Examination: Cardiovascular Flashcards
(CV) Step 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.
Step 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.
Step 2:
Hand Hygeine
Step 3:
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
What are some things that you might notice during the general inspection?
cyanosis, scars, pacemaker, breathing, frailty, oedema, oxygen assistance
Step 4:
Inspection of the Hands:
- Nicotine stains
- Clubbing
- Anaemia signs in palmar creases
Step 5:
Measurement of Radial Pulse:
- Measure rhythm and rate
- Is the rhythm regular or irregular
What is a normal pulse rate?
between 60 and 100 beats per minute
Step 6:
Measurment of BP
Step 7:
Examination of Head and Neck:
- Check the eyes (conjunctivae) for pallor
- Look at the lips and tongue (bottom) for cyanosis
(CV) Step 2:
Hand Hygeine
(CV) Step 3:
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
(CV) What are some things that you might notice during the general inspection?
cyanosis, scars, pacemaker, breathing, frailty, oedema, oxygen assistance
(CV) Step 4:
Inspection of the Hands:
- Nicotine stains
- Clubbing
- Anaemia signs in palmar creases
(CV) Step 5:
Measurement of Radial Pulse:
- Measure rhythm and rate
- Is the rhythm regular or irregular
(CV) Step 6:
Measurment of BP
(CV) Step 7:
Examination of Head and Neck:
- Check the eyes (conjunctivae) for pallor
- Look at the lips and tongue (bottom) for cyanosis
(CV) Step 8:
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
What does an elevated JVP indicate?
Increased right atrial pressure –> can be too much fluid in the venous system –> R heart failure
What are some strategies if you cannot find the JVP?
- Step back
- Lay the patient flat
(CV) Step 9:
Examination of Carotid Artery Pulse
- feel both sides but not at the same time
- feel for pulse, strength and rhythm.
(CV) Step 10:
Inspection of the chest
- scars, pacemakers etc
- apex beat
(CV) Step 11:
Palpation of the chest
- palpate the apex beat
Where is the apex beat usually found?
in the fifth intercostal space in the mid clavicular line
(CV) Step 12:
Auscultation of the heart
- use the bell and then the diaphragm to listen at:
1. the apex
- lower left sternal edge (left side of sternum at level of 5th intercostal cartilage)
- upper left sternal edge (left of sternum in the second intercostal space)
- 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
What is the difference between the bell and the diaphragm?
Bell: better for low-pitched sounds such as heart sounds
Diaphragm: better for higher pitched sounds such as murmurs
Which valves are heard at each of the auscultation locations?
- the apex –> mitral
- lower left sternal edge –> tricuspid
- upper left sternal edge –> pulmonary
- upper right sternal edge –> aortic
Which valves are heard at each of the auscultation locations?
- the apex –> mitral
- lower left sternal edge –> tricuspid
- upper left sternal edge –> pulmonary
- upper right sternal edge –> aortic
(CV) Step 13:
Examination of the posterior chest
- listen at the lung bases for crackles/creps
(CV) Step 14:
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
Where is the dorsalis pedis pulse located?
- 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)
Where is the posterior tibial pulse located?
- behind the medial malleolus
(CV) Step 15:
Complete the Examination
