Cardiovascular Examination Flashcards
What signs are you looking for in the nails and what would these suggest?
Splinter haemorrhages - infective endocarditis
Clubbing - infective endocarditis, cyanotic heart disease
Koilonychia - iron deficiency anaemia
What signs are you looking for in the hands and what would these suggest?
Tar staining - smoker Xanthomata (raised yellow lesions on tendons) - hyperlipidaemia Janeway lesions (palm) - infective endocarditis Osler nodes (red tender nodules on fingers) - infective endocarditis
What would a radial-radial delay indicate?
Aortic dissection
Coarctation at the aortic arch
What would radio femoral delay indicate?
Coarction of the aorta (narrowing)
What is a collapsing pulse and what would it indicate?
Looking for an increase in the strength of the character of the pulse
Indicates Aortic regurgitation
What would a weak carotid pulse indicate?
Hypotension
Cardiac failure
What is corrigans sign and what does it indicate?
Visibly exaggerated carotid pulse
Indicates aortic regurgitation
What signs are you looking for in the eyes and why?
Xanthelasma - indicates hypercholesterolaemia
Corneal Arcus - indicates hypercholesterolaemia
Conjunctival pallor - indicates anaemia
How do you measure the JVP?
How do you know if it is raised?
Measure the number of centimetres from the sternal angle to the upper border of pulsation
Raised if JVP >4cm
What could a raised JVP indicate?
Fluid overload Right sided heart failure Massive PE Tension pneumothorax Cardiac tamponade
What signs are you looking for in the mouth and what could they indicate?
Central cyanosis
Angular stomatitis - iron deficiency
High arched palate - suggestive of Marfan syndrome (increases risk of AAA)
Dental hygiene - risk factor for infective endocarditis
What are you looking for on inspection of the chest?
Visible pulsation e.g, forceful apex beat
Any scars from surgery
What would a palpable murmur (thrill) indicate?
A murmur which is grade 4 or above
What would a paraternal heave indicate?
Right ventricular hypertrophy
What would lateral displacement of the apex beat indicate?
Cardiomegaly
What should you do if you hear a murmur?
Palate the carotid/brachial pulse to determine if the murmur is systolic or diastolic
How would you check for a mitral stenosis murmur
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
How would you check for aortic regurgitation murmur?
Get patient to sit forward
Hold breath in expiration
Listen to lower left sternal edge with diaphragm
Where do aortic stenosis and mitral regurgitation murmurs radiate to?
Aortic stenosis - to the carotid
Mitral regurgitation - to the axilla
What would crepitations in the lung bases indicate?
Pulmonary odema due to Left sided heart failure
What would sacral or ankle odema indicate?
Right sided heart failure
How would you complete your cardiac examination?
Blood pressure
Record 12 lead ECG - check for arrhythmias or MI
Full peripheral vascular exam
If indicated - ECHO, Chest X-ray
