Cardiovascular Examination

Question 1

What signs are you looking for in the nails and what would these suggest?

Answer 1

Splinter haemorrhages - infective endocarditis
Clubbing - infective endocarditis, cyanotic heart disease
Koilonychia - iron deficiency anaemia

Question 2

What signs are you looking for in the hands and what would these suggest?

Answer 2

Tar staining - smoker
Xanthomata (raised yellow lesions on tendons) - hyperlipidaemia 
Janeway lesions (palm) - infective endocarditis 
Osler nodes (red tender nodules on fingers) - infective endocarditis

Question 3

What would a radial-radial delay indicate?

Answer 3

Aortic dissection

Coarctation at the aortic arch

Question 4

What would radio femoral delay indicate?

Answer 4

Coarction of the aorta (narrowing)

Question 5

What is a collapsing pulse and what would it indicate?

Answer 5

Looking for an increase in the strength of the character of the pulse

Indicates Aortic regurgitation

Question 6

What would a weak carotid pulse indicate?

Answer 6

Hypotension

Cardiac failure

Question 7

What is corrigans sign and what does it indicate?

Answer 7

Visibly exaggerated carotid pulse

Indicates aortic regurgitation

Question 8

What signs are you looking for in the eyes and why?

Answer 8

Xanthelasma - indicates hypercholesterolaemia
Corneal Arcus - indicates hypercholesterolaemia
Conjunctival pallor - indicates anaemia

Question 9

How do you measure the JVP?

How do you know if it is raised?

Answer 9

Measure the number of centimetres from the sternal angle to the upper border of pulsation

Raised if JVP >4cm

Question 10

What could a raised JVP indicate?

Answer 10

Fluid overload 
Right sided heart failure 
Massive PE
Tension pneumothorax 
Cardiac tamponade

Question 11

What signs are you looking for in the mouth and what could they indicate?

Answer 11

Central cyanosis
Angular stomatitis - iron deficiency
High arched palate - suggestive of Marfan syndrome (increases risk of AAA)
Dental hygiene - risk factor for infective endocarditis

Question 12

What are you looking for on inspection of the chest?

Answer 12

Visible pulsation e.g, forceful apex beat

Any scars from surgery

Question 13

What would a palpable murmur (thrill) indicate?

Answer 13

A murmur which is grade 4 or above

Question 14

What would a paraternal heave indicate?

Answer 14

Right ventricular hypertrophy

Question 15

What would lateral displacement of the apex beat indicate?

Answer 15

Cardiomegaly

Question 16

What should you do if you hear a murmur?

Answer 16

Palate the carotid/brachial pulse to determine if the murmur is systolic or diastolic

Question 17

How would you check for a mitral stenosis murmur

Answer 17

Roll patient over to left side
Get them to hold breath in expiration
Listen to apex with BELL
Mitral stenosis murmur will increase in sound

Question 18

How would you check for aortic regurgitation murmur?

Answer 18

Get patient to sit forward
Hold breath in expiration
Listen to lower left sternal edge with diaphragm

Question 19

Where do aortic stenosis and mitral regurgitation murmurs radiate to?

Answer 19

Aortic stenosis - to the carotid

Mitral regurgitation - to the axilla

Question 20

What would crepitations in the lung bases indicate?

Answer 20

Pulmonary odema due to Left sided heart failure

Question 21

What would sacral or ankle odema indicate?

Answer 21

Right sided heart failure

Question 22

How would you complete your cardiac examination?

Answer 22

Blood pressure
Record 12 lead ECG - check for arrhythmias or MI
Full peripheral vascular exam

If indicated - ECHO, Chest X-ray