Examination: Cardiovascular

Question 1

(CV) Step 1:

Answer 1

Prepare the Patient:

• Explain what the exam will involve and that they will need to remove their shirt.
• Ask them to remove their shirt and shoes/socks
• Position the patient on the bed etc. with their chest at a 45 degree angle.

Question 2

Step 1:

Answer 2

Prepare the Patient:

• Explain what the exam will involve and that they will need to remove their shirt.
• Ask them to remove their shirt and shoes/socks
• Position the patient on the bed etc. with their chest at a 45 degree angle.

Question 3

Step 2:

Answer 3

Hand Hygeine

Question 4

Step 3:

Answer 4

General Inspection:

• DO THIS WELL
• “Just give me a moment while I have a general look at you”
• Get them to sit up so you can see their back as well
• Take note of patient’s general mental state, alertness and respiratory effort

Question 5

What are some things that you might notice during the general inspection?

Answer 5

cyanosis, scars, pacemaker, breathing, frailty, oedema, oxygen assistance

Question 6

Step 4:

Answer 6

Inspection of the Hands:

• Nicotine stains
• Clubbing
• Anaemia signs in palmar creases

Question 7

Step 5:

Answer 7

Measurement of Radial Pulse:

• Measure rhythm and rate
• Is the rhythm regular or irregular

Question 8

What is a normal pulse rate?

Answer 8

between 60 and 100 beats per minute

Question 9

Step 6:

Answer 9

Measurment of BP

Question 10

Step 7:

Answer 10

Examination of Head and Neck:

• Check the eyes (conjunctivae) for pallor
• Look at the lips and tongue (bottom) for cyanosis

Question 11

(CV) Step 2:

Answer 11

Hand Hygeine

Question 12

(CV) Step 3:

Answer 12

General Inspection:

• DO THIS WELL
• “Just give me a moment while I have a general look at you”
• Get them to sit up so you can see their back as well
• Take note of patient’s general mental state, alertness and respiratory effort

Question 13

(CV) What are some things that you might notice during the general inspection?

Answer 13

cyanosis, scars, pacemaker, breathing, frailty, oedema, oxygen assistance

Question 14

(CV) Step 4:

Answer 14

Inspection of the Hands:

• Nicotine stains
• Clubbing
• Anaemia signs in palmar creases

Question 15

(CV) Step 5:

Answer 15

Measurement of Radial Pulse:

• Measure rhythm and rate
• Is the rhythm regular or irregular

Question 16

(CV) Step 6:

Answer 16

Measurment of BP

Question 17

(CV) Step 7:

Answer 17

Examination of Head and Neck:

• Check the eyes (conjunctivae) for pallor
• Look at the lips and tongue (bottom) for cyanosis

Question 18

(CV) Step 8:

Answer 18

Examination of Jugular Venous Pulse

• Examine the right JVP (internal jugular vein)
• dont rotate the head as it will tense the sternocleiodomastoid muscle
• measure the JVP height against the sternal angle
• > 3cm is a raised pressure in the right side of the heart

Question 19

What does an elevated JVP indicate?

Answer 19

Increased right atrial pressure –> can be too much fluid in the venous system –> R heart failure

Question 20

What are some strategies if you cannot find the JVP?

Answer 20

• Step back

- Lay the patient flat

Question 21

(CV) Step 9:

Answer 21

Examination of Carotid Artery Pulse

• feel both sides but not at the same time
• feel for pulse, strength and rhythm.

Question 22

(CV) Step 10:

Answer 22

Inspection of the chest

• scars, pacemakers etc
• apex beat

Question 23

(CV) Step 11:

Answer 23

Palpation of the chest

- palpate the apex beat

Question 24

Where is the apex beat usually found?

Answer 24

in the fifth intercostal space in the mid clavicular line

Question 25

(CV) Step 12:

Answer 25

Auscultation of the heart

• use the bell and then the diaphragm to listen at:
  1. the apex

2. lower left sternal edge (left side of sternum at level of 5th intercostal cartilage)
3. upper left sternal edge (left of sternum in the second intercostal space)
4. upper right sternal edge (right of sternum in the second intercostal space)

• listen for quality of heart sounds
• you can palpate the carotid at the same time for timing purpses

Question 26

What is the difference between the bell and the diaphragm?

Answer 26

Bell: better for low-pitched sounds such as heart sounds
Diaphragm: better for higher pitched sounds such as murmurs

Question 27

Which valves are heard at each of the auscultation locations?

Answer 27

1. the apex –> mitral
2. lower left sternal edge –> tricuspid
3. upper left sternal edge –> pulmonary
4. upper right sternal edge –> aortic

Question 28

Which valves are heard at each of the auscultation locations?

Answer 28

1. the apex –> mitral
2. lower left sternal edge –> tricuspid
3. upper left sternal edge –> pulmonary
4. upper right sternal edge –> aortic

Question 29

(CV) Step 13:

Answer 29

Examination of the posterior chest

- listen at the lung bases for crackles/creps

Question 30

(CV) Step 14:

Answer 30

Examination of the lower limbs

• look for peripheral oedema by palpating behind the medial malleolus or the anterior tibia
• palpate the dosalis pedis and posterior tibial pulses

Question 31

Where is the dorsalis pedis pulse located?

Answer 31

• palpates on the dorsum of the foot lateral to the extensor hallicus longus tendon
  (can ask the patient to stretch the tendon by bringing their big toe back)

Question 32

Where is the posterior tibial pulse located?

Answer 32

• behind the medial malleolus

Question 33

(CV) Step 15:

Answer 33

Complete the Examination