Cardiovascular Examination Flashcards
Before exam
- Wash hands
- Introduce yourself
- Consent
- Comfortable position at 45 degrees and head supported
- Inspect at side of bed
What should bedside inspection include?
-Build
-Colour
-Demeanour
=Relaxed?
=Appear breathless/ in pain?
=Oxygen/ IV/ ECG monitoring electrodes
What do we look for in the hands?
- Tobacco staining
- Tendon xanthomata
- Pallor
- Signs of endocarditis
- Clubbing
- Peripheral perfusion
What is finger clubbing?
Deformity of nail and soft tissues of terminal phalanx
-Associated with cardiovascular disease such as infective endocarditis and cyanotic congenital heart disease
What are the three main features of finger clubbing?
-Increased fluctuance of nail
-Loss of nail bed angle
-Increasing curvature of nail
=Advanced= drumstick
=Borderline clubbing unnecessary
How is nail bed fluctuance assessed?
- Rest patient’s finger on your thumbs
- Gently palpate from side to side at the base of the nail bed
What is capillary refill time?
-Indicator of peripheral perfusion
=Pressure applied to blanch the nail for 5 seconds
=Release
=Normal colour should return in 2 seconds if perfusion is good
What are tendon xanthomata?
Cholesterol laden deposits present on extensor tendon of hands
-Diagnostic of familial hypercholesterolemia
What is pallor?
- Diagnostic of anaemia
- Best assessed in hands by looking at the palmar creases
What are splinter haemrrhages?
-Linear lesions visible in nail bed
=Can signify endocarditis
=More common cause mechanical trauma
What are Osler’s nodes?
-Tender nodes at the fingertips
What are Janeway lesions?
Flat purple lesions on palms
-Uncommon signs of endocarditis
What pulse is checked at the wrist?
Radial pulse at lateral side of wrist using three fingers
What do we measure in taking the radial pulse?
-Rate
-Rhythm
-Synchrony
=Count number of pulses in 15 seconds x4
=Regular or irregular?
=Pulse volume better indicated at brachial pulse
=Compare both radial pulses simultaneously
What is a collapsing pulse a sign of?
Aortic regurgitation
=Pulse volume appears exaggerated when arm raised vertically as gravity dependent fall in diastolic pressure