Cardiovascular Examination Flashcards
Introduction
Wash hands, PPE Introductions Explanation of the exam and gain consent Adjust bed to 45 Ask patient to expose themselves from waist up -offer blanket Ask about any pain
Step 1 General observations (around the bed)
-what could you find
Medical equipment
- O2
- ECGs
- medication, prescriptions
- catheters (contents and location, IV access)
Mobility aids
-mobility status
Pillows
-orthopnea in CCF => cannot lie flat
Charts
- vital signs
- drugs
- fluid balance
Step 1 General observations
(patient)
-what may you see
-what could this mean
Complexion
- pallor => anemia (haemorrhage, chronic disease)/poor perfusion(CCF)
- cyanosed => poor circulation(VC)/inadequate oxygenation(R=>L cardiac shunting)
General state
- SOB => CCF, pericarditis or respiratory disease (PE, pneumonia)
- edema => CCF
- malar flush => MITRAL STENOSIS
Step 2 Hands
- what might you look for
- what could this mean
Colour
- pallor => poor peripheral perfusion (CCF)
- cyanosis => hypoxemia
Fingers
- tar staining => smoking, CV risk factor
- arachnodactyly (long, slender fingers, toes => Marfans (mitral/aortic prolapse, dissection)
Endocarditis signs
- splinter haemorrhages
- Janeway lesions (non tender haemorrhagic lesions on palms
- Osler’s nodes => red painful lumps on fingers
Step 2 Hands
Clubbing
-what could this mean
Infective endocarditis
Atrial myxoma
Congenital cyanotic heart diseases
Step 2 Hands
Temperature
CRT
-what could this mean
NORMALLY SYMMETRICALLY WARM
- cool => poor peripheral perfusion (CCF, ACS)
- clammy => ACS
CRT
-greater than 2s => poor peripheral perfusion (hypovolemia, CCF)
Step 2 Hands
Pulses
-what could this mean
Radial rate, rhythm, character
- bradycardia => AV block, medications, sick sinus
- tachycardia => anxiety, SVTachy, hypovolemia, hyperthyroidism
- irregular => AF
RRdelay => aortic dissection/coarctation/subclavian artery stenosis
Collapsing pulse => aortic regurgitation, PDA
Step 2 Arms
BP
-what could abnormal readings mean
Narrow pulse pressure (less than 25) => aortic stenosis, CCF, tamponade
Wide pulse pressure (more than 100) => aortic regurgitation, dissection
Step 2 Neck
Pulses
-what would be abnormal
-what does this mean
Auscultate carotid
NORMALLY SHOULD NOT HEAR ANYTHING
-bruit => carotid stenosis, aortic stenosis
Palpate carotid pulse
-rate, rhythm, character
Step 2 Neck
JVP and hepatojugulareflex
-what would be abnormal
-what does this mean
Raised JVP (venous HTN)
- RHF (LHF)
- tricupsid regurgitation (infective endocarditis)
- constrictive pericarditis
- restrictive cardiomyopathy
Step 3 Face
Eyes
-what are you looking for
-what does this mean
Conjunctival pallor => anemia
Corneal arcus => hypercholesteremia
Xanthelasma => hypercholesteremia
Kayser Fleischer rings => cardiomyopathy
Step 3 Face
Mouth
-what are you looking for
-what does this mean
Central cyanosis => hypoxemia, shunt
Angular stomatitis => Fe deficiency
High arches palate => Marfans (mitral/aortic prolapse, dissection)
Poor dental hygeine => endocarditis
Step 4 Chest
Inspection
-what are you looking for
-what does this mean
Scars
-previous thoracic surgery
Pectus excavatum, carinatum => Marfans (aortic/mitral prolapse, dissection)
Visible pulsations => forceful apex beat (ventricular hypertrophy)
Step 4 Chest
Palpation
-what are you looking for
-what does this mean
Heaves (heel of hand lifted during systole
-RVhypetrophy
Thrills (palpable vibration from turbulent blood flow over each valve)
Apex beat
-displaced => ventricular hypertrophy
Step 4 Chest
Auscultation
-how would you do this
-what does this mean
Auscultate valves with diaphragm and bell
Roll patient onto left
Expiration, hold, axillary - MR accentuation
Expiration, hold, mitral region - MS
Normal breathing, sit patient up
Inspiration, hold - pulmonary, tricupsid accentuation
Expiration, hold - AR
Carotid expiration hold - aortic accentuation => AS
Step 5 Posterior
Inspection, auscultations
-what would you look for
-what does this mean
Deformities/scars
Bottom lung field auscultation
-coarse crackles => oulmonary edema (LVF)
-no air entry, stony dull percussion => pleural effusion (LVF)
Step 6 Sacrum, legs
- what would you look for
- what does this mean
Sacral pitting edema, Peripheral pitting edema => RVF
Legs (saphenous vein harvest => CABG
Completion of examination
Explain to the patient that the examination is now finished
Thank patient for their time
Dispose of PPE, wash hands
Summarise findings
Possible further investigations
- BP
- Peripheral vascular examination
- 12ECG
- dipstick urine (proteinuria, haematuria => HTN)
- Fundoscopy => HTN
- Capillary glucose => DM, CV risk factor
Opening script
Hello, I’m An Nakamura, a 3rd year medical student.
Can I confirm your name and and date of birth?
I would like to perform an examination of your heart. This will involve an examination of your hands, arms, face, neck, chest and legs. It will also require you to remove your top.
Is this ok with you?
Do you have any questions for me?
