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Clinical Examinations > Cardiovascular System 1 > Flashcards

Cardiovascular System 1 Flashcards

1
Q

What method is used to assess pain?

A

SOCRATES

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2
Q

What does SOCRATES stand for?

A

S - Site - central/left/right

O - Onset - sudden/over time/ at rest/on exertion

C - Character - dull/sharp/aching/tightness/pleuritic

R - Radiation - spread to shoulder/jaw/neck/back

A - Alleviating factors - rest/position/pain relief

T - Time - duration of symptoms

E - Exacerbating factors - exertion/position/food

S - Severity 1-10

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3
Q

What are the 5 main presenting symptoms in cardiovascular disease?

A

Chest pain

  • due to inadequate oxygen supply to the heart

Dyspnoea:

  • breathlessness due to inadequate oxygen supply to the heart

Oedema:

  • due to failure of pumping action of the heart

Palpitations:

  • due to problems with electrical conduction

Syncope/Pre-syncope:

  • due to inadequate cerebral perfusion
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4
Q

What topics should be asked about when assessing cardiovascular risk factors?

A
  1. diabetes
  2. smoking
  3. diet and exercise
  4. hypertension
  5. hyperlipidaemia
  6. family history
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5
Q

What other questions should be asked to complete the history?

A
  1. current medication
  2. any allergies
  3. do they drive?
  4. occupation
  5. alcohol consumption
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6
Q

In the cardiovascular examination, what 5 steps are involved in the general inspection?

A

bedside:

are there any treatments or adjuncts?

check the patient is comfortable at rest

malar flush:

plum red discolouration of cheeks

inspect chest:

are there any scars or visible pulsations?

inspect legs:

are there any scars from saphenous vein harvest for CAGB / peripheral oedema / missing limbs or toes

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7
Q

What may malar flush suggest?

A

plum red discolouration of cheeks may suggest mitral stenosis

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8
Q

What types of treatments or adjuncts should be looked for at the bedside?

A

GTN spray

oxygen

medication

mobility aids

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9
Q

When inspecting the chest for scars or pulsations, where else should you look?

A

look underneath the arms for thoracotomy scars and for small scars from minimally invasive surgery

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10
Q

In the cardiovascular examination what should be looked for on the dorsum of the hand?

A

splinter haemorrhages:

reddish/brown streaks on the nail bed suggest bacterial endocarditis

finger clubbing:

this is associated with infective endocarditis and cyanotic congenital heart disease

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11
Q

How is finger clubbing checked for?

A

using Schamroth’s window

a small diamond-shaped window should be observed when a patient places the nails of their index fingers back to back

when clubbing is present, the window is lost

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12
Q

What are the 8 things that should be looked for when a patient puts their hand out with their palms facing upwards?

A
  1. colour
  2. temperature
  3. sweaty/clammy
  4. Janeway lesions
  5. Osler’s nodes
  6. tar staining
  7. xanthomata
  8. capillary refill time
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13
Q

What specifically does looking at the colour of the palms assess?

A

dusky bluish colouration is seen in cyanosis

this suggests hypoxia

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14
Q

What specifically does looking at the temperature of the palms assess?

A

cool peripheries may suggest poor cardiac output/hypovolaemia

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15
Q

What can sweaty/clammy hands be associated with?

A

acute coronary syndrome

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16
Q

What are Janeway lesions ?

What are they associated with?

A

non-tender maculopapular erythematous palm pulp lesions

suggestive of bacterial endocarditis

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17
Q

What are Osler’s nodes?

What are they suggestive of?

A

tender red nodules on finger pulps/thenar eminence

they are suggestive of infective endocarditis

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18
Q

What is shown by tar staining?

A

this is seen in smokers

smoking is a risk factor for cardiovascular disease

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19
Q

What is xanthomata?

What is it associated with?

A

raised yellow lesions often seen on the tendons of the wrist

they are caused by hyperlipidaemia

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20
Q

What is normal capillary refill time?

What does it suggest if it is prolonged?

A

normal is < 2 seconds

prolonged refill time suggests hypovolaemia

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21
Q

What 6 pulses should be palpated in a cardiovascular examination?

A
  1. radial pulse
  2. radio-radial delay
  3. collapsing pulse
  4. brachial pulse
  5. blood pressure
  6. carotid pulse
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22
Q

How should the radial pulse be assessed?

A

assess rate and rhythm

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23
Q

What is radio-radial delay?

How is it measured and what is it associated with?

A

palpate both radial pulses simultaneously

in a healthy adult, they should occur at the same time

radio-radial delay can be associated with subclavian artery stenosis or aortic dissection

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24
Q

What commonly causes subclavian artery stenosis?

A

compression of the subclavian artery by a cervical rib

25
Q

What is aortic dissection?

A

an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart

26
Q

How is collapsing pulse assessed?

A
  1. ensure the patient has no shoulder pain
  2. palpate the radial pulse with your hand wrapped around the wrist
  3. raise the arm above the head briskly
  4. feel for a tapping impulse through the muscle bulk of the arm as blood empties from the arm very quickly in diastole, resulting in the palpable sensation
27
Q

What is the name of the “palpable sensation” felt when assessing collapsing pulse?

When does it occur?

A

water hammer pulse

normal physiological states:

  • fever
  • pregnancy

cardiac lesions:

  • aortic regurgitation
  • patent ductus arteriosus

high output states:

  • anaemia
  • atrioventricular fistula
  • thyrotoxicosis
28
Q

What is the main condition that a collapsing pulse is associated with?

A

aortic regurgitation

29
Q

How is brachial pulse assessed?

A

assess volume and character

30
Q

How is blood pressure measured?

What is wild and narrow pulse pressure associated with?

A

it is measured and any abnormalities are noted

narrow pulse pressure is associated with aortic stenosis

wide pulse pressure is associated with aortic regurgitation

31
Q

How is carotid pulse assessed?

A

character and volume are assessed

e.g. slow rising character in aortic stenosis

32
Q

What is it advised to do before palpating the carotid pulse?

A

auscultate the carotid artery for a bruit before palpating

theoretically, palpation may dislodge a plaque which could lead to a stroke

33
Q

How is jugular venous pressure assessed?

A
  1. ensure patient is positioned at 45o
  2. ask patient to turn their head away from you
  3. observe the neck of the JVP
  4. measure the JVP
34
Q

How is the JVP measured?

A

it is located inline with the sternocleidomastoid

the JVP is measured by the number of centimetres from the sternal angle to the upper border of pulsation

35
Q

What may a raised JVP suggest?

A
  1. fluid overload
  2. right ventricular failure
  3. tricuspid regurgitation
36
Q

How is the hepatojugular reflex tested?

A
  1. apply pressure to the liver and observe the JVP for a rise

in healthy individuals, the rise should last no longer than 1-2 cardiac cycles

if the rise is sustained and equal to or greater than 4cm, this is a positive result

37
Q

What does a positive hepatojugular reflux sign suggest?

A

right-sided heart failure and/or tricuspid regurgitation

38
Q

In the face part of the cardiovascular examination, how are the eyes assessed?

A
  1. conjunctival pallor
  2. corneal arcus
  3. xanthelasma
39
Q

How is conjunctival pallor assessed?

What does it suggest?

A

ask the patient to gently pull down their lower eyelid

this is a sign of anaemia

40
Q

What is corneal arcus?

What is it associated with?

A

yellowish/grey ring surrounding the iris

this shows hypercholesterolaemia

41
Q

what is xanthelasma?

What is it associated with?

A

yellow raised lesions around the eyes

this occurs in hypercholesterolaemia

42
Q

What signs are looked for when examining the mouth?

A
  1. central cyanosis
  2. angular stomatitis
  3. high arched palate
  4. dental hygiene
43
Q

What is central cyanosis?

A

bluish discolouration of the lips and/or the tongue

44
Q

What is angular stomatitis?

What is it associated with?

A

inflammation of the corners of the mouth

this is present in iron deficiency

45
Q

What is high arched palate associated with?

A

it is suggestive of Marfan syndrome

there is an increased risk of aortic aneurysm/dissection

46
Q

Why is dental hygiene considered?

A

it is important if you are considering sources for infective endocarditis

47
Q

What scars are looked for when inspecting the chest?

A
  1. thoractomy - minimally invasive valve surgery
  2. sternotomy - valve surgery
  3. clavicular - pacemaker
  4. left mid-axillary line - subcutaenous implantable cardioverter defibrillator
48
Q

Upon close inspection of the chest, what other factors should be looked for?

A
  1. chest wall deformities
  2. visible pulsations
49
Q

Where is the apex beat palpated for?

A

it is located at the 5th intercostal space in the midclavicular line

it is palpated with the fingers placed horizontally across the chest

50
Q

What does lateral displacement of the apex beat suggest?

A

cardiomegaly

51
Q

What is a parasternal heave?

What is it associated with?

A

a precordial impulse that can be palpated

parasternal heaves are present in patients with right ventricular hypertrophy

52
Q

How are heaves examined for?

A

the heel of the hand is placed parallel to the left sternal edge with the fingers vertical

if heaves are present, you should feel the heel of the hand being lifted during systole

53
Q

What is a thrill?

A

a palpable vibration caused by turbulent blood flow through a heart valve

the thrill is a palpable murmur

54
Q

How are thrills assessed for?

A

thrills are assessed for across each of the heart valves in turn

the hand is placed horizontally across the chest wall, with the flats of the fingers and palm over the valve to be assessed

55
Q

Where are each of the heart valves auscultated for?

A

mitral valve:

midclavicular line - 5th intercostal space

tricuspid valve:

lower left sternal edge - 4th or 5th intercostal space

pulmonary valve:

left sternal edge - 2nd intercostal space

aortic valve:

right sternal edge - 2nd intercostal space

56
Q

What are the 6 stages involved in auscultating the four valves?

A
  1. palpate the carotid pulse to determine the first heart sound
  2. auscultate ‘upwards’ through the valve areas using the diaphragm of the stethoscope
  3. repeat auscultation across the four valves with the bell of the stethoscope
  4. auscultate the carotid arteries with the patient holding their breath to check radiation of an aortic stenosis murmur
  5. sit the patient forwards and auscultate over the aortic area during expiration to listen for the murmur of aortic regurgitation
  6. roll the patient onto their left side and listen over the mitral area with the bell during expiration for mitral murmurs
57
Q

What is looked for when auscultating the lung bases?

A
  1. crackles may suggest pulmonary oedema secondary to left ventricular failure
  2. if there are no other signs of fluid overload, consider chronic lung diseases
  3. sacral oedema or pedal oedema may suggest right ventricular failure
58
Q

What are the following sites for ausculatation for heart sounds?

A

Clinical Examinations (12 decks)

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