Mitral valve (5th ICS, midclavicular line)
Mitral stenosis
Aortic regurgitation
Lung bases

Question 11

What peripheral pulses should be identified?

Answer 11

Dorsalis Pedis (top of foot) 
Posterior Tibial (inside of ankle) 
Popliteal (behind knee)

Question 12

Where should oedema be checked for?

Answer 12

Peripheral - ankles/ lower legs

Sacral - lower back

Question 13

What additional tests could be suggested at the end of the examination?

Answer 13

ECG
AAA
Cardiac monitoring
Vital signs