Cardiovascular examination (JVP and CXR) Flashcards
Introduction
Standard- hello my name is, confirm name and DOB- been asked to do CV exam, will involve looking from end of bed, feeling pulses in neck and arm and listening to chest
- Hands
tobacco staining, vasodilation, sweating
finger clubbing
splinter haemhorrages
xanthoma
Capillary reflex time- pinch fingertip
Check temperature of arms with dorsal hand
Feel radial pulse in wrist- radio radio delay, and pulse rate (15 secs x 4)
Collapsing pulse- hand on right wrist and raise arm quickly- any pain in shoulder?
- Pulses
Brachial pulse in elbow
Then carotid- feel and listen (1 side) hold breath
- JVP and hepatojugular reflux
head at 45 degree angle tilted left- between heads of 2 sternocleidomastoids- raised in RHF
press down on liver to see if evidence of hepatojugular reflux- positive result = sustained rise above or at 4cm
- Face and eyes
Cyanosis- central or peripheral
malar flush- rheumatic mitral valve disease
Xanthelasma and corneal arcus
Open mouth
Dental hygiene- infective endocarditis risk factor
Pallor/ conjunctiva in anaemia
- Chest inspection
Scars? Pectus carnatum/excavatum
Lift both arms- any scars? thoracotomy
Palpate apex beat- 5th ICS midclavicular line
Parasternal heave- right ventricular hypertrophy
Thrills across all 4 valves
- Auscultation
Listen to all 4 valves while feeling carotid pulse
Mitral- 5th ICS, MC line
Tricuspid- 4th ICS, lower left sternal edge
Pulmonary- 2nd ICS, left sternal edge
Aortic- 2nd ICS, right sternal edge
Repeat using bell (murmurs)
Accentuation manouevre- on aorta, sit forward
On mitral, move to left hand side- deep breath in, hold
Back of chest- listen for pulmonary oedema and feel for sacral oedema
Assess for pedal oedema (RV failure)
- Summary
On inspection, no peripheral stigamata of cardiovascular disease- regular pulse- palpation, undisplaced apex, normal heart sounds, normal exam
full PV exam- look at ECG and measure BP
