Clinical Practice - Cardiology Flashcards
Cardio Exam - General Inspection
-Does the patient look unwell or in pain
-is there signs of respiratory distress
-Do they look cachetic/ chec body habitus
-Are they on cardiac monitoring
Cardio Exam - Hands
- Clubbing
- Tar Staining
- Splinter heamorrhages
- Osler’s Nodes
- Janeway lesions
- Tendon Xanthomata
- Peripheral Cyanosis
- Pallor of the Palmar crease
- Capillary refill (less than 2s is normal)
Clubbing, Cause by chronically low oxygen levels
Congenital heart disease, infective endocarditis, IBS, Coeliac disease
Splinter haemorrhages
Most often due to trauma, but can also be ineffective endocarditis
Osler’s Nodes
-sign of ineffective endocarditis
Janeway lesions
Sign of ineffective endocarditis
Tendon Xanthomata
Sign of hyperlipidemia (type II/high levels of LDLs)
Peripheral cyanosis
-Congestive heart failure
-Anemia
-COPD
-Pneumonia
Pallor of the Palmar creases
To check push fingers don and then also press down of the creases
Sign of anemia
Cardio Examination - Arms
-Radial Pulse (rate and rhythm + Check both at the same time for radio radial delay)
-Respiratory rate
-Blood pressure
-Temp and o2 saturdation
Radio-radial delay
When the radiation pulses beat at different times
Causes include: Subcalvain artery stenosis, Aortic dissection, or occlusion due to atherosclerotic plaque
Cardio Examination- Face
- Xanthelasma
- Jaundice of the sclera
- Acrus Cornelia’s
- Pallor of the cunjuctivae
- Mitral Facies
- Dentition
- Central Cyanosis
-High arched palate (Marfan’s syndrome)
Xanthelasma
Type II Hyperlipidemia (high LDL) or Type III Hyperlipidemia (increase total cholesterol and triglyceride levels, decreased HDL due to genetics)
jaudice of the sclera
Yellow white but of the eyes
-serve congestive heart failure and hepatic congestion, gallstones
Arcus Cornealis
-normal with aging
-Cornanry artery disease or high lipid levels
Pallor of the conjuctivae
Sign of anemia
Mitral facies
Pulmonary hypertension, or low cardiac output such as in mitral stenosis
Central cyanosis
COPD, Pneumonia, pulmonary embolism, acute asthma attack
Look under younger for this cheeky little thing
Cardio Examination - Neck
-Auscultate each carotid artery for Brewis or radiation of aortic heart mummers with bell
-palpate the carotid pulses, one at a time, take note of character and volume of the pulse
-Measure jugular venous pressure for its height and charater get them to look to their left
-perform the hepatojugular reflex to accentuate
- Press down on the liver (if increases then suggests volume over load
Raised JVP
Sign of right sided heart failure
-raised = more than 3cm above sternal angle
Cardio Exam- Chest
-General inspection for scars, asymmetry, skeletal abnormalities, pacemakers and defibrillators
Get them to lift arms out to check for scars near armpit
-Palpate the apex beat (5th intercostal space in midclavicular line)
-Palpate for heaves (heel of hand vertically on left sternal edge)
-Palpate for thrills with flats of finger in the 5th ICS MC, 4th ICS LSE, 2nd ICS LSE, 2nd ICS RSE
Ausculation cardiac exam
Ausculatate all four regions to assess all valves
-listen for normal heart sounds and murmur
-S1= start of ventricular systole/closing of mitral and tricuspid valves
-S2 = end of systole/closing of aortic and pulmonary valves
-S2 splitting = separation of aortic and pulmonary valve closure
-start at mitral area (5th intercostal space in midclavicular line)
-then tricuspid area (4th inter coastal space left sternal border)
-Pulmonary area (2nd intercostal space left sternal border)
-Aortic area (2nd intercostal space right sternal boarder
Heart zones for auscultation
NB: auculatet the tricuspid valve on the eft sternal edge, 4th ICS
Dynamic manoeuvres.
Mitral stenosis: get patient to roll over onto left side, and listen over mitral area (5th ICS MC) with bell of stethoscope
Mitral Regurgitation: diaphragm over mitral area during expiration, Patient still on their left side
Aortic regurgitation: patient sit foward and deeply breathe out, listening over the left sternal edge 3ICS with the diaphragm
Cardio exam - Back
-percussion over the base of the lungs to listen for dullness of cracking
-palpate the sacrum for any odema (middle of hip)
-Auckland base of lungs for crackles
Cardio exam legs
-palpate peripheral pulses (posterior tibial behind ankle in middle side and dorsal pedial post, lateral to the high point behind big toe)
-check for pitting oedema
