Clinical Skills: Cardiovascular Examination Flashcards
Outline the main sections covered in cardiovascular examination. (10)
Task 2 in Clinical Skills OSCE station.
General Inspection
Set of basic observations (e.g. ECG)
Hands Inspection
Face Inspection
JVP Inspection
Pulse Palpation
Chest Inspection
Chest Palpation
Heart Auscultation
Additional Checks
Perform a CV general inspection of the patient. (6)
Environment
General health of patient
Obvious pain
Skin colour (pale = anaemia, flushed = raised BP/infection, cyanoses = hypoxia)
Weight
Conditions linked to CVD e.g. Marfan/Down’s.syndrome.
Perform a CV hands inspection of the patient. (6)
Temperature (high = infection, low = poor perfusion)
Capillary refill (perfusion)
Splinter Haemmorhage (IE)
Clubbing (chronic disease)
Pale palmar creases (Anaemia)
Tar Staining (smoking)
Perform a CV pulse inspection of the patient. (5)
For each pulse inspection, you will need to state that you are going to compare both sides i.e. left + right for rate & rhythm and volume. (30 seconds if regular pulse or x by 2 if irregular i.e. count for 60 seconds.)
Radial pulse (wrist)
Brachial (elbow folds)
Carotid pulse (not together)
Dorsal is pedal ##
Posterior tibial
Perform the CV face inspection to a patient. (7)
Xanthelasma - High cholesterol
Corneal Arcus - High cholesterol
Jaundice - chronic disease
Pale Conjunctiva - Anaemia
Mouth and Teeth - high risk of IE
Central cyanosis - Hypoxia
Perform a JVP inspection of the patient. (3)
Patient is lay at a 45 degree angle.
Head positioned left lateral.
Identify JVP if raised >4cm = HF.
Perform a CV chest inspection. (7)
Expose chest.
Inspect anterior and lateral of chest for:
- Deformities
- Pacemakers
- Scars (Trauma or previous surgery)
- Bruising/Trauma (chest wall injury)
- Visible heaves (Heart enlargement)
Perform a CV chest palpation to a patient. (11)
Palpate for chest wall tenderness.
Apex beat: (5th intercostal space midclavicular line)
- Prominent beat (LVH)
- Displaced laterally (L/RVH)
- Difficult detection (obesity/hyperinflation)
Heaves - palpable pulsation of chest wall:
- Sugggests enlarged heart (RVH)
- Felt on left parasternal region.
Thrills - Palpable murmur
- Palpable across the 4 heart valves.
- Suggests palpable murmurs.
Perform a heart auscultation on a patient. (9)
Listen with a diaphragm and bell:
- Diaphragm = higher pitched sound
- Bell - lower pitched sound
S1 - Closure of the tricuspid and mitral valves.
S2 - Closure of the aortic and pulmonary valves.
S3/S4 - Additional sounds.
Heart Valves:
Aorta - 2nd intercostal space right sternal edge.
Pulmonary - 2nd intercostal space peft sternal edge.
Tricuspid - between 4th and 5th intercostal space left sternal edge.
Mitral - 5th intercostal space midclavicular line.
What does finger clubbing and splinter haemorrhage indicate? (3)
Finger clubbing (IE + cyanotic CHD)
Splinter Haemorrhage (IE)
What does nicotine stains, Osler nodes on the fingers indicate? (2)
Nicotine stains = smoking
Osler nodes = IE
What does Janeway lesions on the palms indicate? (1)
IE
What does palmar xanthomas and tendon xanthomas indicate? (2)
Palmar Xanthomas = Type 3 hyperlipidaemia.
Tendon Xanthomas = Familial hypercholesterolaemia.
What does a raised JVP indicate? (3)
Heart Failure
SVC obstruction (Superior vena cava)
Increased blood volume (pregnancy, acute nephritis, excess fluid therapy.)
What does a rise in JVP upon inspiration indicate? (2)
Pericarditis
Cardiac tamponade
How can you determine the position of the apex beat? (2)
Place hand across chest, feel with fingers for lateral edge of pulsating apex (5th intercostal space midclavicular line)
If not palpable turn patient onto left side and palpate anterior axillary line.
What does a prominent apex beat indicate? (1)
LVH
What does a medially displaced apex beat indicate? (2)
Lung Collapse
Lung Fibrosis
What does a laterally displaced apex beat indicate? (3)
LVH
Pleural Effusion
Pneumothorax
What does a downward displaced apex beat indicate? (2)
Volume overload
Mitral/aortic incompetence.
What does a sustained apex beat forceful but not displaced indicate? (4)
Pressure overload
Aortic stenosis
Hypertension
LVH
What does a failed detection of apex beat indicate? (2)
Obesity
Hyperinflation
What does a parasternal heave pulsation at left base of sternum indicate? (1)
RVH
What does tapping apex beat, palpable first heart sound indicate? (1)
Mitral Stenosis
What does a palpable second heart sound indicate? (1)
Systemic or pulmonary hypertension
W. does thrills indicate? (1)
Palpable murmurs
What does systolic thrills in aortic area indicate? (1)
Aortic stenosis
What does a systolic thrills at apex indicate? (1)
Mitral regurgitation
What does a diastolic thrill indicate? (1)
Mitral stenosis
State the clinical features of Angina. (5)
Radiating to neck or jaw
Nausea and vomiting
Pale, cold and clammy
Anxious
Chest pain has disappeared.
State the clinical features of MI. (6)
Chest pain
Breathlessness
Radiating to neck or jaw
Nausea / vomiting
Pale, cold and clammy
Anxious
State the clinical features of Heart Failure. (7)
Chest pain
Breathlessness
Basilar crackles
Sacral oedema
Bilateral peripheral oedema
S3 heart sound present
Raised JVP
State the clinical features of IE. (8)
Chest pain
Breathlessness
Fever
Mouth Infection
Joint aches + pains
S3 heart sounds present
Splinter Haemorrhage
Finger clubbing
State the clinical features of DVT. (2)
Unilateral calf swelling/heat.
Calf tenderness
