Cardiovascular Examination Flashcards
How should the patient be positioned in the cardiac examination?
At 45 degrees
List 5 things you would look for on general inspection?
Pain Obvious distress Breathing - normal, rapid, laboured Cachexia Look well/unwell
What do you look for in the nails in the cardiac examination? (4 things)
Clubbing
Splinter haemorrhages
Nicotine staining
Peripheral cyanosis
What do you inspect for in the fingers/palms in a cardiac examination? (3 things)
Warmth indicating perfusion
Osler’s nodes
Janeway lesions
Palmar crease pallor
What would you do with the wrist in a cardiac examination?
Inspect: tendon xanthomata
Take the radial pulse for rate and rhythm
Radio-radial delay
Offer radio-femoral delay
What are 4 causes of bradycardia with a regular rhythm?
Physiological - e.g. athletes Drugs - e.g. B-blockers Hypothyroidism Hypothermia Complete heart block
What could cause bradycardia with an irregular rhythm? (2 causes)
AF with conduction disease
Second degree heart block
What are 5 causes of tachycardia with a regular rhythm?
Anxiety Fever Thyrotoxicosis Anaemia Congestive heart failure Drugs - e.g. salbutamol Shock SVT VT
What is the main cause of tachycardia with an irregular rhythm?
Atrial fibrillation
What would you look for in the face during a cardio examination?
Face: mitral facies? (rosy cheeks with bluish tinge)
Eyes: conjunctival pallor? jaundice? (severe CHF with hepatic congestion) xanthelasmata? (hyperlipidaemia) fundoscopy? (hypertensive changes)
Mouth: high arched palate? (Marfan’s syndrome), dentition? (IE risk factor), central cyanosis?
What should you do in the neck region during a cardio examination?
Take the carotid pulse
Auscultate for carotid bruits
Assess JVP
What would you inspect for in the praecordium during a cardiac examination?
Scars? Pacemaker? Implanted defibrillator? Visible apex beat? Pulsations?
Where would you normally find the apex beat?
5th intercostal space
Mid-clavicular line
Describe your approach to chest auscultation in the cardiac examination.
Auscultate the 4 areas: mitral, tricuspid, pulmonary and aortic. Auscultate all areas with the diaphragm, also auscultate the mitral area with the bell.
Determine if there is a murmur.
Then roll the patient to their left away from you and listen again in the mitral area.
Then have the patient sit up and lean forwards. Ask them to breathe in and then breathe out fully and hold their breath while you auscultate.
What can cause an abnormally loud S1?
Mitral stenosis
Tachycardia
What can cause an abnormally soft S1?
Mitral regurgitation
What can cause an abnormally loud S2?
Aortic stenosis
Systemic hypertension
What can cause an abnormally soft S2?
Aortic regurgitation
What does a S3 sound like?
A third heart sound is similar in cadence to ‘Kentucky’.
What does a S4 sound like?
A fourth heart sound is similar in cadence to ‘Tennessee’
What causes a pansystolic murmur? (2 causes)
A pansystolic murmur extends from S1 to S2 without varying in loudness or pitch. It is caused by blood in the ventricle leaking to a lower pressure chamber/vessel. Causes of this are:
Mitral regurgitation
Tricuspid regurgitation
VSD
What is a midsystolic murmur? What causes a midsystolic murmur? (2 causes)
A midsystolic murmur begins after S1 and is of greatest intensity in mid-systole. It then wanes during late systole. It is therefore called a 'crescendo-decrescendo' murmur. It is caused by: Aortic stenosis Pulmonary stenosis ASD
What is a late systolic murmur? What causes a late systolic murmur? (2 causes)
In a late systolic murmur there is a gap between S1 and the beginning of the murmur, but the murmur continues right up to S2 (no crescendo-decrescendo). It is caused by:
Mitral valve prolapse
Papillary muscle dysfunction
What causes an early diastolic murmur? (2 causes)
Aortic regurgitation
Pulmonary regurgitation
What causes a mid-disatolic murmur? (2 causes)
Mitral stenosis
Tricuspid stenosis
What causes a pre-systolic murmur? (2 causes)
Mitral stenosis
Tricuspid stenosis
What causes a continuous murmur? (2 causes)
Patent ductus arteriosus
AV fistula
Give 6 features you would inspect for in the lower limbs during a cardio exam.
Cyanosis Trophic changes Ulceration Tendon xanthomata Oedema Erythema
What are the names of the two pulses you routinely feel for in the feet?
Posterior tibial pulse
Dorsalis pedis pulse
