Cardiovascular Examination

Question 1

Introduction

Answer 1

Introduce self
Ask to confirm name and DOB
Check on wrist band
Ask for consent to examine patient and explain what you are going to do

Question 2

Assessment of Patient

Answer 2

Distressed
Breathing
Sweating
Pale

Question 3

Assessment of Environment

Answer 3

Inhalers/Nebulisers
Medication
Breathing equipment
Vomit bowl/sputum pot
NEWS chart- Temp, pulse, BP and RR (check it belongs to patient)

Question 4

Hands

Answer 4

Temperature/Joint pain
Tar staining
Splinter Haemorrhages
Peripheral cyanosis
Clubbing: fluctuation and diamond
Capillary refill (under 3 seconds)
Scars/Bruises
Palms (palmar creases/temperature/colour)

Question 5

Pulse and Respiratory Rate

Answer 5

Rate- bpm
Rhythm- irregular/regular
Volume- full
Character- no collapsing pulse

Question 6

Arms

Answer 6

Fine Tremor
Hydration
Venous damage
Scars/bruises

Question 7

Head

Answer 7

Malar flush
Symmetry
Acromegaly
Eyes: Conjunctivae
Xanthelastmata and Corneal arcus
Mouth: angular stomatitis, central cyanosis, ulcers, tonsil, gingivitis

Question 8

Chest

Answer 8

Sacral oedema

Question 9

Lower limbs

Answer 9

Pitting oedema (15 secs)
Temperature
Capillary refill
Gangrene
Varicose veins

Question 10

JVP

Answer 10

Double flickering blood of internal jugular vein
Look for highest point and measure vertical height from sternal angle
«4cm- normally

Question 11

Precordium

Answer 11

Chest deformities (Pectus Excavatum)
Scars
Pacemaker
Tracheal position
Apex beat
Heaves- L sternal
Thrills (MTPA)

Question 12

Auscultation of chest

Answer 12

Locate carotid pulse
Listen with both bell and diaphragm
Identify S1 (M and T valve closing)- synchronous with carotid
Identify S2 (P and A closing)
No added heart sounds

Question 13

Systolic Murmur (high pitched)

Answer 13

Aortic Stenosis- listen over aortic valve and both carotid arteries
Mitral regurgitation- listen over mitral valve (apex) and left axillary

Question 14

Diastolic Murmur (low pitched, rumbling)

Answer 14

Mitral stenosis (bell of stethoscope)- ask patient to turn over the left hand side and take a deep breath in and breath out and hold on expiration- APEX

Aortic regurgitation (diaphragm)- ask the patient to sit up and lean forwards, asking them to take a deep breath in breath out and hold on expiration-LEFT LOWER STERNAL EDGE

Question 15

Peripheral Pulses

Answer 15

Radial
Brachial
Carotid
Femoral (Femoral-Radial delay)
Popliteal
Poster tibial- medial malleolus
Dorsalis pedis (1st and 2nd metatarsals using 2-3 fingers)
Bruits- auscultate carotid and femoral