Cardiovascular Examination Flashcards
What should you look for in the hands of a patient when performing a cardiovascular examination?
- Warmth
- Capillary refill
- Evidence of peripheral cyanosis
- Tar staining
- Clubbing
- Splinter haemorrhages
- Janeway lesions
- Osler’s nodes
- Koilonychia
What should you look for in the face of a patient when performing a cardiovascular examination?
- Mallar flush
- Pallor
- Clinical anaemia
- Xanthelasmata
- Corneal arcus
- Central cyanosis
What should the normal capillary refill time be?
Less than 2 seconds
What appearence does malar flush give?
A high colour over the cheekbones, with a bluish tinge caused by reduced oxygen in the blood
What is the underlying cause of malar flush?
Considered to be a sign of mitral valve disease which often follows rheumatic fever (however all but extinct in UK) so it is likely to be something else)
What 1st year clinical skill must you remember to offer when doing a cardiovascular examination?
Blood pressure
What area of the body should you work from and towards when doing a cardiovascular examination?
The hands up to the head
What amount roughly of deoxyhaemoglobin gives the appearence of central cyanosis?
> 5 g/dL
What does pale conjunctiva indicate?
Anaemia
What is the characteristic skin lesion of systemic lupus erythematosus (SLE) referred to as?
A butterfly rash
What does Koilonchychia look like in a patient?
Abnormality of the nails that is also called spoon-shaped (concave) nails
What is Koilonchychia recognised as a manifestation of?
Chronic iron deficiency
What is the most common cause of clubbing?
Lung cancer
What can cause clubbing?
Reduced oxygen in the blood as a result of heart and lung diseases.
Congenital cyanotic heart disease, chronic lung infections, interstitial lung disease, coeliac disease. cirrhosis of the liver, overactive thyroid, infective endocarditis, other types of cancer (e.g liver, GI, Hodgkin lymphoma).
What percentage of patients with infective endocarditis fever?
90%
What percentage of patients with infective endocarditis have a heart murmur?
85%
What are splinter haemorrhages?
Tiny blood spots underneath the nail. A result of infective endocarditis
What are osler’s nodes?
Painful, red, raised lesions found on the hands and feet. Associated with infective endocarditis. Immunological reaction to the infective emboli.
What are Janeway lesions?
More common on palms. little bleeds on the skin. Indicative of infective endocarditis.
What are Roth’s spots?
A red spot (caused by haemorrhage) with a characteristic pale white center. Most commonly seen in infective endocarditis.
What is the pale white centre of a Roth’s (Litten) spot a result of?
Represents fibrin-platelet plugs
What other conditions can Roth spots be seen in?
- Leukaemia
- Diabetes
- Intracranial haemorrhage
- Hypersensitive retinopathy
- Cerebral malaria
- HIV retinopathy
What is the duke criteria for diagnosis?
- 2 major
- 1 major + 3 minor
- 5 minor
What are the duke major criterea?
- Two positive blood cultures
- Positive echo
- New regurgitant murmur
What are the duke minor criteria?
- Predisposing condition
- Fever
- Immunologic signs
- One positive blood culture
- Positive eho not meeting major criteria
What does xanthelasma palpebrarum appear like?
Sharply demarcated yellowish flat plaques on the upper and lower eyelids.
What is the underlying cause of xanthelasma palpebrarum?
Atherosclerosis along with disturbed lipid metabolism
What does corneal arcus appear as?
opaque ring in the corneal margin. Or white ring in front of the periphery of the iris.
What are XP and corneal arcus associated with high levels of?
Increased levels of serum cholesterol and low density lipoprotein (LDL) cholesterol
What is an erythematoes rash?
A red rash (blanching)
What can low volume pulses indicate?
- Hypovolaemia
- Left ventricular failure
What can increased volume pulses indicate?
- Anaemia
- Fever
- Thyrotoxicosis
What does a slow rising pulse indicate?
- Aortic stenosis
What does a collapsing pulse indicate?
Aortic regurgitation
At what angle should the patient be resting at when assessing internal jugular vein?
45 degrees
If the internal jugular vein moves more than a flicker what does this indicate?
Increased venous pressure (often the ear lob can flicker)
What is the internal jugular vein deep to?
The sternocleidomastoid
Where can the apex beat be found?
In the 5th intercostal space inthe mid-clavicular line
Where is the praecordium?
the area of the anterior chest wall over the heart.
What are thrills?
Palpable murmers
What other areas can be examined?
- Ankle oedema
- Check BP
- Fundoscopy
- Urinalysis
