CLIN Cardiovascular Exam Flashcards
Process of General Inspection
a. Pain/discomfort
b. ‘Noting body habitus’
c. Signs of dysnoea, fatigue or cachexia
d. Congenital abnormalities
e. Hydration
Process of Hand Examination
a. Look
i. Fingernails
1. Clubbing
a. Use Schamroth window/diamond test
2. Splinter haemorrhages
ii. Fingertips
1. Peripheral cyanosis
a. Assess colour of nails & fingers
iii. Fingers
1. Osler’s nodes
2. Tendon xanthomata
3. Tar staining
iv. Palm
1. Janeway lesions
b. Feel
i. Cold/sweaty
ii. Capillary return/refill
1. 5 sec pressure
Causes of congenital abnormalities associated with CVS findings
Marfan’s, Turner’s, Down’s syndrome
Characteristic of Osler’s nodes and associated condition
Painful nodules - may suggest infective endocarditis
Remember fingers more sensitive, therefore painful.
Tendon xanthomata associated condition
Hypercholesterolaemia
Characteristic of Janeway lesions and associated condition
Non-painful, red, flat lesions on palms - may suggest infective endocarditis
Remember palms less sensitive, therefore not painful.
Radio-radial delay may indicate what associated condition/s
Aortic dissection/stenosis
Radio-femoral delay may indicate what associated condition/s
Coarctive delay
Process of Wrist Examination
- Wrists
a. Palpate
i. Arterial pulses for 30secs - Rate
- Rhythm
a. Classify as regular/irregular - Radial-radial delay
- Radio-femoral delay
Process of Elbow Examination
- Elbows
a. Look
i. Tendon xanthoma
b. Palpate
i. Brachial pulse
c. Measure
i. Blood pressure
ii. Temperature & Respiratory Rate
Process of Face Examination
- Face
a. Look
i. Eyes - Pallor of the conjunctiva
- Colour of the sclera
- Corneal arcus
ii. Eyelids - Xanthelasma
iii. Cheeks - Malar flush
- Mitral facies (rosy flushed cheeks)
iv. Mouth - Tongue & inner surface of the lips (use torch & tongue depressor)
a. Central cyanosis - Inner surface of the lips & palate
a. High arched palate
b. Mucous membrane petechiae - Teeth & gums
Pale pallor of conjunctiva may indicate what associated condition/s
Anaemia
Yellow discoloration of the sclera may indicate what associated condition/s
Jaundice/icterus
Mitral facies may indicate what associated condition/s
Mitral stenosis
High arched palate is often associated with what condition
Marfan’s syndrome
A wave is associated with what part of heart contraction and is classified as +ve/-ve
Atrial contraction. +ve
C wave is associated with what part of heart contraction and is classified as +ve/-ve
Closure of tricuspid valve & slight bulge into R atrium. +ve
X wave is associated with what part of heart contraction and is classified as +ve/-ve
Atrial relaxation. -ve (descent)
V wave is associated with what part of heart contraction and is classified as +ve/-ve
Atrial ‘V’illing. +ve
Y wave is associated with what part of heart contraction and is classified as +ve/-ve
Atrial emptying. -ve (descent).
Process of Neck Examination
- Neck
a. Palpate
i. Carotid artery palpation ONE AT A TIME - Comment on pulse character & volume
- Listen for bruits – pt may need to hold breath (use bell)
- Note pulse character
ii. JVP examination - Examine pulsation
- Check height (3cm normal )
a. Place one ruler on sterno-clavicular angle
b. Point this ruler vertically
c. Line other ruler up perpendicularly
d. Note height and angle of bed when measured - Perform abdomino-jugular reflex test
a. Check if the pt has any abdominal pain first
Normal height of JVP
<3cm
Remember J V P = 3
Process of Precordium Examination
- Precordium
a. Inspect
i. Scars
ii. Rashes
iii. Presence of pacemaker/defibrillator box
iv. Breathing pattern
v. Thoracic cage abnormalities - Barrel chest
- Pigeon chest
- Funnel chest
vi. Apex beat
vii. Abnormal pulsations
b. Palpate – pt 45
i. Apex beat - Locate 2nd intercostal space
- Locate apex beat (usually near 5th intercostal space, may help for pt to roll L)
- Classify the apex beat as normal, heaving, tapping, double impulse
ii. Heaves - Place heel of hand over lower L parasternal border .
iii. Thrills - Place flat of hand over APTM areas
- Comment on presence/absence.
c. Auscultation
i. Pt at 45 - Mitral area (bell then diaphragm)
a. Lying down first
b. Then rolls left - Tricuspid area (diaphragm)
- Pulmonary area (diaphragm)
- Aortic area (diaphragm)
a. Mention listening to heart sound
b. Mention presence/absence of murmurs
c. Mention presence/absence of additional sounds
ii. Pt at 90 - Mitral area (bell then diaphragm)
- Tricuspid area (diaphragm)
- Pulmonary area (diaphragm)
- Aortic area (diaphragm)
a. Mention listening to heart sound
b. Mention presence/absence of murmurs
c. Mention presence/absence of additional sounds
d. Palpate
i. Sacral oedema
Apex beat may indicate what condition/s
Cardiomegaly
Apex beat heave may indicate what condition/s
L ventricular hypertrophy
Apex beat tapping may indicate what condition/s
Mitral stenosis
Apex beat double impulse may indicate what condition/s
Hypertrophic cardiomyopathy
Heave over lower L parasternal border may indicate what condition/s
R ventricular hypertrophy
Inspiration makes what murmurs louder? Expiration makes what murmurs louder?
P & T - inspiration makes louder
A & M - expiration makes louder
Process of Lower Limb Exam
- Lower limbs
a. Inspect
i. Leg - Hair loss
- Skin colour changes
- Varicose veins
ii. Ankle - Ankle oedema
a. Check how high oedema extends upwards (towards the head) - Achilles tendon xanthomata
iii. Feet - Ulcers
- Janeway lesions
iv. Toes - Clubbing
- Cyanosis
- Osler’s nodes
b. Palpate
i. Capillary refill
ii. Temperature
iii. Peripheral pulses - Femoral
- Popliteal
- Posterior Tibial
- Dorsalis pedis
Clinical findings associated with aortic/pulmonary stenosis
Early systolic murmur.
Clinical findings associated with mitral/tricuspid valve regurgitation
Pan systolic murmur
Clinical findings associated with mitral/tricuspid valve regurgitation
Pan systolic murmur.
What valve murmur is heard loudest on auscultation of the apex beat during systole?
Mitral valve.
Causes of valve murmur during systole
Pulmonary and aortic stenosis/
Mitral and tricuspid insufficiency
Remember PASS PAID
Causes of valve murmur during diastole
Pulmonary and aortic insufficiency/
Mitral and tricuspid stenosis
Remember PASS PAID
