CVS Examination Flashcards
What position should a patient be in for a CV exam?
45 degrees with chest adequately exposed
What should you look for in a patients hands?
Cap refill, peripheral cyanosis, tar staining, splinter haemorrhages, janeway lesions, osler’s nodes and koilonychia.
What should you look for in a patients face?
Examine the face, eyes and mouth for signs of malar flush, pallor, anaemia, xanthelasmata, corneal arcus and central cyanosis
What is malar flush?
A high colour over the cheakbones with a bluish tinge caused by reduced oxygen concentration in the blood.
What is a butterfly rash?
Erythema that occurs in a butterfly distribution over the cheeks and nose. Often occurs in systemic lupus erythematosus
What is koilonychia
Spooning of the nails which often common in chronic iron deficiency.
What is clubbing?
The ends of fingers appear large or bulging, may be warm and red. Occurs in heart and lung diseases
What are the causes of clubbing?
Lung cancer (most common), congenital cyanotic heart disease, chronic lung infections, coeliac disease, cirrhosis, overactive thyroid, other cancers and infective endocarditis.
What are the classic signs of infective endocarditis
Petechiae, subungual hemorrages, oslar nodes, janeway lesions and roth spots
What are Subungual hemorrhages?
Dark red linear lesions in the nail bed
What are Osler nodes?
Tender subcutaneous nodules usually found on distal pads of fingers (culture = neg)
What are Janeway lesions
Nontender maculae (flat dots) on palms and soles (culture = pos)
What are roth spots?
Retinal hemorrages with small, clear centres
What is Xanthelasma
Yellowish flat plaques on upper and lower eyelids. Cutaneous marker of atherosclerosis
What is Corneal Arcus?
deposition of lipids around the outer iris. It appears light grey in colour (grey rim)
Name some abnormal pulse and an example of an explanation.
Fast and regular (anxiety, exercise, pain, meds, hyperthyroidism).
Regularly irregular (ectopic beat)
Irregularly irregular (atrial fibrillation).
Slow and regular (Athlete, meds, hypothyroidsm).
Slow are irregular (heart block and sick sinus syndrome)
What may be the cause of a low volume pulse?
Hypovolaemic or left ventricular failure
What may be the cause of an increased volume pulse?
Anaemia or fever
What may be the cause of a slow rising and slow falling pulse
Aortic stenosis (stenosis meaning tight)
What may be the cause of a collapsing pulse
This is where there is a rapid raise and fall of pulse. This is due to aortic regurgitation (leaky valve)
why do you preform a jugular venous pulse assesment?
The jugular vein closely reflects the pressure changes in the right atrium.
What is an abnormal JVP and what does this mean?
The venous column will be seen about the right sternoclavicular joint meaning the right arterial pressure is increased. The further up the neck it is then the larger the increased pressure is.
Describe the differences between the carotid and jugular pulses
Jugular - Inward movement, not palpable, two peaks per beat, raises with abdominal pressure.
Carotid - outward movement, one peak per pulse, palpable, independent of abdo pressure.
Where are the four areas you should listen too for a precordial exam?
Aortic valve - The right 2nd intercostal space.
Pulmonic valve - Left 2nd intercostal. space.
Tricuspid - Left 4th intercostal space.
Mitral - 5th intercostal space at the midclavicular line
Picture of murmers blanked… Identify the murmers
Normal, Aortic regurgitation (diastolic), Aortic stenosis (systolic), mitral regurgitation (systolic), mitral stenosis (diastolic)
Where are some other areas you could consider examining?
Ausculate lung base, look for sacral oedema, offer abdo exam, peripheral vascular exam, ankel oedema, check BP, urinalysis, fundoscopy and obs chart
What are the features of an innocent murmer?
Occurs in systole, Ejection (blood flow through narrow vessel), Sort or vibratory, Grade 1/2, Normal S1 S2, no extra sounds and louder when supine
What are the features of a pathological murmer?
Occurs in diastole, holosystolic (murmer that beings at S1 and continues to S2, Harsh, grade 3-6, abnormal split S2, extra sounds and louder when standing
