Cardiovascular examination (inc. general principles) Flashcards
What should be included in the introduction to the consultation?
- Greet your patient
- Introduce yourself and your role
- Explain what you are going to do and why, and gain consent to proceed with the examination
- Clean your hands
- Ongoing communication to patient involves clear instructions and attention to your patient’s comfort.
- Demonstrate a Professional manner throughout
- Examination method is structured and performed fluently and in a logical order.
What should you note in your general observation of the patient?
- colour
- conscious level
- any pain or breathing difficulty
- build
What should your note in your general observation of the observation?
oxygen or other bedside equipment
- GTN spray/medication
What key signs of cardiovascular disease might be observed in the hands and nails?
- clubbing
- nicotine staining
- splinter haemorrhages
- tendon xanthoma
- Janeway lesions
- Osler’s nodes, pale palmar creases
- palpate to ascertain capillary refill time which should be
What might clubbing indicate?
- Lung disease (see respiratory exam)
- GI disease (see GI exam)
- Cardio disease:
- Any disease featuring chronic hypoxia (e.g. COPD)
- Congenital cyanotic heart disease (most common cardiac cause)
- Subacute bacterial endocarditis
- Atrial myxoma (benign tumor)
- Tetralogy of Fallot
What might splinter haemmorhages indicate?
- subacute infective endocarditis,
ALSO - scleroderma, - trichinosis - systemic lupus erythematosus (SLE) rheumatoid arthritis - psoriatic nails - antiphospholipid syndrome - haematological malignancy - trauma
What are Janeway’s lesions are what might they indicate?
Non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are indicative of infective endocarditis.
What are Osler’s nodes and what might they indicate?
Painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition.
ALSO
- SLE
- Marantic endocarditis
- Disseminated gonococcal infection
- Distal to infected arterial catheter
What might pale palmar creases indicate?
Anaemia
What is tendon xanthoma and what does it indicate?
Deposition cholesterol-rich substance in tendons. Seen in hyperlipidaemia.
How should the patient’s pulse be measured and reported?
- palpate for 30 secs ( 60 secs if pulse irregular)
- report rate, rhythm & character
- Check for radio-radial delay and radio-femoral delay
- Ensure your patient does not suffer with arm or shoulder pain before
Describe the various radial pulse abnormalities and their causes.
Irregularly irregular
- atrial fibrillation (or multiple ectopics)
Regularly irregular
- 2nd degree heart block
Water hammer pulse (= Collapsing)
Strong radial pulse that taps hand on lifting of arm
indicates wide pulse pressure of aortic regurgitation
Bounding pulse
- CO2 retention
- Liver failure
- Sepsis
Small volume thready pulse
- shock
Radio-radial delay
- suggests coarctation or dissection
Arterio-venous fistulae - buzzing - for dialysis
What else should you do following pulse assessment?
Offer to take a standing BP to assess for postural hypertension.
What should be of note in the patient’s face if present?
Malar flush - mitral stenosis
Eyes, lips & tongue
- look in the eyes for xanthelasma, a corneal arcus and for pallor of conjunctivae.
- Look at the lips for peripheral cyanosis and under the tongue for central cyanosis.
- Ascertain general dental hygiene.
What might a high-arched palate be suggestive of?
Marfan’s syndrome
